Protecting Cervical Health Across the Ages

Most women take their cervical health for granted. It’s one of the “out of sight, out of mind” topics that come up only when it’s time for your annual physical. But for Chung-Kuang “Timothy” Lin, MD, a family medicine physician at Washington Township Medical Foundation’s Warm Springs Clinic, it’s a timely topic for all women, no matter their age.

Dr. Lin will be presenting an online seminar, “Cervical Health: Why is it Important?” on January 11, at 11 a.m. This seminar is part of the Health & Wellness seminars presented by Washington Hospital Healthcare System. The presentation can be viewed online live at Facebook.com/WashingtonHosp or on their YouTube channel, YouTube.com/whhsInHealth.

Moving Forward

Cervical cancer was once one of the most common causes of cancer death for American women. Then, in 1928, George Papanicolaou, MD, developed a routine screening test he claimed could detect cancer of the uterine cervix. In the new test, named the Pap smear (now called Pap test) for its developer, a speculum is used to access the cervix, then a tool is inserted to scrap and collect a sample of cells from the cervix. The cells are examined under a microscope for signs of cancer (abnormal cells), infection and inflammation. In 1960, the American Medical Association began recommending Pap tests for women. In the 60 years since, the mortality rate for cervical cancer has declined by more than 50% as Pap tests detect abnormal cells in the cervix before they become cancerous.

While the Pap test is able to find abnormal, precancerous and cancerous cells under the microscope, Dr. Lin said the test can’t detect viruses that could lead to these changes on a cellular level. For that, women also need a test that looks for infection by high-risk types of the human papillomavirus (HPV) that can cause pre-cancers and cancers of the cervix.

HPV is a DNA virus that causes common infections as well as cervical cancer and genital warts. Dr. Lin said HPV has more than 150 strains and is the most common virus affecting cervical health. While most cases of HPV infection usually resolve on their own, there are more than 40 strains that can cause cancer. HPV infection is responsible for more than 90% of cervical cancers; one particular strain is found in nearly all cervical cancers. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7089001/)

HPV testing was first recommended by the American Society for Colposcopy and Cervical Pathology (ASCCP) in 2001. In 2003, the American Cancer Society and American College of Obstetricians and Gynecologists recommended HPV tests as an option for screening women 30 years and older. In 2011, the FDA approved an HPV test for use in conjunction with or as a follow-up to a Pap test.

Testing for Cancer

Dr. Lin said the double-pronged combination of a Pap test and an HPV test is the best way to check for cervical cancer. “Both tests can reveal abnormal cells,” he said. “Depending on the age, women can have a stand-alone HPV test, or both tests. Our goal is not just to catch cancers early, but to find the cells before they have a chance to become cancerous. This gives our patients the best chance.”

According to Dr. Lin, cervical cancer is most frequently diagnosed in women between the ages of 35 and 44. It rarely develops in women younger than 20. For that reason, he follows the ASCCP recommendations for testing.

“For women between ages 21-29, we only do a Pap test,” Dr. Lin explained. “If the first test is normal, we recommend women come back every three years for repeat Pap tests. Between ages 30-65, we do both a Pap test and an HPV test. If both are negative, we recommend women come back every five years for repeat testing. Women over age 65 who have had negative Pap and HPV tests back-to-back every five years for 10 years can stop having the tests if they choose. If they haven’t been receiving HPV tests, we look for negative Pap test back-to-back every three years for 10 years before we make that recommendation.”

Preventive Care

Dr. Lin said making a Pap and HPV test part of a woman’s routine care is very important, but it’s not the only tool in the cancer prevention playbook. In 2007, a vaccine was introduced that could help protect women from HPV infection, and through that interaction, from cervical cancer. The HPV vaccine also offers protection from other cancers (including oral and genital cancers) associated with different HPV strains and is now recommended for both men and women. The vaccines require two or three doses depending on a person's age and immune status. Most insurances will cover the vaccine up to age 26, though Dr. Lin noted some insurances will cover it until age 45.

“HPV is transmitted by contact,” he said. “The vaccine is available for boys and girls starting at age 9, but our practice recommends parents vaccinate their children at age 11, when they can receive the HPV vaccine at the same time as meningitis and tetanus. The vaccine is one way parents can help their children prepare for a healthier life.”

“Parents can wait,” Dr. Lin continued, “but it’s much better to get the vaccine before becoming sexually active. Once you get an HPV infection, you have it for life.”

To learn more about Dr. Lin and other WTMF providers, visit www.mywtmf.com. To register for Dr. Lin’s seminar or to learn more about upcoming seminars, see whhs.com/events.