Cervical Cancer Prevention

The Pap test can detect HPV and precancerous abnormal changes in the cervix. Treating these problems can stop cervical cancer before it has a chance to fully develop.

A Pap test involves the removal of a small sample of cells from the cervix. These cells are transferred to a slide and later examined under a microscope to check for abnormal cells. Most women who have Pap tests on a regular basis and are found to have abnormal cells can usually be successfully treated.

Both the Cancer Research Foundation of America and the American Cancer Society recommend that women have yearly Pap tests starting at age 18, or when they begin having sex, whichever comes first.

After a woman has had three normal tests in a row, her physician may advise her that the test can be done less frequently. Even women who have had their uterus removed and those who have reached menopause still need to have regular Pap tests.

Although the Pap test is the best method for preventing cervical cancer, the Pap test is still not perfect. Some changes in cells can be missed, or cells that appear abnormal can be merely inflamed. Additional testing may be needed.

In the United States, the incidence of invasive cervical cancer has steadily decreased over the last several decades due to the early detection and treatment of pre-invasive disease.

In 2002, there were approximately 12,800 new cases of invasive cervical carcinoma, and despite the fact that this disease is largely preventable, 4,600 U.S. women died.

Data derived from the Surveillance, Epidemiology, and End Results (SEER) database (1992 through 1996) indicate that population-based cervical cancer mortality rates in the United States declined by 2.1% per year.

Despite the widespread availability of cervical cytologic screening in the United States, approximately 20-30% of adult women no longer continue to undergo routine pelvic examinations and cytological screening [Papanicolaou (PAP) smears] after completion of childbearing.

About half of cervical carcinomas develop after suboptimal screening, and another 25% are diagnosed following incorrect interpretation of an antecedent PAP smear. Thus, up to 30% of cases, particularly adenocarcinomas, develop despite good preventive surveillance.

Adenocarcinomas usually develop within the endocervical canal, and because adenocarcinoma incidence rates relative to squamous cell carcinomas are increasing, it is possible that routine cervical cytological screening is less effective at detecting adenocarcinoma precursor and early invasive adenocarcinomas.

A recent analysis of U.S. trends (SEER 1973-1998) indicated a 32.4% (1.63% per year) and 32.9% (1.57% per year) increase in incidence of adenocarcinoma and adenosquamous cell carcinoma, respectively.

     Frequency of screening         % reduction in cumulative

(in women aged 35-64)            cervical cancer rate

1 year                                    93.5
2 years                                   92.5
3 years                                   90.8
5 years                                   83.6
10 years                                  64.1

Preventing infection with HPV also will prevent cervical cancer. This primary prevention approach presents greater challenges than prevention of most other sexually transmitted diseases (STDs), however: HPV is easily transmitted, the treatment currently available is ineffective and the virus can remain infectious in an individual for years.

Also, HPV infection can occur throughout most of the anogenital area, including areas not covered by male condoms, and it can be transmitted from mother to child during childbirth.

The standard recommendations for STD prevention--regularly using condoms or other barrier methods, or engaging in mutually monogamous sexual relationships--will help some women avoid HPV infection, but the degree to which they will affect the overall incidence of cervical cancer is unclear.

Last updated Nov 26/06