January is cervical health month. Why is this important? Each year around 12,000 women will be diagnosed with cervical cancer and 4,000 will die from it. Cervical cancer is ranked 14th in regards to cancers that kill women. It used to be much higher before the introduction of the Papanicolaou smear or pap smear in the 1980s.
What is the difference between a pelvic exam, an annual or well-woman exam and a pap smear?
A pelvic exam is when the pelvic is examined by use of either a speculum or manually. A speculum is used to view the interior of the vagina or the cervix.
A speculum exam does not mean that a woman is getting a pap smear. A well-woman or annual exam is a yearly exam to review a woman’s health specific to her anatomy, this is where a woman may get an annual breast exam and annual speculum exam if she so desires. It is recommended that women have annual exams every year, but it is a woman’s choice to have breast and vaginal exams each year. It is recommended that women aged 19-39 are offered a breast and pelvic exam every 1-3 years and that women over the age of 40-65 be offered a yearly breast and pelvic exam.
What is a pap smear?
A pap smear is where cells are collected from the cervix during a speculum exam and they are checked under a microscope to look for pre-cancerous or cancerous cells. Pap smear schedules have changed since we started regularly screening in the 80s. Currently, we do not start pap smears until a woman reaches the age of 21 – this is because we have learned that the virus that causes cervical cancer often is cleared by a healthy young immune system. It is suggested that women get a pap smear every three years from the ages of 21-30. After the age of 30, a pap smear when co-tested for the human papilloma virus is recommended every five years.
So what causes cervical cancer?
Certain strains of the human papilloma virus (HPV) cause cervical cancer. Other strains of the virus cause cervical warts.
HPV is a sexually transmitted disease and most (up to 70%) of cervical cancer is caused by the HPV types 16 and 18. These strains of HPV do not cause penile cancer. Is there anything that can be done to prevent cervical cancer? The is a HPV vaccine, called Gardasil, that protects against the HPV types 16 and 18. It does not protect against the other strains that can cause cervical cancer. It is recommended that all children aged 11-12 years get two shots of the HPV vaccine 6 months apart. Those who begin the vaccination series as teenagers will require a third shot.
According to the Centers for Disease Control (CDC), the vaccine can be administered for young women through the age of 26 and young men until age 21. However, last year the Food and Drug Administration (FDA) approved the use of the vaccine for women and men aged 27-45. At the Bogachiel clinic, we can only provide vaccinations that will be covered by the state until age 18. After that age then patients will have to pay out of pocket, go to the Public Health department or Planned Parenthood.
Rachael Adair – ARNP, CNM, PMHNP
National Institute of Health. (2018). Cervical cancer. Retrieved from https://report.nih.gov/nihfactsheets/viewfactsheet.aspx?csid=76.
Centers for Disease Control. (2016). Human Papillomavirus (HPV). Retrieved from https://www.cdc.gov/hpv/parents/whatishpv.html.
Disclaimer: This column is not intended as a diagnosis or recommended treatment of a specific condition. Answers are not a replacement for an individual medical evaluation. Individual health concerns should be evaluated by a licensed clinician.