By Heather Shannon, MS, CNM, WHNP, MPH
January is national cervical cancer awareness month. Would you know if you had cervical cancer? Let us look at it more closely.
According to American Cancer Society (ACA, 2019), it is estimated approximately 13,170 new cases of invasive cervical cancer will occur in 2019 and approximately 4,250 women will die. At one time, cervical cancer was the most common cancer death in women. With the new cervical cancer screening guidelines and HPV vaccine, death from cervical cancer has dropped significantly at a rate of 2 percent per year.
Midlife, ages 35 through 44, is when cervical cancer tends to occur. In women under the age of 20, cervical cancer will rarely develop. However, 15 percent of women older than 65 are diagnosed with cervical cancer and is commonly related to not receiving regular screening. It has also been found that most women who have abnormal cervical cancer screenings that progressed to cancer either have not had screening ever or in the past three to five years. Hispanic women are most likely to get cervical cancer, followed by African American women. American Indians and Alaskan natives have the lowest risk of cervical cancer in the United States. (ACS, 2019 and NCCC. 2019)
As reported in July 2019 SWM article “HPV Vaccine. What is the real deal?” HPV accounts for most all diagnosed cervical cancers. We learned that receiving the HPV vaccine series and abstinence could prevent cervical cancer. Keeping up with your cervical cancer screening (Cotesting: Pap smear and human papillomavirus screen) will help reduce the chance of abnormal findings progressing to cervical cancer. In addition, limiting the number sex partners and properly using a condom along with cervical cancer screening per current recommendations will greatly reduce your risk. Please talk to your health care provider to determine your risks and screening needs.
According to the American Society for Colposcopy and Cervical Pathology (ASCCP), United States Preventive Services Task Force (USPSTF) Consensus Screening Guidelines, and American College of Obstetrics and Gynecologists (ACOG), women should have recommended cervical cancer screening as outlined below:
- <21: no screening – even if sexually active
- Age 21-29: a pap smear alone every three years or HPV screen alone every five years
- Age 30-65: co-testing every five years or pap only every three years until the age of 65
- >65: no longer need screening if there is no cervical cancer history or severe cervical dysplasia (pre cancer/abnormal cells) and have had adequate screenings
- >65: continue screening for at least 20 years with cervical cancer history or more severe cervical dysplasia
- Hysterectomy: no screening unless history of cervical cancer or more severe cervical dysplasia
What is the cervix?
For a better understanding, we will review the female anatomy. The uterus is a hollow muscle that is responsible for carrying a baby or shedding its lining during menses. The cervix is located in the lower part of the uterus and is the opening that allows the passage of a baby, semen and menstrual blood. The cervix has two parts and contain different types of cells. When the two cells come together, it is called the transformation zone. Here is where cervical cancer starts.
- The endocervix is the furthest away from the vaginal opening and is covered with glandular cells.
- The exocervix (or ectocervix) is the closest to the vaginal opening and is covered in squamous cells.
Figure 1 illustrates female anatomy.
Figure 2 illustrates the progression of abnormal cells into cancer.
Figure 1, (ACS, 2019)
Figure 2, ACOG, 2018
It takes several years for cervical cancer to develop. Cotesting can detect early changes in cervical cells or pre cancer cells called dysplasia or cervical intraepithelial neoplasia (CIN). Approximately 80 to 90 percent of cervical cancers are squamous cell cancers and develop in the exocervix (outer cervix). The remaining 10 to 20 percent is adenocarcinoma, which develops from the glands that produce mucus in the endocervix (inner cervix) and has become more common in the past 20 to 30 years. Rely on your provider to provide the best management of abnormal findings.
What are the Symptoms of Cervical Cancer?
Unfortunately, pre-cancer cell changes and early cancers do not cause symptoms. For this reason, keeping up with your screenings are important to detect any abnormalities. However, possible symptoms of more advanced disease may include abnormal vaginal bleeding, pain during sex, generalized pelvic pain, urinary pain, frequency, or unusual vaginal discharge with a foul odor. Contact your GYN provider with any unusual symptoms.
Examples of abnormal bleeding:
- Between your periods
- After vaginal sex
- After douching
- After a pelvic exam
- Post-menopausal bleeding
These symptoms could also be signs of other health problems, not related to cervical cancer. If you experience any of the symptoms above, talk to a healthcare provider. Rely on your GYN provider to help you understand how often you need to have screenings.
Cervical cancer has declined over the years and can be attributed improvement with cotesting, HPV vaccine and efforts to educate on HPV. Women who have pre-cancer findings on cotesting can prevent further progression to cervical cancer with proper follow up. Please talk to your GYN provider about any unusual symptoms you are having and continue with the recommended cervical cancer screening.
American Cancer Society (ACS) 2019: https://www.cancer.org/cancer/cervical-cancer/about/what-is-cervical-cancer.html
American College of Obstetrics and Gynecologists (ACOG) 2018: https://www.acog.org/Clinical-Guidance-and-Publications/Patient-Education-Pamphlets/Files/Cervical-Cancer
National Cervical Cancer Coalition (NCCC) 2019: A Program of the American Sexual Health Association: https://www.nccc-online.org/hpvcervical-cancer/cervical-cancer-overview/