Written by Sarah Tyler-Peterson, Certified Nurse Midwife, Western Wisconsin Health

As women, we often cringe as we hear the dreaded words “pap smear”. This appointment has been a part of women’s lives for many years; some may even consider it a rite of passage into womanhood. However, many women do not understand the power behind this simple screening test. As we ring in the new year, we would like to highlight January as being Cervical Cancer Awareness month. So, let’s talk about it… what is cervical cancer; who gets it; and most importantly, how we can prevent it from happening.

Throughout a woman’s lifespan there are many screening tests that can help medical providers find early stages of cancer, cervical cancer being a very important one. As a Certified Nurse Midwife and women’s health provider, I discuss cervical cancer screening with my patients every day. Why? Because it’s a common and life-threatening cancer that rarely has any symptoms. The good news? Cervical cancer is highly preventable, and if found early, can be cured.

What is cervical cancer? Let’s start with anatomy 101. A woman’s cervix is the opening to the uterus, or the womb. The cervix is made up of tissue and cells that are vulnerable to the effects of some human papilloma viruses (HPV). There are many types of HPV, just like there are many types of the common cold virus. Some HPV types are harmless; some lead to genital warts; and some high-risk types can cause cervical cancer. Nearly all people who are sexually active are infected with HPV at some point in their lives. Thankfully, in healthy women, these viruses are typically cleared away by the immune system.  However, if one of the high-risk HPV types is present for a long time, it can lead to changes in the cells of the cervix. A precancerous lesion could develop, and if not removed, may lead to cervical cancer.

Who gets cervical cancer? As women’s health providers, we are always on the lookout for people who have risk factors, or things that increase their chance of developing a certain disease. Cervical cancer risk factors include a weakened immune system, smoking and obesity. Some diseases weaken the immune system, and the body’s ability to clear viruses like HPV. Some medications can also suppress a person’s immune system. Smoking increases a person’s risk of developing cervical cancer, especially if they are heavy smokers who have smoked for many years. If a woman has obesity, cervical cancer screening procedures can be difficult, resulting in lower detection of cancer.

How can we prevent cervical cancer? There are three easy steps to prevent cervical cancer. One: prevention of HPV infection via vaccination. Two: regular cervical cancer screening. Three: follow-up appointments for abnormal tests.

HPV vaccination is a safe and effective way of preventing infection of seven high-risk types of HPV, as well as two types that cause genital warts. The FDA approved vaccination, Gardasil 9, can be given to both boys and girls, ages 9 through 45. The CDC (Centers for Disease Control) recommends vaccination with Gardasil 9 between age 11 and 12. If a child is vaccinated before the age of 15, only two doses are needed. If the vaccine series is started after the age of 15, three doses are needed. People ages 27 to 45 may benefit from the vaccine as well.

Regular cervical cancer screening is the second step in preventing cervical cancer. While vaccination can prevent many of the high-risk HPV types, it does not prevent infection of all the cancer-causing types. Regardless of vaccine status, routine cervical cancer screening is important in the prevention of cervical cancer.

Medical providers have two ways to screen people for cervical cancer. This is done through HPV testing/typing; and cytology (cell test) via a pap smear/test. These samples are taken from the cervix itself. To collect this sample, your provider will use a device that is shaped like a duck bill, which is inserted into the vagina, and gently opened. This allows the provider to see the cervix and collect the sample. Different women have different experiences with this procedure. Most women describe it as a pain-free but slightly uncomfortable test. In people who have experienced a painful pap, or are the survivor of sexual trauma, the appointment can cause significant anxiety. Women should feel empowered to find a provider they trust and explore options for cervical cancer screening.

Screening via a pap test should begin at age 21 and continue through age 65. Some research says the addition of HPV tests should start at age 25, some at age 30. Different organizations recommend different schedules, which can be confusing to women. As a women’s health provider, it’s my job to take the confusion out of these schedules and help women decide what screening test is best for them.

Sometimes these screening tests will return abnormal. Detection of abnormal cells on the pap test, or the presence of a high-risk HPV will trigger these abnormal results. A follow-up appointment will be recommended based on the abnormality. Follow-up can range from repeat testing in 6-12 months, or a procedure called a colposcopy. During a colposcopy, a provider will look closely at the surface of the cervix using a special instrument. If there are abnormalities in the surface, they may take a biopsy, or tissue sample. Based on these results, additional procedures may be needed to remove any precancerous or cancerous areas.

Let’s use the power of prevention by talking with a healthcare provider about HPV vaccination and cervical cancer screening. For more information about Cervical Cancer, visit the National Cancer Institute’s website at www.cancer.gov.

Works Cited “What Is Cervical Cancer?” NCI, 15 June 2023, www.cancer.gov/types/cervical. Accessed 24 Dec. 2024.