January is Cervical Health Month

5 mins read

By Dr. Amanda Hepler
Rangeley Family Medicine

RANGELEY – An important test in helping to ensure good cervical health is the Pap smear. This test was developed in 1923 by Georgios Papanikolaou, and regular use of this screening tool has helped to significantly decrease the incidence of cervical cancer. This type of cancer is usually caused by the human papilloma virus (HPV) which is a virus that is often sexually transmitted. This virus can cause changes (atypia) in the cells of the cervix, but if these changes are found early, interventions can prevent progression to cancer which is why screening is so important. Certain behaviors increase the risk of cervical cancer such as beginning sexual activity at a young age, multiple partners, and smoking.


Dr. Amanda Hepler

The U.S. Preventive Services Task Force released guidelines in 2003 regarding the appropriate intervals for screening. The first screening is recommended at age 21 or three years after becoming sexually active – whichever comes first. They recommend that women be screened at least every three years, but the American College of Obstetrics and Gynecology recommends yearly screening until the age of 30, and if a woman has had normal pap smears, then after the age of 30, the screening interval can be increased to every 2-3 years.

The USPSTF recommends against screening for any women who have had a total hysterectomy for benign disease (such as fibroids) and for women over the age of 65 who have had adequate screening which is defined as at least three normal pap smears in the last 10 years. Some women, though, are considered high risk for cervical cancer and should receive yearly screenings regardless of age. These women include those who were exposed to DES before birth and those with immune compromise including HIV, organ transplant, chemotherapy, and chronic steroid use.

Since its invention, some advances have been made to the Pap test. One is the introduction of the liquid based cytology, where the sample is sent in liquid form instead of on a slide. This test is more expensive than the traditional pap smear, but has the advantages of increased sensitivity and that it can permit HPV testing in the setting of an abnormal pap.

Another advancement in preventing cervical cancer has been the introduction of the HPV vaccine. The one commonly being used now is Gardasil which targets the four most common cancer causing strains of HPV, and is a series of three shots given over six months. These strains cause 70 percent of cervical cancer and 90 percent of genital warts. It is recommended that the vaccine be given at age 11-12 which is before most young girls become sexually active as this provides the greatest amount of protection, and the vaccine can be given up to age 26.

Cervical cancer is a preventable disease which is why regular screening is so important. Services such as low cost screenings are available to women without insurance, so we should be making every effort to screen as many women as possible in order to save as many lives as possible.

Dr. Hepler is a full-time medical provider at Rangeley Family Medicine, one of 11 federally qualified health centers in central and western Maine that are operated by HealthReach Community Health Centers (HRCHC).

Dedicated providers at the health centers deliver first-class healthcare to citizens in over 80 rural communities. To ensure access for everyone, HRCHC accepts Medicare, MaineCare, major insurances and offers an Affordable Care Program based on family size and income to uninsured and underinsured residents. HRCHC is a private, non-profit organization with a 30-year history, and is funded by patient fees, grants and individual donations.

For more information on the web:
www.cdc.gov/std/hpv/hpv-vaccine.pdf
www.ahrq.gov/clinic/3rduspstf/cervcan/cervcanrr.htm#clinical
www.wikipedia.org/wiki/georgios_papanikolaou

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