Disease Prevention in Women

  • Medical Author:
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Cancer of the cervix

Cancer of the cervix (the portion of the uterus that extends into the vaginal cavity) is the third most common gynecologic cancer. Cancer of the cervix is most often caused by infection with the human papillomavirus (HPV). Cervical cancer typically develops over the long term from abnormal precancerous (before-cancer) cells on the surface of the cervix. These abnormal cells can transform into cervix cancer over a number of years. After turning cancerous, these cancer cells can invade or spread to other parts of the body.

Screening tests

Pap test also known as Pap smear.

A Pap test is a simple, quick office test in which a sample of cells from a woman's cervix is collected by swabbing and spread (smeared) on a microscope slide or placed in a special solution. The cells are examined under a microscope in order to look for precancerous (before-cancer) or cancer cells.

Who to test and how often

Women should have Pap tests as part of an annual pelvic examination beginning at age 21. Because the risk of cervical cancer increases sharply in the first few years after sexual activity begins, some physicians begin screening women as soon as they become sexually active, but not before. High-risk factors for cancer of the cervix include:

  • cigarette smoking;
  • previous genital warts or other genital infection with the human papilloma virus (HPV);
  • multiple sexual partners or a partner who has multiple sexual partners; and
  • onset of sexual activity at a young age.

In 2009, the American College of Obstetricians and Gynecologists (ACOG) revised its recommendations regarding Pap screening. Instead of beginning at age 18 as previously recommended, the new recommendations advise beginning Pap smears at age 21. Further changes to the ACOG guidelines are:

  • Women younger than 30 years of age should have a Pap test every 2 years.
  • Women aged 30 years of age and older should have a Pap test every 2 years. After three normal Pap test results in a row, a woman in this age group may have Pap tests every 3 years if:
    • she does not have a history of moderate or severe dysplasia;
    • she is not infected with human immunodeficiency virus (HIV);
    • her immune system is not weakened (for example, if she has had an organ transplant); and
    • she was not exposed to diethylstilbestrol (DES) before birth.

It is rare to find pre-cancer or cancer of the cervix in women over age 65 who have repeatedly had normal Pap smears, so many doctors stop screening in women over age 65 who have had consistently normal Pap smears. Other doctors decrease the frequency of Pap screening under these circumstances.

Women who have had a hysterectomy (surgery to remove the uterus, including the cervix) may need Pap smears less often, but they should continue with manual pelvic and rectal examinations by their doctors as a part of their periodic medical evaluations for reasons other than cancer of the cervix.

Benefits of early detection

There has been a 70% decrease in the deaths from cancer of the cervix by regular use of the Pap test. Benefits of the Pap test include:

  1. Pap tests can prevent cancer of the cervix by identifying and allowing treatment of abnormal cells before they become cancerous.
  2. Pap tests can identify cancer of the cervix at an early curable stage, before cancer cells spread (metastasize) to other parts of the body.

Prevention

A vaccine (Gardasil) has received U.S. FDA approval for use in women between 9 and 26 years of age and confers immunity against HPV types 6, 11, 16, and 18. Initial trials with the vaccine have shown that the HPV-16/18 vaccine is safe and induces a high degree of protection against HPV-16/18 infection. Gardasil is given in three shots over six-months. The U.S. Centers for Disease Control and Prevention (CDC) recommends that girls 11-12 years of age receive the vaccine. It is also recommended for girls and women age 13 through 26 who have not yet been vaccinated or completed the vaccine series.

A newer vaccine (Cervarix) was approved by the FDA in October, 2009, for use in girls and young women ages 10-25 to help prevent cervical cancer. Cervarix targets two HPV strains, HPV 16 and HPV 18, A comparison of the two vaccines has not been carried out.

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