Well-Woman Care: Cervical Cancer Screenings & Beyond

In 2016, nearly 13,000 new cases of cervical cancer were reported by the Centers for Disease Control and Prevention (CDC)—and more than 4,000 women died of cervical cancer in the U.S. That same year in Maryland, 215 new cases were reported.

Thanks to advanced vaccination and screening options, including pap tests, cervical cancer is one of few diseases that’s highly preventable and treatable. This Cervical Health Awareness Month, educate yourself and your female loved ones in well-woman care, a meaningful way to help you stay healthy and prevent cervical cancers and more.

Did You Know All Women Are at Risk for Cervical Cancer?

Cervical cancer starts in the cells lining the cervix or the lower part of the uterus. Typically, normal or healthy cells will gradually develop pre-cancerous changes that evolve into cancer. These changes can be detected during a pap screening. If abnormal cells are found, they can be treated to prevent cancer from developing.

Only some women with pre-cancerous cells will actually develop cancer, but all women are at risk. For most women, pre-cancerous cells will go away without any treatment. For others, these cells turn into true (or invasive) cancers. Women with early cervical cancers and pre-cancers often show no symptoms—that’s why it’s so important to have regular screenings by your healthcare provider.

While most women have no symptoms, several risk factors could increase your chance of developing cervical cancer:

• Being overweight
• Being younger than 17 at your first full-term pregnancy
• Chlamydia infection
• Diet low in fruits and vegetables
• Diethylstilbestrol (DES)
• Family history of cervical cancer
• Having a weakened or suppressed immune system
• Having multiple full-term pregnancies
• HPV infection
• Intrauterine device (IUD) usage
• Low-income status, or lack of access to adequate healthcare services
• Smoking

Most women do not experience symptoms until a pre-cancer becomes a real invasive cancer and spreads to other tissues. Those symptoms may include:

• Abnormal vaginal bleeding or discharge
• Painful intercourse

While these symptoms do not always indicate cervical cancer, you should consult your primary care provider immediately if you’re experiencing them. Otherwise, begin regular screenings as recommended to monitor your cervical health.

Cancer-Related Screening Guidelines for Women by Age

Early screening offers the best chance of finding and treating cervical cancer and human papillomavirus (HPV), which can lead to cervical cancer. The sooner you’re screened, the earlier abnormal changes can be detected and treated before they turn into cancer.

Regardless of where you are in life, all women should take control of their health and embrace a healthier lifestyle, including annual cancer-related screenings and immunizations. The following are guidelines for women only, including screenings that can detect other forms of cancer popular with women, including skin cancer. Always talk to your healthcare provider to personalize the timing of each recommended test.

In your teens:

• Discuss beginning checkups with pelvic exams and gynecological visits with your healthcare provider and parent or guardian.
• Consider an immunization for HPV at least once between the ages of 9-26. HPV is a common virus especially devastating to women because it causes nearly all cervical cancers. The vaccine provides a safe, effective, and long-lasting protection against certain types of cancer, including cervical cancer, later in life. Unfortunately, there’s no way to prevent HPV infection. But you can take action to lower your chances. Consider the HPV vaccine, use condoms during sexual activity, and limit your number of sexual partners. And, most importantly, get tested. The pap screening looks for changes in cervical cells caused by HPV infection, while the HPV test looks for the infection itself.
• Don’t smoke. Keep active and maintain a healthy weight. These apply to women of all ages.

In your 20s:

• Schedule a mole exam every 3 years with your healthcare provider and complete a monthly self-exam to check for signs of skin cancer.
• Get a cervical cancer screening (pap) every 3 years starting at age 21 and HPV immunization once between the ages of 9-26.

In your 30s:

• Start thyroid testing (TSH) at age 35, then every 5 years.
• Get a cervical cancer screening (pap) every 3 years or every 5 years with HPV testing.

In your 40s:

• Schedule a thyroid test every 5 years.
• Mammograms should occur every 2 years.
• Cervical cancer screening (pap) is recommended every 3 years or every 5 years with HPV testing.

In your 50s:

• Get a thyroid test every 5 years.
• Schedule a mammogram every 1-2 years. Discuss with your primary care provider.
• Begin colorectal cancer screenings:
  • Fecal occult blood test annually
  • Flexible sigmoidoscopy every 5 years; OR double-contrast barium enema every 5-10 years; OR colonoscopy every 10 years
  • Rectal exam every 5-10 years with each screening
• Cervical cancer screening (pap) should happen every 3 years or every 5 years with HPV testing.
• Heart disease is the #1 killer of women ages 50 and older. The most common symptom for both men and women is chest pain, but women tend to have many other less common symptoms, including nausea, cold sweats or chills, and shortness of breath. Call 911 immediately if you’re experiencing any of these symptoms.

In your 60s+:

• Schedule a thyroid test every 5 years.
• Get a mole exam every year by a healthcare provider, plus a monthly self-exam.
• Get a mammogram every 1-2 years.
• Continue colorectal cancer screenings:
  • Fecal occult blood test annually
  • Flexible sigmoidoscopy every 5 years; OR double-contrast barium enema every 5-10 years; OR colonoscopy every 10 years
  • Rectal exam every 5-10 years with each screening
• Schedule a cervical cancer screening (pap) every 3 years, or every 5 years with HPV testing until age 65.

Know Your Prevention & Treatment Options

The best way to prevent cervical cancer is with a screening to find pre-cancerous cells before they become invasive. The second is to prevent pre-cancerous cells before they begin. This includes making healthier lifestyle choices—these serve as your first line of defense against cancer. We recommend:

• Saying no to smoking and tobacco use.
• Keeping your skin safe from sun damage and ultraviolet light exposure.
• Maintaining a healthy diet.
• Getting active.
• Getting scheduled screenings and vaccinations.
• To lower your risk of exposure to HPV, consider limiting your number of sexual partners and avoiding sex with people who have had many other sexual partners.
• Always using condoms to protect against HPV.

Once worrisome cells have advanced to true invasive cancer, an oncology care provider will determine the best options for treatment depending on the stage of the disease. In addition to the stage, your provider may also consider other factors like your age, general health, lifestyle, and personal preferences. For example, cervical cancer can affect your ability to have children, so younger women diagnosed with cancer may prefer considers these factors if they want kids later in life.

The most common forms of treatment include:

• Chemotherapy
• Radiation therapy
• Surgery
• Targeted therapy

For earlier stages of cervical cancer, surgery or radiation plus chemotherapy may be used. For cases at later stages, radiation plus chemotherapy is the primary treatment. Chemotherapy alone is often used to treat advanced cancers. Our expert team of cancer specialists will always help you make the best decisions for your needs.

Take Action to Prevent Cancer: Schedule a Well-Woman Exam

Between the ages of 18 and 21, women should start to receive an annual well-woman exam. For females of all ages, a well-woman exam is one of the most important steps they can take to protect their overall health and well-being, which includes cancer prevention. A well-woman exam takes all health factors—from preventive to reproductive health—into consideration. Frederick Health sees to it that every woman receives the screenings and services she needs to remain in the best health possible.

These services are available at all locations:

• Physical exam
• Routine breast exam
• Mammogram (depending on age)
• Contraceptive discussions
• Vaccinations, screenings, and other preventive services, as needed
• Long-acting reversible contraception (LARC), available at Frederick Health Medical Group only
• Routine pelvic exams
• Pap smear (depending on age)
• Education and health consultations
• And more

Talk to your primary care provider today about scheduling a well-woman exam, or visit www.frederickhealth.org/Well-Womens to learn more.