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Most women who have abnormal cervical cell changes that
progress to cervical cancer have never had a Pap test or have not had
one in the previous three to five years. Cancer of the cervix tends to
occur during midlife. Half of the women diagnosed with the disease are
between 35 and 55 years of age. It rarely affects women under age 20,
and approximately 20 percent of diagnoses are made in women older than
65. For this reason, it is important for women to continue cervical
cancer screening until at least the age of 70.
The cervix is the narrow opening into the uterus from the vagina. The
normal “ectocervix” (the portion of the uterus extending into the
vagina) is a healthy pink color and is covered with flat, thin cells
called squamous cells. The “endocervix” or cervical canal is made up of
another kind of cell called columnar cells. The area where these cells
meet is called the “transformation zone” (T-zone) and is the most likely
location for abnormal or precancerous cells to develop.
Most cervical cancers (80 to 90 percent) are squamous
cell cancers. Adenocarcinoma is the second most common type of cervical
cancer, accounting for the remaining 10 to 20 percent of cases.
Adenocarcinoma develops from the glands that produce mucus in the
endocervix. While less common than squamous cell carcinoma, the
incidence of adenocarcinoma is on the rise, particularly in younger
women.
Causes of Cervical Cancer
Human Papillomavirus (HPV) is found in about 99% of cervical cancers.
There are over 100 different types of HPV, the majority of which are
considered Low Risk and do not cause cervical cancer. High Risk HPV
types may cause cervical cell abnormalities or cancer. More than 70
percent of cervical cancer cases can be attributed to two types of the
virus, HPV-16 and HPV-18, often referred to as High Risk HPV Types.
HPV is estimated to be the most common sexually transmitted infection in
the United States. In fact, by age 50 approximately 80% of women have
been infected with some type of HPV. The majority of women infected with
the HPV virus do NOT develop cervical cancer. For most women the HPV
infection is transient and 90% of infections resolve spontaneously
within 2 years. A small proportion of women do not clear the HPV virus
and are considered to have persistent infection. A woman with a
persistent HPV infection is at greater risk of developing cervical cell
abnormalities and cancer than a woman whose infection resolves on its
own.
Signs and Symptoms of
Cervical Cancer
Precancerous cervical cell changes and early cancers of the cervix
generally do not cause symptoms. Abnormal or irregular vaginal bleeding,
pain during sex, or vaginal discharge may be symptoms of more advanced
disease.
Notify your healthcare provider if you experience: Abnormal bleeding,
such as,
- Bleeding between regular menstrual periods
- Bleeding after sexual intercourse
- Bleeding after douching
- Bleeding after a pelvic exam
- Pelvic pain not related to your menstrual cycle
- Heavy or unusual discharge that may be watery,
thick, and possibly have a foul odor
- Increased urinary frequency
- Pain during urination
Detecting Cervical Cancer
The best way to determine if precancerous or cancerous cells are present
is with a Pap test. The Pap test can determine if cell changes have
taken place that may indicate precancerous or cancerous development.
(See Pap Testing for more information). In addition to a Pap test, your
doctor may recommend an HPV test. The HPV test does not indicate the
presence of precancerous or cancerous cells. It determines whether or
not a woman has an HPV infection with any of the 13 high-risk HPV types.
The test cannot tell you whether your infection is new or if it is
persistent. This information will assist you and your doctor to
determine appropriate follow-up and intervals for cervical cancer
screening. (See HPV Testing for more information).
Protecting Myself from
Cervical Cancer
Cervical cancer is one of the most preventable cancers today. If caught
early, the 5-year survival rate is almost 100%. Regular Pap testing is
the best method to protect against invasive cervical cancer. It is most
important to remember that cervical cancer takes many years to develop.
Regular Pap tests will help detect any precancerous or abnormal cells
early enough so that cervical cancer can be prevented.
In addition to routine Pap testing, you may want to consider minimizing
risk factors that could contribute to cervical cancer. Those factors
include:
- Multiple sexual partners
- Multiple full-term pregnancies
- Sexual intercourse at an early age
- Chlamydia infection
- Cigarette smoking
- Use of oral contraceptives
- Weakened immune system or HIV infection
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