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    Cervical Cancer Screening and the HPV Vaccine

    Dr. Lauren Veazey, Family Practice Physician at Deaconess Clinic Mt. Pleasant. 06/20/2014

    We’ve come a long way with cervical cancer.  Cervical cancer used to be the number one cancer killer of American women.  That number has gone down in recent years due to improved screening methods, but there are still improvements to be made.
    I know screening recommendations can be confusing, as they’re based both on age and prior screening results.  Hopefully this information will help you understand current screening options.

    Current Cervical Cancer Screening Recommendations

    • Initial Screening. Women should begin to have Pap tests at age 21 regardless of whether or not they have been sexually active. Women under age 21 should not be screened.
    • Women Ages 21 - 29. Women ages 21 – 29, who are at average risk for cervical cancer should be screened once every three years with a Pap test. They do not need an HPV test unless they have had an abnormal Pap test result.
    • Women Ages 30 - 65. Women in this age bracket can have either a Pap test every three years OR a Pap test and HPV test every five years.
    • Women Ages 65 and Older. Women age 65 and older no longer need Pap tests as long as they have had regular Pap tests with normal results. Women who have ever been diagnosed with pre-cancer should continue to receive regular screenings.
    • After a Hysterectomy. Women who have had a hysterectomy that preserves the cervix (called a supracervical hysterectomy) should continue to have Pap screening according to the guidelines listed above.
    HPV Test
    The HVP test is a special screening test looking for the human papilloma virus, particularly the high-risk strains of the virus. HPV is the main cause and risk factor of cervical cancer. Nearly all cases of cervical cancer are caused by HPV. In general, doctors assume that a woman with cervical cancer has been infected with HPV.
    HPV is a very common sexually transmitted virus. There are many different types of HPV:
    • Low-risk HPV types, such as HPV 6 and 11, cause genital warts but are rarely associated with cancer
    • High-risk HPV types cause cervical cancer, as well as cancers of the vagina, vulva, anus, penis, oropharyngeal (throat, tongue, soft palate) and possibly lung.
    • HPV 16 and HPV 18 are the causes of most cases of cervical cancer

    At least half of sexually active women and men are infected with HPV at some point in their lives. HPV usually goes away on its own. Only 10% of women remain infected for more than five years. But sometimes HPV does not go away. A chronic, long-term infection with a high-risk type of HPV can cause changes in cervical cells that eventually lead to cancer.

    HPV infection is spread primarily by having sex with a partner infected with HPV. It is transmitted through skin-to-skin contact with infected areas of the genitals, anus, or mouth. Using condoms and limiting the number of sexual partners can help reduce the risk of contracting HPV.

    HPV Vaccine
    Two vaccines are approved by the Food and Drug Administration (FDA) to prevent either HPV or cervical cancer: Gardasil and Cervarix.

    Gardasil is approved for:
    • Girls and women ages 9 - 26, for protection against HPV-16 and HPV-19, the HPV strains that cause most cases of cervical cancer. It also protects against HPV-6 and HPV-11, which cause genital warts.
    • Boys and young men ages 13-21, to prevent genital warts.
    • Because it protects against four strains of HPV, Gardasil is called a quadrivalent or HPV4 vaccine.

    Cervarix is approved for:
    • Girls and women ages 9-25 for protection against HPV-16 and HPV-18, the HPV strains that cause most cases of cervical cancer.
    • Cervarix does not protect against genital warts.
    • Cervarix has not been approved for use in boys or men.
    • Because it protects against two strains of HPV, Cervarix is called a bivalent or HPV2 vaccine.

    Current immunization guidelines for either vaccination include:
    • Routine vaccination for girls ages 11 - 12. The vaccine should be administered in three doses, with the second and third doses administered two and six months after the first dose. The HPV vaccine can be given at the same time as other vaccines. Either Gardasil or Cervarix may be used, and one vaccine can be substituted for another in the three-dose series.
    • Girls as young as age nine can receive the vaccine at their doctor’s discretion.
    • Girls and women ages 13 – 26, who have not been previously immunized or who have not completed the full vaccine series, should get vaccinated to catch up on missed doses. [The U.S. Advisory Committee on Immunization Practices (ACIP) and the American Academy of Pediatrics (AAP) recommend catch-up doses for ages 13 - 26. The American Cancer Society (ACS) recommends catch-up for ages 13 - 18. The ACS suggests that women ages 19 - 26 discuss with their doctors the relative risks and benefits of vaccination.]
    • Women should not get the vaccine during pregnancy.
    • In 2011, the ACIP recommended routine 3-dose vaccination with Gardasil for all 11 - 12 year-old boys. The vaccine is safe for all men through age 26 but is most effective when given at a younger age.

    The HPV vaccine can only prevent -- not treat -- HPV infection, genital warts, and cervical cancer. Because the vaccine cannot protect females who are already infected with HPV, doctors recommend that girls and boys get vaccinated before they become sexually active. Studies indicate that the vaccine is nearly 100% effective in preventing cervical cancer and genital warts (caused by the HPV types covered in the vaccine) when given prior to HPV exposure. However, young women who are sexually active may still derive some benefit from the vaccine, at least for protection against any of the four HPV strains that they have not yet acquired.

    The most common side effects of the vaccine include discomfort or pain at the injection site, headache, and mild fever.

    These vaccines do not protect against all types of cancer-causing HPV. Women should receive regular screening to detect any early signs of cervical cancer. For girls and women who have been sexually active before they receive the vaccine, screening still provides the best protection against cervical cancer.

    If you have any questions or concerns about this vaccine, talk with your or your child’s doctor. He or she can help you decide what is best for you and your family.
    Finally, I want to note some other important points about preventing cervical cancer.

    Preventing Cervical Cancer
    • Avoid getting infected with human papillomavirus (HPV). Because HPV is sexually transmitted, practicing safe sex and limiting the number of sexual partners can help reduce risk.
    • Get vaccinated before becoming sexually active. A vaccine can protect against the major cancer-causing HPV strains in girls and young women who have not yet been exposed to the virus.
    • Have regular Pap test screenings. Pap tests remain the most effective way of catching cervical cancer while it is in its earliest pre-cancerous stages and preventing the development of invasive cervical cancer.
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