About 9,700 women in the United States will be diagnosed with cervical cancer this year. It may seem like a small number, until you consider that another 1.2 million women will develop a pre-cancerous condition called dysplasia. And if left untreated, dysplasia will become cervical cancer.
"Because of Pap smears, a huge number of women are no longer dying of cervical cancer in this country, but this is a disease that can be almost entirely prevented," says Carolyn Johnston, M.D., clinical associate professor of obstetrics and gynecology at the University of Michigan Medical School and a gynecologic oncologist at the U-M Comprehensive Cancer Center.
In addition to early detection through screening, a new vaccine now available could help prevent cervical cancer. In honor of Cervical Cancer Awareness Month, which is January, U-M experts respond to common myths and misconceptions about this disease.
Myth 1: Cervical cancer cannot be prevented.
Truth: Infection with the human papillomavirus, or HPV, is an absolute requirement for cervical cancer to develop. This virus is transmitted sexually, but the majority of the most worrisome types of infection can be prevented with a newly available vaccine. Preventing HPV infection dramatically reduces a woman's risk of cervical cancer. In addition, cervical cancer usually develops slowly after persistent infection with HPV and will first appear as a precancerous condition called dysplasia. If detected at this stage, it can be effectively treated to prevent cervical cancer from developing. Screening with Pap smears and tests for HPV detect these pre-cancerous conditions so patients are treated early.
Behavioral issues can also influence cervical cancer. "A woman can reduce her risk of these problems by limiting the number of sexual partners over a lifetime, by not smoking cigarettes and by following accepted screening guidelines. Each of these behaviors relates to known risk factors for this disease," says Anthony Opipari, M.D., Ph.D., associate professor of obstetrics and gynecology at the U-M Medical School.
Myth 2: I'm too young to worry about cervical cancer.
Truth: The average age of cervical cancer patients is 48. While it's not common, women can be diagnosed in their 20s. HPV infection and the precancerous condition dysplasia are common in younger women.
Myth 3: I don't have intercourse, so I don't need the HPV vaccine.
Truth: HPV can be passed from one partner to another through intercourse, as well as orally and through touching. In 2006, the Food and Drug Administration approved a vaccine, Gardasil, to protect against four types of HPV, two of which are commonly linked to cervical cancer and two linked to genital warts. A CDC advisory committee recommended that Gardasil be given routinely to girls age 11-13. Until everyone is vaccinated, girls and women ages 13-26 are also candidates for the vaccine. Experts believe the vaccine should be given at a young age before a woman becomes sexually active.
Myth 4: I had the HPV vaccine, so I don't need to use condoms during sex.
Truth: The HPV vaccine will protect you from infection with four types of HPV - but there are other strains of this virus and many other sexually transmitted diseases that it does not protect against. Continue using condoms to protect against STDs.
Myth 5: I don't need a Pap test.
Truth: A woman's first Pap test should be given when she turns 21 or three years after she begins having intercourse, whichever comes first. Recommendations differ for how often a woman should receive a Pap test. Ask your doctor how often you should be screened. Even if you have the HPV vaccine, you still need a regular Pap test. The vaccine targets four types of HPV but it will not protect against all the types of HPV that can cause cervical cancer, so it's still important to continue regular screenings.
Myth 6: I'm too old to need a Pap test any longer.
Truth: "We have seen an increase in cervical cancer and HIV in older populations," says Lauren Zoschnick, M.D., clinical assistant professor of obstetrics and gynecology at the U-M Medical School. "Women can have new sexual partners, which puts them at risk of cervical cancer and other STDs." Talk to your health care provider about the need to have Pap smears even if you have gone through menopause, have had a hysterectomy, or are over the age of 65.
Myth 7: My doctor gave me a pelvic exam, which is the same as a Pap test.
Truth: The Pap test collects cells from the cervix, which are sent to a lab to be evaluated. In a pelvic exam, your doctor physically examines the cervix and other parts of a woman's anatomy. Both are important to detect problems early.
Myth 8: My Pap test was abnormal, which means I must have cancer.
Truth: Not necessarily. You'll likely need follow-up tests, possibly a test for HPV, colposcopy or a biopsy to test for cancerous cells. An abnormal Pap test could indicate a precancerous condition that can be treated. Conversely, a negative Pap test does not always mean a woman is cancer-free. About 10 percent of all Pap tests return a false negative result, meaning the test did not identify a problem that is there. If you have problems such as bleeding or pain, seek further care even if your last Pap test was normal.
Myth 9: Cervical cancer has no symptoms.
Truth: Bleeding after intercourse, bleeding between menstrual periods or bleeding after menopause may indicate cervical cancer. Other symptoms include an abnormal discharge or pain in the pelvic region.
Myth 10: If I am diagnosed with cervical cancer, I am going to die.
Truth: Survival after cervical cancer caught in its earliest stage is 92 percent. The later it is diagnosed, the lower the chance of survival. Survival is lower in developing countries because of inadequate screening. Regular screening will help ensure cervical cancer is caught at an early, treatable stage.
Myth 11: After I finish treatment, I will live the rest of my life worried about cancer returning.
Truth: If cervical cancer is going to recur, it is most likely to happen in the first two years after treatment. Most patients are followed for five years, after which the risk of recurrence is extremely low.
Myth 12: I must have a hysterectomy to treat cervical cancer.
Truth: Early cervical cancer is typically treated with a hysterectomy, surgery that removes the cervix and uterus. But it's not the only option. Radiation and chemotherapy are used to treat more advanced disease and may also be options for women with early stage disease who cannot have surgery. Some women with early cervical cancer can also avoid hysterectomy with procedures such as a cone biopsy that removes only the cancerous tissue and a small margin of surrounding healthy tissue, or a procedure called radical trachelectomy, which removes the cervix but not the uterus.
Myth 13: I won't be able to conceive a child after cervical cancer treatment.
Truth: If you have a hysterectomy or radiation to treat cervical cancer, you will not be able to conceive. But newer surgical procedures help preserve a woman's fertility without compromising survival. A radical trachelectomy removes the cervix but not the uterus so that a woman can still conceive. For small, early cancers, a cone biopsy may be appropriate and will also preserve fertility.
Myth 14: A hysterectomy to treat cervical cancer will put me in menopause afterward.
Truth: Hysterectomy to treat cervical cancer does not remove the ovaries, which are what determines whether a person is menopausal. Cervical cancer very rarely spreads to the ovaries. Women who receive pelvic radiation to treat cervical cancer will likely experience menopause because the radiation will affect the ovaries.
Myth 15: Taking hormone replacement therapy will increase my risk of cervical cancer.
Truth: Cervical cancer does not respond to hormones like breast or ovarian cancers. Low doses of hormone replacement therapy can treat menopausal symptoms without increasing the risk of cervical cancer.
For more information about cervical cancer and the HPV vaccine, visit the following resources:
- U-M Cancer Center: www.mcancer.org
- U-M Cancer AnswerLine: 800-865-1125
- Michigan Cancer Consortium: www.michigancancer.org/
- National Cancer Institute: www.cancer.gov
- HPV Questions and Answers: www.cdc.gov/std/hpv/STDFact-HPV-vaccine.htm
Written by Nicole Fawcett