This year, the American Cancer Society estimates that more than 14,000 women will be diagnosed with invasive cervical cancer, and more than 4,000 women will die from cervical cancer. However, the Papanicolaou test – more commonly referred to as a Pap test – has helped to significantly lower the cervical cancer death rate. In addition, the HPV (human papillomavirus) test has been approved to help screen for cervical cancer, since many cervical cancers are caused by HPV.
Debra Richardson, an OBGYN, associate professor and section chief of the gynecologic oncology division at OU Health Stephenson Cancer Center in Oklahoma City, says there are several different guidelines regarding at what age and frequency testing should occur. She suggests women begin having Pap tests at age 21 and repeat every three years. For women over 30, she recommends combining the Pap test and HPV test, called a co-test, every five years.
“Alternatives are the HPV test alone every five years or the Pap test alone every three years,” she says, adding that these recommendations are for women at average risk, not for those with a higher risk for cervical cancer.
Theresa Murch, an OBGYN specialist physician with Ascension Medical Group St. John Women’s Health in Bartlesville, says factors that may increase the risk of cervical cancer include vaginal sexual intercourse, multiple sexual partners, cigarette smoking, HIV, exposure to DES (Diethylstilbestol) while in utero, and a weakened immune system.
“Common symptoms of cervical cancer can be spotting or bleeding after intercourse, mucous vaginal discharge with an odor, post-menopausal bleeding or abnormal uterine vaginal bleeding, and an abnormal appearance or examination of the cervix,” says Murch. “Most women do not have symptoms in the very early stages of cervical cancer, so a regular physical examination and Pap smear can detect early cancer.”
As a cancer preventative, Richardson strongly recommends the HPV vaccine.
“There are two options: Gardasil 4 and Gardasil 9,” she says. “I recommend Gardasil 9 if available, this protects against HPV 6 and 11 which cause genital warts, and seven high risk types of HPV, giving about 90% protection against cervical cancer. The HPV vaccine also protects against vaginal, vulvar, anal, and head and neck cancer.”
Richardson says treatment for cervical cancer depends on the stage of the cancer. If detected early, a cold knife cone procedure or simple hysterectomy may be used.
“If stage IB2 or less…a radical hysterectomy (removing the uterus, cervix, parametria, upper vagina) and lymph node dissection through an open abdominal incision – because there is data showing worse outcomes if done via a minimally invasive approach,” says Richardson. “For more advanced stages, chemoradiation is recommended. If metastatic, treatment is palliative, not curative, and includes chemotherapy.”
Both Richardson and Murch stress the importance of routine screening.
“Cervical cancer is an easily detected and preventable disease when Pap smears and physical examinations are performed routinely,” says Murch. “Precancerous disease of the cervix can easily be removed to prevent the development of cervical cancer. Examination and screening should not be put off, and if you are having any symptoms of abnormal bleeding, an examination is recommended as soon as possible.”