January has been designated as Cervical Cancer Awareness Month to raise awareness of the importance of early detection and treatment. In 2005, over 10,000 women in the U.S. found out they had cervical cancer. Over 3,900 women die from cervical cancer each year. However rates of advanced cervical cancer have gone down. The ability to detect cervical cancer early—before it causes symptoms—is one of the great success stories in women’s health. Since the introduction of the screening test known as the Pap smear in the 1950s, the death rate for cervical cancer has declined by 70 percent. Health care professionals now know that virtually all cases of cervical cancer can be traced to infection with the human papillomavirus, or HPV, which spreads through sexual contact. This is largely due to more women being screened and treated earlier. A Pap test is one of the most effective ways to detect cervical cancer. Here’s what you need to know:

Why is a Pap test so important?

Cervical cancer is one of the most treatable kinds of cancer. Women who have cervical cancer may not have any symptoms. Cervical cancer can be found early by regular Pap tests. If detected early, many deaths from cervical cancer can be prevented through proper treatment.

When should I have a Pap test?

The American Cancer Society Screening Guidelines for Cervical Cancer are as follows:

• Screening should begin about three years after a woman begins having intercourse, but no later than age 21.
  
  
• Women should have a regular Pap test every year OR a liquid-based Pap test every two or three years. At or after age 30, women who have had three normal test results in a row may get screened every two to three years. A health care professional may suggest getting more frequent testing if a woman has certain risk factors such as human immunodeficiency virus (HIV) infection or a weakened immune system.
  
  
• The combination of HPV testing with a Pap test should be considered as an alternative for routine screening in women age 30 and older.
  
  
• Women age 70 and older who have had three or more normal Pap test results and no abnormal results in the last 10 years may stop screening.
  
  
• Screening after a total hysterectomy (with removal of the cervix) is not necessary unless the surgery was done as a treatment for cervical cancer or pre-cancer. Women who have had a hysterectomy without removal of the cervix should continue cervical cancer screening at least until age 70.

What happens during a cervical cancer screening?
A Pap test is a test that checks the cells of the cervix. It can identify both cancer and abnormal cells that could lead to cancer. Your doctor will collect some cells from the cervix using a cotton swab. The cells will then be sent to a lab to be analyzed. 

Are you at risk?
Factors that put you at higher risk include:

• Have/had human papillomavirus (HPV) also known as genital warts
  
• Sexual intercourse at an early age and/or many sexual partners
  
• Had/have a sexually transmitted disease
  
• Smoking

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What are the symptoms of cervical cancer?

• Precancerous changes and early cancers of the cervix generally do not cause pain or other symptoms; therefore, it is important to get regular Pap screenings to detect cervical pre-cancers or cancers at a stage when they can be treated most effectively.
• As the disease progresses, women may notice one or more of the following symptoms:
  • Abnormal vaginal bleeding: - Bleeding that occurs between regular menstrual periods - Bleeding after sexual intercourse, douching or a pelvic exam - Menstrual periods that last longer and are heavier than before - Bleeding after menopause
  • Increased vaginal discharge
  • Pelvic pain
  • Pain during sexual intercourse

How are cervical cancer and pre-cancer treated?
There are a number of treatment options available for cancerous and pre-cancerous cervical lesions. In each case, a woman and her healthcare provider determine the most appropriate treatment.

• Pre-invasive stage (Stage 0 – Carcinoma in Situ) - When the cancer has affected only the outer layer of the lining of the cervix, treatment may include:
  • Laser surgery: uses a laser beam to destroy abnormal cells.
  • Cryosurgery: destroys cancerous and pre-cancerous lesions by freezing them.
  • Loop electrosurgical excision procedure (LEEP): uses a thin wire loop (through which an electrical current is passed) to cut away an area of abnormal cells from the cervix.
  • Conization: surgically removes a cone-shaped piece of tissue from the cervix.
    
    
• Invasive stage (Stages 1-4 )- When the cancer has penetrated into the cervix and possibly to other tissues and organs, treatment may include:
  • Radiation: uses high-energy rays to shrink tumors by destroying the cancer cells’ ability to reproduce.
  • Chemotherapy: uses anticancer drugs which reach all areas of the body to kill cancer cells, including those that have spread to distant organs.
  • Hysterectomy: can be performed two ways, depending on the extent of the cancer:
    • 1) Simple hysterectomy is the removal of the cancer, the cervix and the uterus.
    • 2) Radical hysterectomy involves the removal of the cervix, the uterus, part of the vagina and lymph nodes in the area. How can cervical cancer be prevented?

Cervical cancer can usually be prevented if women are screened regularly with Pap tests. Women should talk to their healthcare providers about having regular Pap screening tests and discuss results with them.