January 27, 2021
Many women can recall their annual physical with a pap smear, often starting in their teenage years. It was a normal expectation that, at some point, every woman would begin having these exams once a year. As research has developed, medical providers have learned a lot about the causes of cervical cancer and what we can do to help keep women healthy.
Why is cervical health important?
Cervical health is a very important part of a woman's well being. Not only can cervical cancer cause death in some cases, but it can also significantly impact overall health and future pregnancies. The cervix is the organ at the lowest part of the uterus. It is what dilates during labor to allow for vaginal childbirth. For women who plan on getting pregnant, injuries, procedures and cancer cell removal can cause pregnancy loss, early labor or increase the possibility of a cesarean section. Aggressive types of cervical cancer can also require a hysterectomy or even chemotherapy and/or radiation therapy.
Unlike many kinds of cancer, cervical cancer is common in women in their 30s and 40s. In 2017, the latest year of available data from the Centers for Disease Control and Prevention (CDC), 12,000 women were diagnosed with cervical cancer in the United States. The good news is that cervical cancer, when caught early, is often treatable. Even better, it can often be detected early through regular exams, or pap smears. The pap smear screening is a swab of the cervix that determines the skin cells' health and can help identify any irregularities.
What are the guidelines for cervical cancer screening?
Currently, the American Society of Colposcopy and Cervical Pathology (ASCCP) recommends that women start getting pap smears at age 21 and continue to receive the screening every three years unless an abnormality is identified from a screening. Typically, medical providers will complete the basic swab test along with a HPV virus test if abnormal cells are detected. Women 30 and older typically have the screening done every three years; OR, in some instances if the provider orders an HPV virus test regardless whether there are abnormal cells, women may only need the screening every five years. Providers will only recommend five-year interval screening for low-risk women. Women who are considered low-risk can discuss this option with their medical provider. Bottom line: all women should speak to their medical provider to identify the right pap smear frequency for them. Also know that recommended pap smear frequency can change for women over their lifetime, so keeping an open line of communication with your provider is important.
Why encourage less frequent pap smears if cervical health is so important?
We have learned that the HPV virus (Human Papilloma Virus) is the No. 1 cause of cervical cancer. With this understanding, there additional testing options that allow providers to identify if the virus is present and monitor changes. Often, the body can clear the HPV virus and heal the cervix's changes that would otherwise have needed a procedure (i.e., to be cut off or frozen off). By allowing more time for these changes to occur under close monitoring, many women do not need to have a procedure and do not experience any associated risks or discomfort.
Why should all women see their provider annually even if a pap smear isn't needed?
Women should still see their medical provider every year for a women’s health exam, even if they are not due for a pap smear. Primary care providers, midwives and OBGYNs all complete women's health exams. These appointments are essential as providers will complete other portions of an annual exam. Plus, it is an opportunity to have a conversation with your provider to share concerns or get questions answered. Often, providers are alerted to potential health concerns through discussion with the patient or other parts of the exam. Annual women's health appointments can also help reduce the chances that there is a delay in care, treatment or diagnosis. For example, a conversation about frequency and length of periods or other irregular symptoms can alert medical providers to a possible issue.
In a year where many things are uncertain, keeping up with routine cancer screening is more important than ever. Ensuring that you see your provider for preventative care, including cervical cancer screening, can protect women from severe complications from cervical cancer. Early diagnosis can lead to successful prevention or treatment.
Dr. Chelsey Field is a primary care provider at St. Peter's Health.
