January is Cervical Health Awareness Month

January is Cervical Health Awareness Month. If you have questions about cervical health, cancer, or women's health in general, don't be shy! We can answer them.

Dr. Lacy Parker, an INTEGRIS OBGYN at Lakeside Women's Hospital, is our guest doctor for this month's Ask The Doctor series. Submit your questions until January 22 and at the end of January Dr. Parker will answer them on I On Your Health. In the meantime, here are some cervical cancer stats.

• More than 12,000 women in the U.S. will get diagnosed with invasive cervical cancer.
• About 4,000 women in the U.S. will die of cervical cancer.
• Nearly all women with cervical cancer have been infected with the human papillomavirus (HPV). HPV is the virus that causes genital warts.
• At least half of all sexually active men and women will develop HPV at some point in their lives, but the risk of developing cancer is small.

In the U.S., the number of women being diagnosed with invasive cervical cancer is very low compared to other cancer types, and continues to trend down every year. This is almost completely due to the widespread use of Pap tests, which identify abnormal cells in the lining of the cervix before they turn cancerous. Cervical cancer is highly treatable when diagnosed at this early stage. So here is the takeaway: if you are between the ages of 21 and 65, get your Pap test! 

Frequently Asked Questions About Cervical Cancer

Q: What is cancer of the cervix?

A: Cervical cancer is cancer that starts in the cells of the cervix — the opening to the uterus or womb. Since the Pap test became a routine test for women in the United States, cervical cancer is not as much of a major health problem here. However, in many developing countries where the Pap test is not a routine test, this form of cancer is very common.

Q: What is the cervix?

A: The cervix connects the vagina to the uterus. The uterus is the female reproductive organ that holds a baby during pregnancy.

The cervix connects the uterus and the vagina. The vagina leads to the outside of the body. Both the uterus and the cervix are located in the pelvis. They are in close contact with other pelvic organs, like the ovaries, upper part of the vagina, bladder, and rectum.

Q: Who gets cervical cancer?

A: Any woman can get cervical cancer, but in the U.S. it happens more often in Hispanic and African-American women. Most cases are found in women younger than 50 years old. But it rarely develops in women younger than 20.

Q: Who is at risk for cervical cancer?

A: Certain risk factors can increase a woman's risk of cervical cancer.

• HPV infection. Some of the human papillomaviruses (HPV) put women at higher risk for cervical cancer. These viruses can be transmitted by sexual contact. Persistent HPV infection is the major risk factor for cervical cancer.
• Smoking. A woman who smokes has a higher chance of getting cervical cancer.
• Weakened immune systems. Women who have the HIV virus, which causes AIDS, and those who have weakened immune systems for other reasons (like a recent organ transplant or exposure to certain medicines) are at greater risk of getting cervical cancer. This is because conditions that affect the immune system make it harder for the body to deal with HPV infection.
• Chlamydia infection. This is a sexually-transmitted bacterial infection that has been linked to an increased risk for cervical cancer.
• Diet. A diet low in fruits and vegetables may increase the risk for cervical cancer.
• Oral contraceptives. A woman who has taken oral contraceptives for a long time may have a higher risk.
• Many pregnancies. A woman who has had many full-term pregnancies may be at greater risk.
• DES. If a woman's mother took the drug diethylstilbestrol (DES) when she was pregnant, the woman has a greater chance of getting cervical cancer.
• Socioeconomic status. Many women with low incomes don't have access to good health care. This may prevent regular screenings and increase their risk of cervical cancer.
• Sexual history. A higher number of sexual partners and first intercourse at an early age are associated with an increased risk for cervical cancer.

Q: What can a woman do to decrease her risk of getting cervical cancer?

A: Regular Pap tests are very important in finding cervical changes early, when they can be more easily treated. These are things women can do to decrease their risk:

• Talk with a healthcare provider about when to go for checkups. It is generally recommended for women who are age 21 and older to have regular cervical cancer screening tests.
• Quit smoking.
• Eat a well-balanced diet rich in fruits and vegetables.
• Avoid intercourse at a young age.
• Discuss the HPV vaccine with your healthcare provider. (Generally, girls and young women between the ages of 9 and 26 are eligible for the vaccine.)
• Use condoms during intercourse.
• Limit the number of sexual partners.

Q: What is the Pap test?

A: The Pap test is a very simple and important test. The healthcare provider uses the Pap test to see if there are any changes in the cervix. The best time for a woman to have a Pap test is at least 5 days after her period. A Pap test can be done in a healthcare provider's office or a health clinic. The healthcare provider or nurse practitioner uses a tool called a speculum to hold the vagina open to see the upper part of the vagina and the cervix. Then, a small brush is used to get some cells from the cervix and vagina. These cells are placed on a glass slide or in a solution and sent to a laboratory to be looked at under a microscope to check for abnormal cells.

Q: Who should get Pap tests and how often?

A: According to the American Cancer Society, all women at average risk for cervical cancer should have Pap tests starting at age 21. Women between ages 21 and 29 should have a Pap test every three years. Women between the ages of 30 and 65 should have a Pap test plus an HPV test (called co-testing) every five years. It is also acceptable to continue to have Pap tests alone every three years. Women at increased risk for cervical cancer may need screenings more often and should discuss their risk factors with their healthcare provider.

Q: What are the symptoms of cervical cancer?

A: Women with precancerous lesions in the cervix usually have no symptoms. That is why it is important to have Pap tests. A woman usually does not have any symptoms until the cells turn into cancer and invade the deepest parts of the cervix or other pelvic organs. These are common symptoms in women with fully developed cervical cancer:

• Vaginal discharge
• Abnormal vaginal bleeding
• Pelvic pain
• Pain during vaginal sex

These symptoms may be caused by cancer or by other health problems. It is important for a woman to see her healthcare provider if she is having any of these symptoms.

Q: How is cervical cancer diagnosed?

A: The healthcare provider asks questions about the woman's medical history and family history. The healthcare provider will also do a pelvic exam and Pap test (with or without an HPV test). If something suspicious is found, other tests can help determine if the woman has cervical cancer. It is very important to know the extent of the cancer — how deeply it has invaded tissues. The treatment can be quite different depending on whether or not the cancer has already spread.

One or more of these tests may be ordered to help make a diagnosis:

• HPV test
• Colposcopy
• Biopsy

Q: What are the treatments for cervical cancer?

A: Treatment for cervical cancer often involves surgery, especially for cancers that have not spread far. Surgery is used to remove as much cancer as possible. Another type of local treatment used for cervical cancer is high-energy X-rays known as radiation therapy.

Q: What check-ups should a woman have after treatment for cervical cancer?

A: In the first year after treatment, most women are advised to see their healthcare providers every three to four months. Your healthcare provider can perform Pap tests as needed. Also, women may have chest X-rays and computed tomography (CT scans) at the end of the first year. Until the fifth year, women may have checkups every six months. After five years, a woman will most likely go back to routine checkups.