Cervical Cancer Can Be Prevented

More than 31,000 Americans annually get cancer caused by human papilloma virus (HPV) and more than 4,200 women die from cervical cancer. The majority of these women had not been tested for cervical cancer in at least five years or had never been tested.

Thanks to the HPV vaccine and regular Pap tests, it is now possible to prevent virtually all cases of cervical cancer.

The HPV vaccine can prevent cervical cancer, genital warts, pre-cancerous cells, vaginal cancer, cancer of the throat and tonsils, anal cancer, oral HPV infections and abnormal Pap test results.

New research finds that the strongest predictor of a woman’s cervical cancer risk is whether she tests positive for HPV. Women who test positive for HPV have a greatly increased risk of developing cervical cancer. Cervical cancer accounts for about 40 percent of all the types of cancers caused by HPV.

Although there are more than 100 types of HPV, only about 15 of them can cause cervical cancer.  HPV infections are so common that nearly all men and women will get at least one type of HPV at some point in their lives. Most people never know they’ve been infected and have no symptoms. However, without knowing it they can give HPV to a sexual partner. About 14 million Americans become newly infected each year. The types of HPV that can cause cancer are transmitted by skin-to-skin contact, almost always during sex.

HPV shots have been recommended for about 10 years for both girls and boy prior to sexual contact. Less than 35 percent of American girls have gotten all three recommended doses. Despite low vaccination rates, HPV infections causing cancer and pre-cancers have declined by 56 percent in the United States. The HPV vaccine’s success in preventing cancer is even greater in European countries where HPV vaccination rates are much higher than in the United States.

HPV infections usually go away before there are symptoms. However, in some cases the infection can cause pre-cancerous changes in cells. If pre-cancerous cells don’t go back to normal on their own, they can turn into cancer if they’re not found and treated. On average, it takes 10-20 years from the time of HPV infection to develop cancer.

Cervical cancer starts in cells lining the cervix, the lower part of the uterus or womb. Normal cells may gradually develop pre-cancerous changes that can turn into cancer. To protect against cervical cancer, it is important to detect and treat all pre-cancerous cells.

Symptoms happen late

There are no symptoms in the early stages of cervical cancer or pre-cancer. Symptoms start when pre-cancerous cells become cancer cells and grow into nearby tissue. If that happens, the most common symptom is abnormal vaginal bleeding. It can include spotting between periods or heavier/longer periods, bleeding after menopause, bleeding after sex, or after douching or a pelvic exam. Symptoms can also include an unusual vaginal discharge or pain during sex.

These symptoms can also be caused by an infection or other causes. All these symptoms should be checked immediately by a doctor. If it’s an infection, it will require treatment. If it’s cancer, the sooner it’s treated, the easier it will be to cure.

Prevention: Three easy steps

Cervical cancer can be prevented in three ways:

1. Get vaccinated against HPV with Cervarix, Gardasil or Gardasil 9 preferably before age 12 and before sexual contact. HPV vaccine is recommended based on age, not sexual experience. The HPV vaccine will prevent most cervical, vaginal and anal cancers. This recommendation includes boys and girls, however, only Gardasil is recommended for boys. Additionally, only Gardasil protects against genital warts.

Both HPV vaccines are extremely safe and provide almost 100 percent protection. Worldwide, more than 175 million doses have been given to girls and boys since 2006. The vaccine can be given to girls as young as nine and up to age 18. Women between the ages of 19-26 should talk with their doctor about getting the vaccine by weighing their risk of previous HPV exposure with the vaccine’s potential benefits.

Although HPV vaccines have been recommended in a three-dose series given over six months, the Centers for Disease Control and Prevention changed the recommendation to two doses for children who start the series before their 15th birthday. Younger teens have a greater immune response to the vaccine and two doses are sufficient (another good reason to be vaccinated early). The second dose of HPV vaccine should be given six to 12 months after the first dose. Adolescents who receive their two doses less than five months apart will require a third dose of HPV vaccine. Young adults who start the series between ages 15 through 26 still need three doses of HPV vaccine. Also, three doses are still recommended for people with certain immunocompromising conditions through age 26. Two doses of HPV vaccine given at least six months apart to adolescents at ages 9 through 14 worked as well or better than three doses given to older adolescents and young adults.

2. Get a Pap test and HPV test regularly to screen for cervical cancer. Randomized clinical trials have proven that the best protection against cervical cancer is both a Pap test and HPV screening. A cancer-screening test means checking for cancer and conditions that could become cancer in people who have no symptoms. Cancer and pre-cancerous conditions that are found early are easier to treat, it provides more treatment options, and treatment is usually shorter and less drastic. Early detection also improves your chances of surviving cancer. By the time you notice symptoms, cancer may have already spread to other places in your body and your chances for survival decline.

A Pap test can find early cell changes, so they can be treated before they become cancer. The HPV test finds HPV infections that can lead to cancer. It is also used to decide the best treatment for women with an abnormal Pap test.

Most women can be safely screened for cervical cancer every three to five years, rather than every year. The American Cancer Society recommends against yearly testing. Check with your doctor about how often you need to be tested.

The American Cancer Society and 25 other national organizations’ new recommendations are:

• Women should begin testing at age 21. Between ages 21-29, women should have a Pap test every three years. They do not need the HPV test unless there is an abnormal Pap test result.
• Women ages 30-65 should be screened with both the Pap and HPV tests (called “co-testing”) every five years. While co-testing is the preferred method, it is still acceptable to use just the Pap test if it’s used every three years. When both tests are normal, no testing is needed for five years.
• Women at high risk for cervical cancer may need more frequent testing. High risk can be caused by an HPV infection, organ transplant or exposure to the drug DES.
• Women already diagnosed with cervical cancer or pre-cancer should be tested as their doctor recommends.

Women who do NOT need to be tested include:

• Women over age 65, who have had regular screenings with normal results
• Women who have had their uterus and cervix removed in a hysterectomy and have no history of cervical cancer or pre-cancer
• Women younger than age 21

3. Make healthy choices. YOU can help control your cancer risk by making these choices:

• Avoid tobacco in any form, including secondhand smoke. Cancer-causing chemicals are more concentrated in secondhand smoke than in smoke inhaled directly by smokers.
• Limit alcohol because it is linked to several types of cancer.
• Keep your weight healthy. Being overweight increases your risk for cancer. Eat lots of fruits and vegetables, limit red meat, and eat fish twice a week to help maintain a healthy weight.
• Get regular exercise. It’s important for weight control, reducing stress and a healthy, cancer-free lifestyle.

Who pays for screening?

The Affordable Care Act (ACA) mandates private insurance coverage of cervical cancer screening. This mandate includes self-insured or self-funded plans paid by employers. The exception to this requirement is plans that were in place before the ACA became law on Sep. 23, 2010. Your health insurance plan must cover the recommended cervical cancer screening tests if it started on or after that date.

Medicaid is required to cover screening for cervical cancer either routinely or as recommended by a doctor.

Medicare beneficiaries can receive a screening Pap test and pelvic exam every two years, more often if at high risk for cervical or vaginal cancer. Medicare does not charge a co-pay, co-insurance or deductible for this screening as long the doctor accepts Medicare as full payment (called “accepting assignment”).

If you do not have health insurance, The National Breast and Cervical Cancer Early Detection Program provides free (or very low cost) screenings for both cervical and breast cancer. Screenings include mammograms, Pap tests, pelvic exams, HPV tests and referrals to treatment. In Arkansas, these tests are provided by the Arkansas Department of Health. Call 1-877-670-2273 to find out if you qualify for free or low-cost tests

HPV vaccine is covered by most insurance plans for patients 18 and younger. The Vaccines for Children (VFC) Program offers free vaccines for eligible children through VFC-enrolled doctors. Children may qualify if they are Medicaid-eligible, uninsured or underinsured.

For more information:

American Cancer Society www.cancer.org

National Cancer Institute at the National Institutes of Health (information on specific screening methods and tests)  www.cancer.gov/cancertopics/pdq/screening

To find the nearest free screening program, call the CDC toll free at 1-800-232-4636 or visit CDC’s website.

To find free vaccines, visit the CDC’s website here. Or call toll free 1-800-232-4636 and ask for information about the VFC program.