Background Information for AMIGAS Sessions

Overview

The following information can help community health workers answer questions during AMIGAS sessions.

Cervical cancer and cervical cancer screening

What is cervical cancer?

• Cervical cancer and cervix cancer are two names for the same thing.
• Cervical cancer begins to develop when the cells of the neck of the uterus or cervix grow rapidly without order.
• These cell changes in the cervix are called high-grade or low-grade intraepithelial lesions. These changes are possibly not yet cancer, but it is important to treat them.

Do Latinas have a high rate of getting cervical cancer?

Hispanic women who live in the United States are more likely to be diagnosed with cervical cancer than women of other races and ethnicities, except American Indian and Alaska Native women.

You may want to review current statistics and trends on cervical cancer so you're ready to answer more detailed questions women may have. CDC's Data Visualizations tool has up-to-date information for the country as a whole and for individual states and counties.

What is a Pap test?

A Pap test is done in a clinic or in a doctor's office to find cell changes in the cervix.

What is an HPV test?

A human papillomavirus (HPV) test checks cells for human papillomavirus, the virus that causes most cases of cervical cancer.

What happens during cervical cancer screening?

• The woman is taken into an exam room and given a medical gown. After the doctor or nurse leaves, she removes her clothing and puts on the medical gown. She lies face up on an exam table, with her knees bent and her feet supported in foot rests.
• To do the exam, the doctor or nurse uses a special instrument made of plastic or metal called a speculum. The speculum holds the walls of the vagina open so the doctor or nurse can see the neck of the uterus, or cervix.
• The doctor or nurse uses a small brush or wooden spatula to get a sample of cells from the cervix. The woman may feel a quick pinch when the doctor or nurse takes the sample.
• The cells are placed on a glass slide or into a small tube and sent to the laboratory for analysis. This test determines if the cells of the cervix are normal or abnormal (not normal).
• If a woman is having an HPV test, these cells will be checked for HPV, the virus that causes most cases of cervical cancer.

Who should get screened for cervical cancer and when?

Several organizations have recommendations about screening for cervical cancer screening. The United States Preventive Services Task Force made the following recommendations for women at average risk:*

• Women who are 21 to 29 should receive a Pap test every 3 years.
• Women who are 30 to 65 can receive a Pap test every 3 years, an HPV test every 5 years, or a Pap test and an HPV test together every 5 years.
• Women under 21 should not be screened for cervical cancer.
• Women younger than 30 should not be screened using an HPV test alone or in combination with a Pap test.
• Women older than 65 may need to be screened for cervical cancer if they have not been screened regularly in the past or are at high risk.
• Women who have a had a hysterectomy with removal of the cervix and do not have a history of high-grade precancerous lesions or cervical cancer should not be screened for cervical cancer.

*These recommendations do not apply to women who have received a diagnosis of a high-grade precancerous cervical lesion or cervical cancer, women with in utero exposure to diethylstilbestrol (DES), or women who are immunocompromised (such as those who are HIV positive).

Why don't doctors recommend the HPV test for women younger than 30?

Doctors do not recommend getting the HPV test to women younger than 30 because HPV is very common in younger women. Most of the time, an HPV infection will go away on its own and never cause health problems in younger women.

Do women who are lesbian, bisexual, or transgender need to get screened for cervical cancer?

HPV can be spread through sexual contact of any kind. Women who are 21 to 65 and have a cervix should get screened for cervical cancer every 3 or 5 years, regardless of their sexual orientation.

How can women who are sexual assault survivors prepare for a cervical cancer screening test?

Women who have been sexually assaulted may be more nervous than other women about getting a cervical cancer screening test. Here are things that can help make the test less stressful:

• Ask to have a female doctor perform the test or to have a female nurse in the room during the test.
• Before the test—either when making the appointment or in the exam room—ask the doctor if he or she is sensitive to patients who have experienced sexual trauma. Make sure you are given time to talk about your fears and anxieties about having a test.
• Talk with the doctor about "trigger words" to avoid during the test and what "safe words" can be used instead. Identify a signal you can give the doctor if you need to slow down or stop the test.
• During the test, ask the doctor to give detailed descriptions about what's being done and why.
• Have a friend or family member in the room during the test, if possible.
• Know that you can leave if you feel uncomfortable.

Why can women wait 5 years between screenings if their HPV test result is normal?

If a woman is 30 or older and her HPV test result is normal, her chance of getting cervical cancer in the next few years is very low. Her doctor may say she can wait 5 years for the next screening.

Do women need a cervical cancer screening test if their cervix has been removed during a hysterectomy?

If a woman has had her cervix removed as part of a total hysterectomy for noncancerous conditions, like fibroids, she may not need to be screened for cervical cancer anymore. She should ask her doctor.

Risk factors

What are the risk factors for cervical cancer?

Factors that can increase the chance that a woman might get cervical cancer include:

• Infection with human papillomavirus (HPV), a common sexually transmitted infection.
• Having HIV (the virus that causes AIDS) or another condition that makes it hard for your body to fight off health problems.
• Smoking.
• Using birth control pills for a long time (five or more years).
• Having given birth to three or more children.
• Having several sexual partners.

What is the difference between HIV and HPV?

HIV and HPV are different viruses that cause different problems.

HIV—the human immunodeficiency virus—attacks the body's immune system. Over time, HIV makes it hard for the body to fight off infections. HIV infection can lead to AIDS. However, with early diagnosis and treatment, many people with HIV don't develop AIDS.

HPV—the human papillomavirus—is a common sexually transmitted infection. More than 40 HPV types can infect the genital areas of men and women. They can also infect the lining of the mouth and throat. HPV types are often called non-oncogenic (wart-causing) or oncogenic (cancer-causing), depending on whether they put a person at risk of cancer. The International Agency for Research on Cancer found that 13 HPV types can cause cervical cancer. The types of HPV that can cause genital warts are not the same as the types that can cause cancer.

Why does having HIV increase the risk of cervical cancer?

Having HIV—the virus that causes AIDS—makes it hard for the body to fight off health problems, such as viral infections that may lead to cancer. Women who are infected with HIV are three times more likely to be diagnosed with cervical cancer.

Why does smoking increase the risk of cervical cancer?

Women who smoke are more likely to develop cervical cancer than women who don't smoke. Smoking can cause cancer and also block the body from fighting it. Poisons in tobacco smoke damage the DNA of cells on the cervix. When DNA is damaged, a cell can begin growing out of control and develop into cancer. Smoking also makes the immune system less able to fight off HPV infections.

Why does giving birth three or more times increase the risk of cervical cancer?

A woman who has had three or more full-term pregnancies has an increased risk of developing cervical cancer. The reasons why aren't clear. It might be because:

• Having unprotected sex means more exposure to HPV.
• Hormonal changes during pregnancy might make women more susceptible to HPV infection or cancer growth.
• Pregnant women might have weaker immune systems, which makes it harder to fight off HPV infection.

Does HPV cause other types of cancer besides cervical cancer?

HPV causes most cervical cancers. It can also cause cancers of the vagina, vulva, penis, anus, and certain oropharynx (the back of the throat, base of the tongue, and tonsils).

Abnormal results and treatment options

What happens if the cervical cancer screening test results are abnormal?

If a Pap test result is abnormal or unclear, or an HPV test result is positive, women should follow up with their doctor. They may need more tests to see if they have cervical cancer. The specific tests needed depend on which tests were done and what the results were.

If a Pap test result is unclear: Unclear Pap test results are common. The doctor may use other words to describe this result, like equivocal, inconclusive, or ASC-US. These all mean the same thing—that the cervical cells look like they could be abnormal. It can be hard to tell if cell changes are related to HPV. They could be related to pregnancy, menopause, or an infection. An HPV test can help find out if cell changes are related to HPV.

If a Pap test result is abnormal: This result means that the test found cell changes on the cervix. It usually does not mean that the woman has cervical cancer. Abnormal changes on the cervix are likely caused by HPV. Cell changes may be minor (low-grade) or serious (high-grade). Most of the time, minor changes go back to normal on their own. But more serious changes can turn into cancer if the cells are not removed. More serious changes are often called "precancers" because they can turn into cancer over time. In rare cases, an abnormal Pap test can show that the woman might have cancer, but other tests are needed to be sure.

If an HPV test result is positive: This result means that the test found a type of HPV that may be linked to cervical cancer. It does not mean that the woman has cervical cancer now. But it could be a warning. Follow-up for a positive HPV test depends on the Pap test result.

CDC has more information about different test results.

What additional tests might be needed if the cervical cancer screening test results are abnormal?

If the results are not normal, the woman might need further tests, like:

• Colposcopy.
• Biopsy.
• Endocervical curettage.
• Conization or cone biopsy.
• Dilatation and curettage.
• HPV test.

What if the test results find cervical cancer or precancerous cell changes?

The earlier cervical cancer is found, the easier it is to treat. If the tests find precancerous or cancerous changes, the doctor will talk with the woman about treatment options. The National Cancer Institute has information about cervical cancer treatment.

How often do women survive cervical cancer?

A woman's doctor is in the best person to ask about cervical cancer survival. CDC's Data Visualizations tool provides general statistics about 5-year relative survival of cervical cancer by race and ethnicity and age group and by stage at diagnosis.