If you are a female, this is likely the first time you have thought about your cervix this week, and you may not even really know what a cervix is. The cervix is the lower part of the uterus that protrudes into the vaginal canal and measures only around one inch in all three dimensions. It’s hard to believe such a small part of your anatomy could significantly impact your health, but it can. According to the Centers for Disease Control and Prevention (CDC), 4,152 women in the United States died of cervical cancer in 2019. The good news is that there are resources to prevent cervical cancer. These prevention methods are typically divided into three categories: primary, secondary and tertiary.
Primary prevention involves intervening before a disease occurs and is the best method of prevention. For cervical cancer, primary prevention comes in the form of vaccination against the human papillomavirus (HPV). The World Health Organization (WHO) states that over 95% of cervical cancer is caused by HPV; therefore, almost all cases of cervical cancer could be prevented by vaccination against HPV. Gardasil 9 vaccine is distributed in the United States and, as the name suggests, protects against nine types of HPV. It is best to get vaccinated for HPV before the onset of sexual activity because HPV is transmitted through intimate skin-to-skin contact. The CDC recommends everyone get vaccinated for HPV at 11-12 years old, but it is safe to get the vaccine from age 9 through 45 years. People under 15 years old need two doses of the vaccine six to 12 months apart, whereas those 15 years old or older need three doses of the vaccine. If you have not been vaccinated for HPV, talk to your health-care provider as soon as possible.
Secondary prevention involves screening to identify disease early in its course. Individuals vaccinated against HPV should still undergo screening for cervical cancer because the current vaccine does not cover every strain of high-risk HPV. The (in)famous Papanicolaou (pap) smear is used to screen for cervical cancer and usually involves brushing the cervix to collect cells. Cervical cytology is the term for studying these cervical cells on the microscopic level to determine if they are precancerous or cancerous. The United States Preventive Services Task Force recommends screening for cervical cancer every three years with only cervical cytology in women aged 21 through 29. Women older than 30 years can be screened with either only cervical cytology every three years, only high-risk HPV testing every five years, or both cervical cytology and high-risk HPV testing every five years, which is referred to as co-testing. Women over 65 years do not require cervical cancer screening if they have had adequate prior screening with normal results. You may be wondering why HPV testing is not recommended in people less than 30 years old if most cervical cancer is caused by HPV. Younger individuals may clear the virus on their own, so HPV testing in that population can lead to unnecessary procedures and their associated risks.
An abnormal screening test may warrant earlier repeat screenings or a procedure called colposcopy. During a colposcopy, a trained health-care provider applies acetic acid or strong iodine solution to the cervix and then looks for abnormalities with a microscope.
The provider may take biopsies of the cervix to obtain a bigger sample for finding precancerous or cancerous cells. Depending on the specific findings, precancerous cells may be observed or treated. Treatment may include freezing, laser vaporizing or excising the cells.
Tertiary prevention involves managing a disease to slow or stop its progression. Some people with cervical cancer will experience no symptoms, which emphasizes the importance of screening for the disease. Early-stage cervical cancer can cause watery and/or bloodtinged vaginal discharge. Another common symptom of cervical cancer is vaginal bleeding after sexual intercourse. An individual diagnosed with cervical cancer should be referred to a gynecologiconcologist, which is a physician who has special training in treating cancers of the female reproductive tract. Physical examination of the cervix can often be normal, so radiologic imaging is used to help determine the stage of the disease. Treatment of cervical cancer may include surgery, radiation and/or chemotherapy.
Hopefully, you are now motivated to start thinking about your cervical health. Getting vaccinated for HPV before exposure to the virus is the best way to prevent cervical cancer. Remember, screening for cervical cancer is still recommended since the vaccine does not protect against every type of high-risk HPV. Abnormal screening results may lead to an altered screening schedule, additional procedures or treatment. Cervical cancer is treated with surgery, radiation and/or chemotherapy, depending on the stage of the disease. Do not delay talking to your health-care provider if you are unsure whether you are up to date on your immunizations and health screenings.
Maira Qayyum, MD is an assistant clinical professor of obstetrics and gynecology at LSU Health Shreveport.