If you can't remember, or if it was years ago, it may be time to schedule a well-woman visit with your primary care doctor or gynecologist.
If you don't have a regular healthcare provider, find out where you can get a free or low-cost Pap smear. This test is too important to skip; it can save your life.
Cervical cancer was previously a common gynecologic cancer in women, explains Patricia P. Jeudin, M.D., an obstetrician and gynecologist with the University of Miami Health System. This is no longer the case, largely because for the past 40 years, many women have been getting regular Pap smears.
In 2018, breast cancer, colorectal cancer and lung cancer ranked as the top three causes of cancer deaths in U.S. women. Cervical cancer came in fourth.
What exactly is a Pap smear?
“It’s a simple test we do to detect not only cervical cancer, but also cervical precancers,” says Dr. Jeudin. Precancers are areas on the cervix where the cells exhibit certain changes that mean they may become cancers if they are not treated appropriately.
Dr. Jeudin explains that pap smears work by alerting physicians to watch for the abnormal areas of the cervix and to treat it if necessary. She goes on to explain that pap smears can decrease the occurrence of cervical cancer.
When a pap smear is abnormal, a biopsy is performed to determine if you have precancer. This test allows treatment to begin early, when treatment is most effective.
What happens during a Pap smear?
Doing a Pap smear takes only minutes, and involves no special preparation on your part. You will need to be undressed from the waist down. You will lie on your back on an exam table, with your knees bent and your feet resting in metal supports.
The doctor gently inserts a device called a speculum into your vagina to separate the vaginal walls so they can easily see your cervix. The speculum may feel cold and you may feel some pressure in your pelvis, but it shouldn’t hurt.
Then doctor scrapes off some cervical cells with a long swab. You may not feel those cells being removed.
The doctor sends those cells to a lab where they are studied under a microscope.
“Most women find the test easy,” says Dr. Jeudin. “For some women who have a low pain threshold or who are anxious about it, we can use medication … but this is rarely necessary.”
Once the test is done, you can carry on with your day, without restrictions. Ask your healthcare provider when and how you will get the results.
And if they find precancerous cells?
Your doctor’s decision to treat depends on the results of a your biopsy, explains Dr. Jeudin. Areas that look abnormal are called cervical dysplasias, and they can range from mild dysplasia to severe dysplasia (or precancer).
The severity of the problem is graded by using numbers that range from one (not serious) to three (very serious).
Many mild cervical dysplasias go away on their own and require no treatment. “If you have a mild cervical dysplasia, your doctor will probably tell you to come back in for another test in a year, to check for further changes,” explains Dr. Jeudin.
Moderate or severe cervical dysplasias can also go back to normal without treatment, at times. But they are more likely than mild ones to stay the same or to progress to cancer. Your doctor may want to remove the cells surgically to be safe.
“Precancers don’t turn into cancer overnight,” explains Dr. Jeudin. This process is usually slow in women and may take months to years to progress. “But once the changes advance into cancer, it’s a different ball game.” Cervical cancer can progress rapidly, spread throughout the body, and cause death.
Another important test—the HPV test
Virtually all cervical cancer is caused by persistent infection with the human papillomavirus or HPV. “About 70% of cervical cancers are caused by two strains of the virus,” explains Dr. Jeudin. There are more than 150 strains of HPV, but the two most common strains involved with cervical cancer are HPV-16 and HPV-18. HPV is a virus that is only transmitted through sexual contact.
“Testing for HPV gives us very specific information about a woman’s risk of developing a precancer in the next five years, and also of the cancer risk in general,” she explains.
HPV testing involves the same sample that is collected at the time of your exam and pap smear. This is studied in a lab to look for traces of DNA that flag certain strains of the HPV virus that cause disease.
“Doing both a Pap smear and the HPV test can provide a lot of valuable information. Doctors often favor doing both kinds of tests,” says Dr. Jeudin. That approach is called co-testing.
So what tests do I need, and how often?
“Guidelines on how often a woman needs screening take into account the person’s age and prior history,” says Dr. Jeudin.
Below are the recommendations from the United States Preventive Services Task Force, a highly respected group of doctors who weigh evidence and issue guidelines to help people stay healthy.
- For women under 21, they say no screening is needed.
- For women ages 21 to 29, they recommend screening every three years with a Pap smear only.
- For women ages 30 to 65, they recommend either a Pap smear alone every three years or HPV testing every five years; or testing with both every five years.
- For women older than 65, they recommend against screening for those who have had adequate prior screening and are not otherwise at high risk for cervical cancer.
Your doctor will consider the guidelines and your own history when advising you.
Get the HPV vaccine if you qualify.
Depending on your age, you may be a candidate for the HPV vaccine, which can prevent cervical cancer. “The vaccine can also prevent genital warts,” says Dr. Jeudin. “Over time, the recommendations for who qualifies for the vaccine have been evolving.”
Speak to your healthcare provider to see if you, or your children, should get the vaccine.
What about tests for other female cancers?
“Cervical cancer is so easy to screen. Women just need to keep up with their routine gynecological checkups,” says Dr. Jeudin. There are no simple screening tests for other female cancers (ovarian, uterine, and vulvar cancers). Still, you can learn symptoms of these other cancers, and see your doctor if you notice unusual changes in your body that linger or get worse.
Look out for abnormal bleeding or discharge from the vagina, and pelvic pain or pressure. “Cancers can also cause pain in your back or abdomen,” explains Dr. Jeudin. “They can leave you feeling bloated or to filling up too fast when you eat.”
"If you have developed these kinds of symptoms, and they don't go away, see your health care provider," says Dr. Jeudin. "Often, they mean nothing, but it's best to find out."
Tragically, 4,207 women died of cervical cancer in the U.S. in 2017, which is the latest year for which data are available. For every 100,000 women, there were eight new cases of cervical cancer and two deaths.
Take this quiz to learn more about both cervical cancer and other cancers of the female reproductive tract.
Milly Dawson is a contributing writer for UMiami Health News.
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