Conditions - C

Who's at risk of cervical cancer

If you have a cervix and have had any kind of sexual contact, with a man or a woman, you could get cervical cancer. This is because nearly all cervical cancers are caused by infection with high risk types of HPV.

You can get HPV through:

• vaginal, oral or anal sex
• any skin-to-skin contact of the genital area
• sharing sex toys

You're still at risk of cervical cancer if:

• you have had the HPV vaccine – it does not protect you from all types of HPV, so you're still at risk of cervical cancer
• you have only had 1 sexual partner – you can get HPV the first time you're sexually active
• you have had the same partner, or not had sex, for a long time – you can have HPV for a long time without knowing it
• you're a lesbian or bisexual – you're at risk if you have had any sexual contact
• you're a trans man with a cervix
• you have had a partial hysterectomy that did not remove all of your cervix

If you've never had any kind of sexual contact with a man or woman, you may decide not to go for cervical screening when you are invited. But you can still have a test if you want one.

If you're not sure whether to have cervical screening, talk to your GP or nurse.

Cervical screening is a choice

It's your choice if you want to go for cervical screening. But cervical screening is one of the best ways to protect you from cervical cancer.

Risks of cervical screening

You may have some light bleeding or spotting after cervical screening. This should stop within a few hours.

If abnormal cells are found and you need treatment, there are some risks, such as:

• treating cells that may have gone back to normal on their own
• bleeding or an infection
• you may be more likely to have a baby early if you get pregnant in the future – but this is rare

How to opt out

If you do not want to be invited for screening, contact your GP and ask to be taken off their cervical screening list.

You can ask them to put you back on the list at any time if you change your mind.

Prevention

Cervical cancer can often be prevented by having regular screenings to find any precancers and treat them, as well as receiving the HPV vaccine.

The HPV vaccine Gardasil is approved by the U.S. Food and Drug Administration (FDA) for prevention of cervical cancer caused by HPV for people between 9 and 45 years old. Gardasil 9 is available in the United States for preventing infection from HPV16, HPV18, and 5 other types of HPV linked with cancer. There were 2 other vaccines previously available in the United States: Cervarix and the original Gardasil. Both of these are no longer available in the United States. However, these vaccines may be in use outside of the United States.

To help prevent cervical cancer, ASCO recommends that girls receive HPV vaccination. Talk with a health care provider about the appropriate schedule for vaccination because it may vary based on many factors, including age and vaccine availability. Learn more about HPV vaccination and ASCO’s recommendations for preventing cervical cancer.

Additional actions people can take to help prevent cervical cancer include:

• Delaying first sexual intercourse until the late teens or older

• Limiting the number of sex partners

• Practicing safe sex by using condoms and dental dams

• Avoiding sexual intercourse with people who have had many partners

• Avoiding sexual intercourse with people who are obviously infected with genital warts or show other symptoms

• Quitting smoking

Screening information for cervical cancer

Screening is used to look for cancer or abnormalities that may become cancerous before you have any symptoms or signs. Scientists have developed, and continue to develop, tests that can be used to screen a person for specific types of cancer before signs or symptoms appear. The overall goals of cancer screening are to:

• Reduce the number of people who die from the cancer, or completely eliminate deaths from cancer

• Reduce the number of people who develop the cancer

The following tests and procedures may be used to screen for cervical cancer:

1. HPV test. This test is done on a sample of cells removed from the woman’s cervix, the same sample used for the Pap test (see below). This sample is tested for the strains of HPV most commonly linked to cervical cancer. HPV testing may be done by itself or combined with a Pap test. This test may also be done on a sample of cells collected from a woman’s vagina, which she can collect herself.

2. Pap test. The Pap test has been the most common test for early changes in cells that can lead to cervical cancer. This test is also called a Pap smear. A Pap test involves gathering a sample of cells from the cervix. It is often done at the same time as a bimanual pelvic exam as part of a gynecologic checkup. A Pap test may be combined with an HPV test.

3. Visual inspection with acetic acid (VIA). VIA is a screening test that can be done with few tools and the naked eye. During VIA, a dilution of white vinegar is applied to the cervix. The health care provider then looks for abnormalities on the cervix, which will turn white when exposed to vinegar. This screening test is very useful in places where access to medical care is limited.

Screening for cervical cancer can be done during an appointment with a primary care doctor or a gynecologic specialist. In some areas, free or low-cost screening may be available.

Screening recommendations for cervical cancer

Different organizations have looked at the scientific evidence, risks, and benefits of cervical cancer screening. These groups have developed different screening recommendations for women in the United States.

ASCO recommends that all women receive at least 1 HPV test to screen for cervical cancer in their lifetime. Ideally, women 25 to 65 years old should receive an HPV test once every 5 years. Women 65 and older or who had a hysterectomy may stop screening if their HPV test results have been mostly negative over the previous 15 years. Sometimes, women who are 65 and older and who have tested positive for HPV may continue screening until they are 70.

Decisions about screening for cervical cancer are becoming increasingly individualized. Sometimes, screening may differ from the recommendations discussed above because of a variety of factors. Such factors include your personal risk factors and your health history. It’s important to talk with your health care team or a health care professional knowledgeable in cervical cancer screening about how often you should receive screening and which tests are most appropriate.

Here are some questions to ask a health care professional:

• At what age should I start being screened for cervical cancer?

• Should my screening include an HPV test? If so, how often?

• Why are you recommending these specific tests and screening schedule for me?

• At what age could I stop being regularly screened for cervical cancer?

• Do any recommendations change if I have had cervical dysplasia or precancer?

• Do any recommendations change if I have HIV?

• Do any recommendations change if I have had a hysterectomy?

• Do any recommendations change if I am pregnant?

• Do any recommendations change if I have had the HPV vaccine?

• What happens if the screening shows positive or abnormal results?

All women should talk with their doctors about cervical cancer and decide on an appropriate screening schedule. For women at high risk for developing cervical cancer, screening is recommended at an earlier age and more often than for women who have an average risk of cervical cancer.