Regarding Cervical Cancer And Its Screening.

A 25 year old recently married woman presents to your clinic wanting information.
1. What are the screening recommendations for cervical cancer and how often should this be done?
2. What is the most appropriate method recommended to prevent cervical cancer?
3. What are the risk factors for cervical cancer and what life style modifications would you suggest?

(Question From MCPS Family Medicine Paper on October 19th 2016)

Solution:

1. What are the screening recommendations for cervical cancer and how often should this be done?

Answer:

• All woman should begin cervical cancer screening at age 21 years. 
• Women between the ages of 21 and 29 should have a Pap test every 3 years. They should not be tested for HPV unless it is needed after an abnormal Pap test result.
• Women between the ages of 30 and 65 should have both a Pap test and an HPV test every 5 years. This is the preferred approach, but it is also OK to have a Pap test alone every 3 years.
• Women over age 65 who have had regular screenings with normal results should not be screened for cervical cancer. Women who have been diagnosed with cervical pre-cancer should continue to be screened. Women who have had their uterus and cervix removed in a hysterectomy and have no history of cervical cancer or pre-cancer should not be screened.
• Women who have had the HPV vaccine should still follow the screening recommendations for their age group.
• Women who are at high risk for cervical cancer may need to be screened more often. Women at high risk might include those with HIV infection, organ transplant, or exposure to the drug DES.

2. What is the most appropriate method recommended to prevent cervical cancer?

Answer: Two tests can help prevent cervical cancer—
1. The  Pap smear which looks for precancers, cell changes on the cervix that may become cervical cancer if they are not treated appropriately. One should start getting Pap tests at age 21.
2. The human papillomavirus (HPV) test looks for the virus that can cause these cell changes.
 

Pap test or Pap smear is easily done in doctor's office where  during the procedure a few cells and mucus from the cervix and the area around it are collected and examined in the laboratory for any pathological precancerous changes.

3. What are the risk factors for cervical cancer and what life style modifications would you suggest? 

Answer :  Almost all cervical cancers are caused by human papilloma virus (HPV),  a common virus that can be passed from one person to another during sex. There are many types of HPV. Some HPV types can cause changes on a woman’s cervix that can lead to cervical cancer over time, while other types can cause genital or skin warts.

Risk factors for cervical cancer are: 

• Smoking.
• Having HIV(the virus that causes AIDS) .
• Immunodeficiency states. 
• Using birth control pills for a long time (five or more years).
• Having given birth to three or more children.
• Having several sexual partners.
• Early marriage or first intercourse at a younger age
• Unprotected sex
• Family history of cervical cancer

Lifestyle modifications to reduce the risk of getting cervical cancer are:

• Delaying first sexual intercourse until the late teens or older
• Limiting the number of sex partners
• Avoiding sexual intercourse with people who have had many partners
• Avoiding sexual intercourse with people who are obviously infected with genital warts or show other symptoms
• Using condoms during sex.
• Quitting smoking