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What is cervical cancer?
Cervical cancer begins in the cervix,
the part of the uterus or womb that opens to the vagina.
Before doctors started using the Pap test in the 1950s,
cervical cancer was the leading cause of death from cancer
in women. In the United States, the Pap test saves the lives
of 70% of the women who might have died from cervical cancer
without the test. Recent advances in screening and work
on a vaccine could help the effort to wipe out cervical
cancer.
Every year, about 10,520 women in the
United States get cervical cancer and about 3,900 women
die from it. In other countries, cervical cancer affects
approximately 500,000 women each year. In some parts of
the world, it is still the most common cancer in women.
What causes cervical cancer?
A virus—the human papillomavirus, or HPV—causes
almost all cases of cervical cancer. HPV is a common sexually
transmitted virus that usually goes away by itself. Most
people with HPV never even know they have it.
There are two types of HPV—"low risk"
and "high risk." Some low risk HPV infections
can cause genital warts. Sometimes, if the high-risk type
of HPV does not go away on its own, it may cause abnormal,
or pre-cancerous, cells to form. If these abnormal cells
are not found and treated, they may become cancer. An HPV
infection rarely leads to cervical cancer. In most women,
the cells in the cervix return to normal after the body's
immune system destroys the HPV infection
The American Cancer Society (ACS) and the American College
of Obstetricians and Gynecologists (ACOG) say that
* Women should
be screened for cervical cancer about 3 years after they
start having sexual intercourse. Screenings should start
by the time a woman is 21 years old.
* Women should be screened every year with a regular Pap
test. As an alternative, the newer liquid based Pap test
can be used every year or every 2 years. All women 30 years
old or younger should get cervical cytology (cancer) screening
at least every two years.
* Some women age 30 and older who have had 3 normal Pap
tests in a row don't need to get a Pap test every year.
They can get the test every 2 or 3 years. Talk with your
doctor about the best screening schedule for you (and follow
the recommended program!) Even though women with normal
results don't need to be screened every year, they should
go to their doctors every year for a check up, including
a pelvic exam.
* According to ACS, women age 70 and older who have had
3 or more normal Pap test results in a row and no abnormal
test in the last 10 years don't have to get a Pap test again.
Since there has not been a lot of research on the risks
that older women have of getting cervical cancer, ACOG recommends
that women over the age of 70 should still get Pap tests
every 2 or 3 years. Talk to your doctor to decide the best
plan for you.
What's New in Cervical Cancer
Screening?
Liquid-based Pap Test
Liquid-based cytology refers to a new
way to process Pap test results. Instead of smearing the
sample on a glass microscope slide, the cervical cells are
placed in liquid in a small bottle. Some of the liquid is
placed on a slide and then examined under a microscope.
Research has shown that liquid-based Pap
tests can be more accurate than the conventional way of
preparing the slides because blood and mucous are removed,
making the cells easier to see. Pap testing using the liquid-based
method of slide preparation is somewhat more expensive,
and not all clinics have this option available. Other clinics
use only the liquid-based method.
Both the American Cancer Society and the
American College of Obstetricians and Gynecology say that
both conventional and liquid-based methods are effective
cancer screening options. The important thing is to get
tested.
For women 30 or older...
The Food and Drug Administration (FDA)
just approved a new way to test for cervical cancer in women
30 and older. The ACS and ACOG state that this combined
test is a reasonable option for screening women over 30.
The new test combines a FDA approved HPV test and a Pap
test. Together these tests help a woman’s doctor find the
cancer-causing or high-risk HPV, along with screening for
pre-cancer changes in the cells. The new HPV test with the
Pap test is not essential. Women in this age group may also
choose to have a regular Pap test without an HPV test.
If the new HPV test is performed along
with a screening Pap test the results will fall into one
of the categories below:
* If the results of both the Pap and
HPV tests are negative (normal), you won't need to be tested
again for 3 years.
* If the Pap test is negative (normal) and the HPV test
is positive, repeat the Pap test and HPV test in 6 to 12
months.
* If both tests are positive, talk with your doctor about
what to do next.
For women under 30...
Women under the age of 30 should not get
the new combined test. HPV testing is not helpful in this
age group. Pap tests, however, are very important at this
time of life. Young women have more frequent HPV infections
(which are likely to be temporary) and more frequent changes
in sex partners. During these years, when HPV infection
and Pap test abnormalities are common, it is recommended
that women be screened often (every 1-2 years depending
on the type of Pap test). Fortunately, in young women, most
HPV infections and Pap test abnormalities clear up on their
own before the infection causes any cell changes or symptoms.
Regardless of which test is used, the
most important thing you can do is to get tested. Every
death from cervical cancer is a tragedy, and most of these
deaths are preventable with screening.
Why should I be screened for cervical cancer?
A woman who is dying of cervical cancer
recently said “I just didn’t get it…..I wish that I’d known
more.” With over 10,000 cases of cervical cancer each year
in the United States, it is clear that she is not alone.
Each death from cervical cancer is a tragedy – a tragedy
made worse by the fact that most cases are preventable.
Pap tests are remarkable because they help to find changes
before cancer starts. Pap tests effectively fight what used
to be the number one cause of cancer death in women.
Hopefully you do not know anyone who’s
had cervical cancer – That’s not because the disease has
gone away – the virus (HPV) that causes the cancer is as
prevalent as ever. Regular screening tests can make the
difference between life and death.
What is HPV?
HPV—human papillomavirus—is a common sexually
transmitted virus. HPV infection is usually harmless and
doesn't last long. Most people with HPV never even know
they have an infection.
There are two types of HPV—"low risk"
and "high risk." Some low-risk HPV infections
can cause genital warts. Sometimes, if the high-risk type
of HPV does not go away on its own, it may cause abnormal,
or pre-cancerous, cells to form. If these abnormal cells
are not found and treated, they may become cancerous. An
HPV infection rarely leads to cervical cancer. In most women,
the cells in the cervix return to normal after the body's
immune system destroys the HPV infection.
Who gets cervical cancer?
Since almost all cervical cancers are
caused by HPV, any woman who has sex can get cervical cancer.
Most women who've had sex have been infected with HPV at
some time in their life. The women at highest risk for cervical
cancer are women in whom infection with one of the high
risk types persists for years. Other risk factors for cervical
cancer include smoking and HIV infection. The women who
are most at risk for the disease are women who do not have
regular check ups that include Pap tests.
How do I know if I have HPV?
In most cases, you won't have any symptoms
of an HPV infection. The only way to know if you have an
HPV infection is to have a direct test for the virus. The
only way to tell if a high-risk HPV infection has caused
the cells in your cervix to change is to have a Pap test.
Signs of an HPV infection may appear weeks, months, or years
after the first infection, which is why it is important
to have regular tests.
Is there a test for HPV?
Yes, there is an HPV test that can detect
high-risk types of HPV that can cause changes in your cervical
cells. Women 30 years of age and older have the option of
having both the Pap test and the HPV test. If your Pap test
shows that you have questionable changes in your cervical
cells, your doctor may do an HPV test to find out more about
the abnormal cells. If your Pap test shows a definite pre-cancerous
abnormality an HPV test is not needed. Virtually all of
these changes are caused by HPV.
Can HPV be treated?
There is no treatment for the virus. There
are treatments for cervical changes that HPV can cause.
If your Pap and HPV tests show that cells in your cervix
have changed, you should discuss treatment options with
your doctor.
What is a Pap test? What's the difference between a Pap
test and an HPV test?
Doctors use the Pap test to see if there
are any cell changes. The Pap test looks at a sample of
cells from your cervix to see if there are any cells that
are abnormal. The Pap test is a good way to find cancer
cells and cells that might become cancerous in the future.
The Pap test can be performed as a normal part of a routine
pelvic exam.
The HPV test checks directly for high-risk
viruses. Both the Pap and HPV tests use a small, soft brush
to collect cervical cells. The cells are sent to a lab,
where they are examined under a microscope. Whether you
have both tests or the Pap test alone, you won't notice
any difference in your exam.
How do you know if you have cervical cancer?
Cervical cancer or early cervical pre-cancers
often have no signs or symptoms. That's why it's important
to get Pap tests regularly. If you have any of these symptoms,
call your doctor right away.
* Any unusual discharge from the vagina
* Blood spots or light bleeding when you're not having your
period
* Bleeding or pain during sex
Just because you have these symptoms,
it doesn't mean you have cervical cancer. You can have these
symptoms for other reasons. Check with your doctor to find
out what's causing your symptoms. Finding cervical cancer
early means you have a better chance of treating it successfully.
How should I prepare for my cervical cancer screening
tests?
* Don't take the tests if you're having
your menstrual period.
* Don't douche for 2 days before the tests.
* Don't have sexual intercourse for 2 days before the test.
* Don't use tampons or birth control foams, jellies, or
other vaginal creams or vaginal medicines for 2 days before
the test.
Can cervical cancer be treated?
Yes, cervical cancer can be treated with
surgery, radiation, or chemotherapy. If you have cervical
cancer, discuss treatment options with your doctor to decide
the best way to treat the cancer. Scientists are working
to find a vaccine that will stop women from getting this
kind of cancer.
When do I need to see a specialist?
If you have cervical cancer, you'll likely
be treated by one or more of the following specialists:
a gynecologic oncologist, a radiation oncologist and a medical
oncologist. An oncologist is a doctor specially trained
in diagnosing and treating cancer.
If you have been diagnosed with precancerous
changes, it's not essential that you see an oncologist.
Depending on the degree of the change seen, your gynecologist
or your primary care doctor may monitor your condition and
provide treatment.
Do I need a Pap test if I've had a hysterectomy?
The answer to this question depends on
why you had a hysterectomy.
* If you had a hysterectomy to treat
cervical cancer, you should continue to have regular Pap
tests to make sure the cancer hasn't come back.
* If you had a hysterectomy to treat pre-cancerous changes
in your cervix you should continue to have regular tests
for at least a few years after the surgery.
* If you had a hysterectomy to treat uterine or ovarian
cancer, your doctor may advise you to have Pap tests regularly,
since the tests are helpful in finding recurrences of these
cancers.
* If you had a hysterectomy where your cervix was not removed
(called a subtotal or supracervical hysterectomy), you should
have regular tests until you are at least 70 years old.
Since your cervix wasn't removed, there is still a chance
you could develop cervical cancer.
* If you had a total hysterectomy (the entire uterus, including
the cervix was removed) for a reason other than cancer or
pre-cancer, you may not need to have the Pap or HPV test
any more. Check with your doctor first, since some conditions
may mean that you should continue to be tested.
* If you had a hysterectomy and have an immune system disease
(such as AIDS) or are taking medicines that suppress your
immune system (such as after a kidney transplant), you may
be more likely to develop problems from an HPV infection.
You should be tested regularly.
Many women don't know why they had a hysterectomy
or what kind of hysterectomy they had. If you go to a new
doctor after the surgery bring whatever records you might
still have from your surgery. With records and an examination
he or she will be able to tell what kind of hysterectomy
you had and whether or not you need to continue to have
Pap tests.
You should discuss your situation and
your risk factors for HPV infection with your doctor. No
matter what you decide about the Pap and HPV tests, you
should continue to have regular pelvic exams.
A Few Things to Remember
* The single
most important thing that a woman can do is to participate
in a regular screening program. All women who are screened
enjoy a dramatic reduction in the risk of cervical cancer
compared to women who do not get tested. Make you appointment
today!
* Most cervical cancer is preventable. Early detection of
abnormal cell changes is important. Cervical cancer is rare
and almost always prevented through regular screening and
treatment of pre-cancerous changes.
* Almost all women will have HPV at some point, but very
few will develop cervical cancer. Most HPV infections are
temporary and will go away on their own. An HPV infection
that does not go away over a period of years might lead
to cervical cancer.
* The new screening options including liquid-based Pap tests
and the test for high-risk HPV are important developments
for women and their physicians. In the future an HPV vaccine
may prevent many Pap test abnormalities and most cervical
cancer.
http://www.cervicalcancercampaign.org/
index.aspx?aspxerrorpath=/faq/faqs.htm
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