Patricia Lee, M.D. 

Cervical cancer is the third most common gynecologic cancer in the United States. The American Cancer Society estimates 11,270 new cases and 4,070 deaths from cervical cancer during 2010 in the United States.  It is a slow growing cancer with symptoms that are usually absent until the cancer is in its advanced stages.  Late stage symptoms can include painless unexplained vaginal bleeding.  Fortunately, since the implementation of wide spread Pap smear screening over the last 50 years, the incidence of cervical cancer and deaths have decreased by almost 50%. Most of the deaths from cervical cancer in the U.S. occur in women who are not screened either on a routine basis or at all.

Cervical cancer is almost always caused by certain strains of the human papillomavirus (HPV).  The virus triggers changes in the cells of the cervix, which causes them to become precancerous.  HPV is a very common and highly contagious virus and is present in about 80% of sexually active men and women.  Although condom use is important and necessary for the prevention of many sexually transmitted diseases, it only offers partial protection against HPV.  Some of the major risk factors for cervical cancer are directly related to increased exposure to HPV.  These include:

  – Having sex at an early age (under 18).  

  – History of multiple sexual partners.  

   – Having sex with a man who has had many sexual partners.

Some of the other factors that increase a woman’s chance of developing cervical cancer are smoking, immunocompromised states, HIV infection, Chlamydia infection, and use of hormonal contraception.

In 2006, the first HPV vaccine, Gardasil, became available for the female population between the ages of 9 to 26.  It provides protection against four different HPV subtypes: the two viruses that cause 90% of genital warts and the two viruses that cause 70% of cervical cancer.  The target population is females who are not yet sexually active and thereby not yet exposed to HPV.  However, even after sexual activity occurs, it is quite rare that a woman would have already contracted all four viruses, thus vaccination would still be beneficial. In 2009, Cervarix, another HPV vaccine was recently approved for use in the U.S; however, it must be remembered that neither vaccines offers protection against all HPV viruses that cause cervical cancer.  Therefore, Pap smear screening will continue to be paramount in cervical cancer prevention.

The Pap smear is a test your gynecologist performs to collect cells from the cervix to be analyzed under a microscope. It is a highly useful test that is capable of detecting precancerous cervical cells and will allow your physician to monitor and treat the cervix before cervical cancer occurs.  In the U.S., Pap smear screening is usually recommended annually starting at age 21.  The test is performed more or less frequently at the discretion of the gynecologist depending on a woman’s history of HPV related disease and risk factors.  Due to the Pap smear, availability of HPV vaccination, and identification and reduction of risky behavior, cervical cancer is one of the most preventable gynecologic cancers.

As with many medical conditions, early detection is usually the way of curing a disease so remember to call your gynecologist and set up an appointment to get your Pap smear!

Patricia Lee, M.D. graduated from the Mount Sinai School of Medicine and received her training in Obstetrics and Gynecology at the University of Maryland.