Minimizing Cervical Cancer Risk
By Margaret McKenzie, M.D.
Cervical cancer occurs when the cells that make up the cervix, which is the opening of the uterus, undergo changes where they multiply out of control, accumulating and resulting in a tumor. About one in 147 women will be diagnosed with cervical cancer in their lifetime. However, routine screening and preventative measures make it one of the most preventable types of cancer.
Although we don’t know for sure what causes some cells to grow abnormally, we do know that certain risk factors are linked to the development of these precancerous changes, some of which can be controlled. Nearly all women who have been diagnosed with a precancerous change of the cervix will survive with appropriate follow-up and treatment, making prevention and early detection a key.
The most important risk factor linked with the development of cervical cancer is infection with the human papillomavirus (HPV). Most women infected with the virus can naturally clear it, but the infection, if it’s persistent, can cause changes in cervical cells that can lead to cancer.
One of the most important steps a woman can take to protect herself from developing it is to receive a vacation against HPV. You may have herd of these vaccines under the brand names of Gardasil® or Ceravix®. The FDA has approved vaccinations that are highly effective at preventing infection with the types of HPV that cause the majority of all cervical cancers. The vaccine is most effective at reducing cervical cancer risk if it is received before HPV infection occurs. Therefore, it is now recommended that young girls and women begin receiving this three-dose vaccination series between the ages of 9 and 26 years old. In addition, new recommendations have been issued suggesting that boys receive the vaccine as well.
Precancerous changes in the cervix often have no symptoms, so early detection is the key to prevention. Because most cervical cancers develop slowly, routine Pap tests can detect precancerous changes at a treatable stage.
The recommendation is that women begin seeing a gynecologist/health care provider for a Pap test at age 21 (repeated every three years until the age of 29). At age 30, a Pap and HPV screen are done, if normal repeat every five years. Women who have had a positive high risk HPV test or who have had an abnormal Pap should discuss their frequency of screening with their health care provider.
After discussion with their healthcare provider, women who are 65 years old may discontinue routine screenings as long as they have had adequate screening and do not have certain risk factors. These risk factors include:
- Women who have HIV/AIDS
- Women who are immunosuppressed
- Women who were exposed to diethylstilbestrol (DES) in utero
- Women who have been treated for cervical intraepithelial neoplasia (CIN) II or higher or if they have had cervical cancer
A woman shouldn’t make the decision to stop cervical cancer screening without checking with her healthcare provider.
No Pap test is necessary if a woman has undergone a hysterectomy that included removal of the cervix and no cancer was present. However, just because a woman no longer needs a Pap does not mean she doesn’t need to still see her women’s health doctor for periodic pelvic exams. Annual exams are still necessary.
In addition to getting vaccinated and receiving regular Pap tests, a woman can make other lifestyle choices that will help to lower her risk of developing cervical cancer. These lifestyle choices include:
- A healthy immune system may help reduce cancer risk by boosting the body’s natural defenses against HPV.
- Stress management and a healthy diet can help your immune system to function effectively.
- Research is indicating that a diet rich in a variety of fruits and vegetables may help women clear HPV infections further.
- Limiting the number of sexual partners can reduce the chance of being infected with HPV. Similarly, using latex condoms can reduce the risk of infection, but because the virus can live on surface areas of the skin that are not protected, condoms don’t completely prevent infection.
- Smoking increases the risk of cervical cancer because it exposes your body to cancer-causing chemicals that, in the presence of other risk factors, contribute to the development of cancer.
It’s important for women to discuss their risk factors with their gynecologist, who will advise them on an appropriate screening and management plan.
This information is not intended to replace the advice of your health care professional. See your provider at the recommended intervals for your age group to maintain your best health!
Dr. Margaret McKenzie is a staff member in in Cleveland Clinic's Ob/Gyn & Women's Health Institute. She has delivered more than 8,000 babies and has devoted much of her recent career to educating future physicians as a professor in the Cleveland Clinic Lerner College of Medicine.
Thank you to Lauren Weber, DO, who acted as Medical Editor for this article:
Lauren Weber, DO
Women's Health Specialist and Family Practice
Center for Women's Health, A NorthBay Affiliate