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Cervical Cancer Screening and Prevention: A Guide
- 1. Cervical Cancer Screening andCervical Cancer Screening and PreventionPrevention Centers for Disease Control & Prevention (CDC) National Center for HIV, STD, & TB Prevention Division of STD Prevention Modified from an original product developed by the Gynecologic Cancer Foundation (GCF), with the support of the National Cervical Cancer Coalition (NCCC)
- 2. About This PresentationAbout This Presentation In this presentation, you will learn about old and new methods of cervical cancer screening We hope that this presentation will help women to take an active part in their health It does not replace a doctor’s diagnosis or treatment
- 3. Cervical Cancer Screening andCervical Cancer Screening and PreventionPrevention You can prevent cervical cancer with screening. Screening is the search for diseases, such as cancer, in people without symptoms. Screening has saved thousands of lives. You should get screened for cervical cancer on a regular basis. Cervical cancer can be prevented!
- 4. You Can Prevent Cervical CancerYou Can Prevent Cervical Cancer In the U.S., it is estimated that in 2004: About 10,520 women will be diagnosed with cervical cancer About 3,900 women will die of cervical cancer Source: American Cancer Society
- 5. What is the Cervix [What is the Cervix [ser-vixser-vix]?]? The cervix is one of the female organs Other female organs include the: Vulva [vul-vah] Vagina [ve-juy-nah] Uterus [yoo-tuh-ris] Fallopian tubes [fuh- loh-pee-an toobs] Ovaries [o-vuh-reez]
- 6. What is cervical cancer?What is cervical cancer? Cancer of one of the female organs (cervix) The easiest female cancer to prevent through screening
- 7. What is a Pap test?What is a Pap test? Cells are collected from the surface of your cervix by a doctor These cells are then checked under a microscope for any abnormalities If abnormal (or precancerous) cells are found, they can be treated before they turn into cancer Cervical cancer can be found in the early stages, when it is easier to treat
- 8. Finding early cell changesFinding early cell changes Normal cervical cells Precancer cells
- 9. What a Pap test isWhat a Pap test is NOT:NOT: A pelvic exam A test for ovarian or uterine cancer A biopsy (“buy-op-see”), or procedure where a needle is used to remove cells to study A test for sexually transmitted diseases (STDs)
- 10. Most cervical cancer can beMost cervical cancer can be preventedprevented Cervical cancer is very rare in women who get regular Pap tests
- 11. What causes cervical cancer?What causes cervical cancer? The main cause of cervical cancer is infection with genital Human Papillomavirus [pap·il·lo·ma·vi·rus] or HPV ▪ Genital HPV is a virus that is spread by sex You could have been infected with HPV years ago but only recently had it found on a test There are many different types of HPV Certain “high-risk” HPV types can cause cell changes and cervical cancer
- 12. How common is HPV?How common is HPV? Most men and women who have had sex have been exposed to HPV Most sexually active women (at least 80%) have been exposed to HPV by age 50
- 13. How do I Know if I am at risk forHow do I Know if I am at risk for HPV?HPV? Anyone who has ever had sex is at risk for HPV
- 14. Who is at higher risk for HPV?Who is at higher risk for HPV? Anyone who has had more than one sex partner Anyone whose sex partner(s) has had more than one sex partner
- 15. How do I know if I have HPV?How do I know if I have HPV? Abnormal Pap test results are often a sign of HPV HPV DNA test can find high-risk HPV types
- 16. If I have HPV, does it mean I willIf I have HPV, does it mean I will get cancer?get cancer? No! Most people get HPV infection, but very few get cervical cancer In most cases, HPV infection goes away on its own Sometimes, the HPV infection does not go away after many years. This type is called “persistent”. It can lead to cervical cancer
- 17. If I have HPV, does it mean myIf I have HPV, does it mean my partner has been unfaithful?partner has been unfaithful? No! HPV is not a sign of unfaithfulness It is not possible to know when you got HPV or who gave it to you You may have had HPV for many years before it shows up
- 18. Who is at risk for cervical cancer?Who is at risk for cervical cancer? Women who do not have Pap tests Women who do not follow up with testing or treatment after an abnormal Pap test, as told by their health care provider Women who have persistent HPV Women who smoke
- 19. Who is at risk for cervical cancer?Who is at risk for cervical cancer? Women with immune problems HIV Transplanted organs Steroid medications Chemotherapy Women whose mothers took the drug, DES
- 20. How do I lower my risk of gettingHow do I lower my risk of getting cervical cancer?cervical cancer? Get regular Pap tests and follow up, if necessary Limit your number of sex partners Choose a sex partner who has had no or few prior sex partners Do not smoke cigarettes Keep a healthy diet and lifestyle Use condoms consistently and correctly during sexual activity
- 21. What will a Pap test tell me?What will a Pap test tell me? That the cells in your cervix are… Normal Abnormal: Minor cell changes of unknown importance, possibly unrelated to precancer (ASCUS) Minor cell changes Moderate cell changes Severe cell changes Possibly cancerous
- 22. How common are abnormal PapHow common are abnormal Pap test results?test results? Abnormal Pap test results are quite common They are usually only slightly abnormal If followed up and treated early, you can prevent the abnormality from turning into cervical cancer
- 23. When do I need my first Pap test?When do I need my first Pap test? No more than 3 years after you first have sex No later than age 21
- 24. How often do I need a Pap test?How often do I need a Pap test? Every year until age 30 After age 30, if you have had only normal results, you may have them every 2 to 3 years (after talking with your health care provider about your level of risk)
- 25. Why do I need to keep gettingWhy do I need to keep getting tested?tested? Just like mammogram screening, Pap testing is not a one-time test The test is not perfect New changes (abnormalities) can occur after you get tested, even if you have not had new partners It could take many years for changes to develop or to be noticed Your risk changes if you have new partners, or if your partner has other partners
- 26. When can I stop having Pap tests?When can I stop having Pap tests? Around the age of 65 or 70, if you are not otherwise at high risk for cervical cancer
- 27. I feel fine, so why do I need a PapI feel fine, so why do I need a Pap test?test? A Pap test can find changes of the cervix (precancer) when you may not have symptoms or notice a problem
- 28. What can I do to make my Pap testWhat can I do to make my Pap test as accurate as possible?as accurate as possible? Schedule your Pap test when you are not having a menstrual period Do not have sex for 2 days before the test Do not douche for 2 days before the test Do not use tampons, birth control foams, jellies, or other vaginal creams and medications for 2 days before the test
- 29. What Should I Expect When I HaveWhat Should I Expect When I Have a Pap Test?a Pap Test? You lie down on a special exam table Your feet are placed in stirrups (foot holders) A speculum (thin duck-billed instrument) is inserted into your vagina and opened This allows your health care provider to see your cervix
- 30. What Should I Expect When I HaveWhat Should I Expect When I Have a Pap Test?a Pap Test? A small spatula, brush, or cotton-tipped swab is used to rub and remove cells from the cervix A sample of cells is put on a slide or vial You may feel a little uncomfortable, but the test is quick You may have some spotting (light bleeding) afterward
- 31. How do I find out about my Pap testHow do I find out about my Pap test results?results? You can ask to have a copy mailed to you You can call for your results If you have an abnormal result, it is extremely important to show up for follow-up appointments and get the recommended testing Even after a normal Pap test, it is still important to report any symptoms of abnormal vaginal bleeding, discharge, or pain to your health care provider
- 32. Do I need a Pap test if I had aDo I need a Pap test if I had a hysterectomy?hysterectomy? If you had treatment for precancer or cancer of the cervix, you may still need a Pap test If the cervix was left in place at the time of your hysterectomy, you will still need Pap tests Preventive health care is still important, even if you do not need a Pap test
- 33. What is new in cervical cancerWhat is new in cervical cancer screening and prevention?screening and prevention? Liquid-based Pap Combination of HPV test and Pap test for women 30 years of age and older HPV test for women with ASCUS Vaccines for HPV currently being tested
- 34. Important Points to Remember:Important Points to Remember: Regular Pap tests are the best way to prevent cervical cancer Getting an abnormal Pap test result does NOT mean you have cancer Getting a positive HPV test result does NOT mean you have cancer Getting a positive HPV test result is NOT a sign of unfaithfulness These results mean you are finding a potential problem now, before it is too late
- 35. Take Control of Your HealthTake Control of Your Health Make an appointment to get a Pap test today
- 36. How do I get my friend to have aHow do I get my friend to have a Pap test?Pap test? Tell her about the importance of preventing cervical cancer Tell her it doesn’t hurt Help her find the right health care provider Help her make an appointment Offer her a ride Offer help with child care
- 37. Screening ResourcesScreening Resources For a free or low-cost Pap test: http://www.cdc.gov/cancer/nbccedp/contacts.htm Other Resources: CDC Division of Cancer Prevention & Control http://www.cdc.gov/cancer/nbccedp/cc_basic.htm American Cancer Society www.cancer.org National Cancer Institute (NIH) www.cancer.gov
- 38. CitationsCitations ACS. (last revised January 2005). Detailed Guide: Cervical Cancer. What are the Key Statistics About Cervical Cancer? (Online) CDC. (January 2004). Report to Congress: Prevention of Genital Human Papillomavirus Infection. CDC. (2004). Genital HPV Infection Fact Sheet. (Online) U.S. Department of Health and Human Services. (2000). Healthy People 2010, Vol 1-2, 2nd Ed. Washington, DC: US Government Printing Office.
- 39. AcknowledgementAcknowledgement CDC gives special thanks to GCF and NCCC. You may visit these organizations online at: www.thegcf.org/ www.cervicalcancercampaign.org/
Editor's Notes
- You can prevent cervical cancer. The number of U.S. deaths from cervical cancer has dropped by 74% in the past 40 years due to Pap test screening. Too many women are still getting cervical cancer. It kills thousands every year. Women in the U.S. who were born outside of the U.S. have higher death rates from cervical cancer than those born in the U.S. More than half of the women with cervical cancer have not been screened within the last 3 years. More women are now learning how to take control of their health. They are learning how to get screened and prevent cervical cancer. This will lower their chances of dying from this disease. This presentation will teach you why screening is important. We hope it will encourage you to get screened for cervical cancer. (ACS, 2005)
- The cervix is one of the female organs. These organs are important for pregnancy and child bearing (reproduction). The vulva is the female organ just outside the vagina. The vagina is the opening between the vulva and the bottom of the cervix. The cervix is the narrow outer end (or neck) of the uterus (or womb). During sex, sperm from the male get into the fallopian tubes through the cervix. This is where the sperm meet the egg from the female. Your cervix is inside your body, which makes it hard to see. It allows sperm to get to the uterus. It also holds the baby in the womb until the baby is ready to be born. Some people refer to the female organs as genitals [jeh-nih-tlz], especially the outer organs.
- It starts with abnormal cells (bits of living tissue) on your cervix. These abnormal cells can turn into cancer. This change normally takes about 10 to 15 years. Some tests can find these abnormal cells before they turn into cancer. These cells can be removed to prevent cervical cancer. Cervical cancer does not have any early symptoms. That is why regular screening is important. It can find abnormal cells that you cannot feel and that your health-care provider cannot otherwise see. If abnormal cells are found, doctors can remove them before they turn into cancer. Cervical cancer can appear in younger women. That is why we urge all women ages 21 and over to get screened and follow up with treatment, if necessary. (CDC, 2004)
- A Pap test is when your doctor takes cells from your cervix so that they can be looked at with a microscope. Abnormal cells (also known as precancer) could turn into cancer with time. If they are found, they can be treated. Thanks to the Pap test, these abnormal cells can be found and treated before they turn to cancer. Today, there are two types of Pap tests: (1) The regular Pap test, as we talked about above; and (2) the liquid-based Pap test, when the cells are placed in a special liquid first, before being looked at for abnormalities. Both tests are accurate. If abnormal cells are found, your doctor may tell you to return for more testing or treatment. Be sure to follow that advice to make sure you receive the proper treatment.
- Pap tests can find changes before cancer starts . Precancerous cells can be treated before they turn into cancer
- The Pap test is a screening test for cervical cancer. It is not a good test for other types of cancer or for sexually transmitted diseases (STDs). Many women think that a pelvic exam is a Pap test. This is not the case. Often, your doctor will give you a pelvic exam but not a Pap test. Ask your doctor if you need a Pap test. He or she can tell you how often you should be getting a Pap test, which depends on your age and medical and sexual history. January is cervical cancer screening month. It is a good time to schedule your physical exam and Pap test.
- Cervical cancer is very rare in women who get regular Pap tests. This is because abnormal cells can be found and treated early. Most women who get this cancer have not had regular Pap tests. Most women (about 80%) in the U.S. have gotten a Pap test in the past 3 years. (HHS, 2000)
- Cervical cancer comes from a virus called the human papillomavirus (or HPV). There are many types of HPV. Some types of HPV are spread by anal, vaginal, or oral sex. Both men and women can get HPV. Most sexually active adults will get HPV at some time. But very few people with this infection will actually get cervical cancer. Only a few of the many HPV types can cause cervical cancer. These are called “high-risk” types. High-risk types can cause changes in the cells of the cervix, which are sometimes called precancerous changes, or precancer. These changes can, but do not always, become cancer. “High-risk” types can also cause cancer of the vagina and vulva. However, most of the high-risk HPV infections go away on their own without treatment.
- HPV is a very common virus. Studies show that most sexually active people get HPV at some time in their lives. HPV is especially common in women 18 to 29 years old. It usually goes away on its own in 8 months to 2 years, without causing health problems. (CDC, 2004)
- Most sexually active men and women are at risk.
- The risk of getting HPV goes up with the number of sex partners. Even with one partner for life, a woman still has some chance (20%) of having HPV infection, if her partner has ever been with someone else. There are other risk factors for HPV, but these have been found to be the most important. We do not know everything about how someone gets this virus. (CDC, 2004)
- Many women will first hear about HPV when they have an abnormal Pap test. The changes found in an abnormal Pap test are often caused by HPV. There is also a new HPV DNA test that can find high-risk HPV types on a woman’s cervix. But this test is not meant for all women. It is only approved for use under certain conditions and for certain women. We will talk more about this new test later in the presentation.
- Most men and women who have HPV never know they are infected. This is because the virus causes no symptoms (i.e., you don’t see or feel it) and goes away on its own. Only women with HPV that stays for many years are at risk for cervical cancer.
- It is not possible to know when you got HPV or who gave it to you. That’s because HPV can stay in the skin for a long time before it ever becomes active or can be found on a test. That means the HPV you find today might have been passed on to you many years ago. It also means the person who gave you HPV may have gotten it many years earlier, and likely never knew s/he had it. For these reasons, you should not blame your partner if you have HPV. Even people in long-term, faithful relationships can be found to have HPV. You should not blame yourself, either. HPV infection is not a sign that you have been unfaithful. This virus is so common that even people with only one lifetime sex partner can get it, if their partner has ever been with someone else.
- A risk factor is something that can increase your chance of getting a disease, such as cancer. Some factors are more likely to cause cervical cancer than others. The most important risk factor is not getting regular Pap tests and treated, when needed. Also, as mentioned earlier, having persistent HPV infection increases your risk of cervical cancer. Women smokers are more likely to get cervical precancer and cancer.
- A weak immune system makes your body less able to fight HPV. Women may have a weak immune system if they have HIV or if they’ve had an organ transplant. Taking steroid medicines or receiving chemotherapy also causes a weak immune system. Women whose mothers took DES when they were pregnant are at higher risk for getting cervical cancer. Doctors gave the drug DES to women at high risk for miscarriages in 1940–1971. Still, most "DES daughters" do not get cervical cancer.
- You can usually prevent cervical cancer with routine Pap tests. Make sure you follow up with more testing if your doctor tells you to. You can lower your risk for cervical cancer by having fewer sex partners over the course of your lifetime. The longer you wait to have sex, the more likely you are to have fewer sex partners. Having a partner who has had no or few prior sex partners can also lower your risk. If you already smoke, talk to your doctor about programs to help you stop. Good nutrition can help make your immune system stronger. Some research suggests that folic acid can reduce your risk of cervical cancer. Folic acid can be found in foods such as uncooked spinach; romaine lettuce; rice; lentils; and, certain cereals. The effect of condoms in preventing HPV infection is not known. However, the use of condoms has been associated with a lower rate of cervical cancer. People who are sexually active should use condoms. When condoms are used consistently and correctly, they help prevent HIV (the virus that causes AIDS) and lower the risk of other STDs.
- If your Pap test is “negative,” your cervical cells are normal. That means that no signs of cancer, precancer, or other abnormalities were found. An abnormal Pap test means that the cells in your cervix have changed from normal to abnormal in appearance. The abnormalities are classified based on how the changes appear -- minor, moderate, and severe. Changes in the cells might be a sign of a precancer, but this is not always true. The most common abnormal result is known as “ASCUS”. This is a medical term that you may hear, which means the test found cells of unknown importance. In this case, the test result is unclear. Your health-care provider cannot even tell if the cells are abnormal due to an infection or irritation (like a yeast infection), or because there is precancer. In this case, you will usually need more testing. Be sure to follow-up as recommended by your provider. Pap tests can also find minor or more severe abnormalities. Generally, the minor cell changes are more likely to go away on their own without treatment. However, the advanced cell changes are more likely to develop into cancer over time, if they are not treated. Finally, Pap test results can suggest that a woman might have cancer. This kind of result is very rare for women who get routine Pap tests. Usually, abnormalities can be caught before they ever get to this stage. When this does happen, other tests are needed to tell whether the abnormality is actually cancer. If your Pap test finds any abnormalities, you should follow your provider’s instructions. Talk with your provider about any abnormal results. There are treatments to fight cervical cancer, if needed. When you get your results, make a file and put all of your Pap test results in it for future reference.
- Millions of women get Pap tests each year. Some of them will have an abnormal result. But most of these abnormal results will not be cancer. The most common abnormal findings on a Pap test are minor abnormalities. The more serious changes (known as severe abnormalities, precancer or cancerous changes) are much less common. It is important to follow up with any abnormal findings. That way, the abnormality can be treated before it ever turns into cancer.
- Since HPV is transmitted through sex, you should have your first Pap test 3 years after you first have sex. Even if you have never had sex, you should start getting Pap tests no later than age 21.
- Women under age 30 should get Pap tests every year. Screening is recommended every 2 to 3 years for women ages 30 and older who have had three normal Pap tests in a row.
- The most important reason you need to keep getting tested is that, just like the mammogram, a Pap test is not a one-time test. You need it on a regular basis. The Pap test has helped thousands of women prevent cervical cancer. Like any other test, however, it is not perfect. Regular Pap testing improves your chances of finding abnormalities. Your first Pap test abnormality may appear years after you were exposed to HPV. Since it takes so long for cervical changes to appear, you could have several normal tests before you get an abnormal result. Therefore, even if you have not had sex (or a new sex partner) for many years, you should still get tested on a regular basis. Also, remember that your risk can change. You may have a new sex partner or your partner may have a new partner, which exposes you to HPV and adds to your risk for cervical cancer.
- Most health experts agree that it is safe for a woman with a history of normal Pap tests to stop screening around the age of 65 or 70, if she is not otherwise at high risk for cervical cancer. If you are 65 or 70 and have had three or more recent normal tests and no abnormal results in the last 10 years, you are at very low risk of cervical cancer and do not need to continue getting Pap tests. Keep in mind that even when you reach these ages, having sex with a new partner can change your risk. In this case, you may want to keep getting screened. Talk to your health care provider about if and when you can stop getting Pap tests.
- The purpose of the Pap test is to find problems early. Cervical cancer cannot usually be seen or felt until it is advanced. This means that by the time you start getting symptoms, the cancer is likely to be harder to treat. This lowers your chances of successful treatment.
- You should get your routine Pap test between periods. If you have abnormal bleeding, make an appointment to see your doctor as soon as possible. Keep your appointment because the bleeding could be a symptom of cancer.
- Like any new experience, you may wonder what will happen during your first Pap test. You will be asked to lie down on a table and put your feet in stirrups (foot holders). A speculum (thin duck-billed instrument) will be put into your vagina and opened. This helps your doctor keep the vagina open so that he or she can see the cervix clearly inside.
- A small spatula, brush, or cotton-tipped swab is then used to lightly scrape the cervix to collect cells. Once this is done, your doctor will put the sample of cells on a slide or vial to look at it under a microscope. You might find the Pap test embarrassing or a little uncomfortable. This is normal. Remember, it is worth it because it can save your life. If you have questions during the test, tell your doctor. You may have some spotting (light bleeding) afterward, which is normal.
- You can take charge of your health by knowing the results of all of your tests. Be sure you receive your results. Do not think everything is okay if you do not receive a letter or phone call. If you have not received your results in a reasonable amount of time, call your doctor’s office. Remember, you know your body best. If something doesn’t seem right, even if you have had a normal Pap test, make an appointment with your doctor.
- If you had a hysterectomy for reasons other than cancer and have never had cervical cancer or precancer, you are at a very low risk. As long as your immune system is healthy, you can stop getting Pap tests. Don’t forget that other preventive health care (such as pelvic exams and annual check-ups) is still important.
- Some doctors now use a new liquid-based Pap instead of the regular Pap test. Cells are collected from your cervix just like the regular Pap test. The only difference is in how your cells are tested in the lab. Just like the regular Pap test, if you have three normal tests in a row, you only need to be screened every 2 to 3 years with this test. The new HPV DNA test checks for a type of HPV called high-risk HPV. Cells are collected from your cervix for the HPV test at the same time they are collected for the Pap test. If you are 30 or over, this new test can be combined with the Pap test. It tells you if your cervical cells look normal and if you have high-risk HPV DNA. If you don’t have HPV and your cervical cells are normal, you are at a very low risk for getting cervical cancer in the next few years. If both tests are normal, you only need this combined test every 3 years. The HPV test can also be used to decide if you need more testing if your Pap test comes back with minor changes of unknown significance (ASCUS). In this case, it can be used for women of all ages. The HPV DNA test should not be used on women younger than 30, unless they have ASCUS. That’s because is HPV is very common and short-lived in women 18 to 29. If these women were tested, they would likely find harmless HPV that will go away on its own anyway. Remember, an HPV infection is common and normally does not lead to cervical cancer. The women with persistent infections, who do not get regular Pap tests, are the ones at highest risk of getting precancer and cancer. You should talk with your doctor about what is new in cervical cancer prevention. If you decide you want to have one of the new screening tests, you might want to make sure your insurance plan covers it. Also, not all doctors offer these tests yet. The most exciting prospect is a new vaccine against the most common HPV types. It is being tested now and may be available in the next 5 years.
- Remember, Pap tests are the best way to find cervical abnormalities early and prevent cervical cancer. Routine screening and follow-up testing are key to prevention. If you get an abnormal Pap test or a positive HPV test result, you are not alone. Hundreds of thousands of women get these results every year and do not get cervical cancer. Talk to your health-care provider about the next steps. Learn about what you can do to resolve the problem before it turns into cancer.
- The most important thing that any woman can do to prevent cervical cancer is to have a Pap test regularly! It is very important to educate your friends about the importance of a Pap test. Women have many reasons for putting off a Pap test Help your friend by reassuring her that a Pap test does not hurt Help her find a doctor or clinic so she can make an appointment for her Pap test Give her a ride to get the Pap test Offer to help her with child care
- ACS. (last revised January 2005). Detailed Guide: Cervical Cancer. What are the Key Statistics About Cervical Cancer? http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_are_the_key_statistics_for_cervical_cancer_8.asp?sitearea= CDC. (January 2004). Report to Congress: Prevention of Genital Human Papillomavirus Infection. CDC. (2004). Genital HPV Infection Fact Sheet. http://www.cdc.gov/std/HPV/STDFact-HPV.htm U.S. Department of Health and Human Services (HHS). (2000). Healthy People 2010, Vol 1-2, 2nd Ed. Washington, DC: US Government Printing Office.