SINCE its introduc-
This is great news, but it shouldn't lull women into a sense of complacency.
HPV, as the name indicates, is a virus. It is passed from one person to another by direct contact, like sexual intercourse.
Once a person is exposed to the HPV virus, one of three things can happen:
The immune system may get to work clearing the virus from the body, and it will never cause any problems.
The virus may enter the cells of the external genital organs like the vulva, vagina or cervix and just lie dormant, causing no detectable disease for an indefinite period of time.
Or, the virus may cause changes to the cells it inhabits that can lead to pre-cancer or, over time, cancer.
PAP SMEAR POWER
There are about 40 different types of HPV that can infect the human genital tract. The current HPV vaccine protects against only four: the two types that cause approximately 90 percent of genital warts, and the two types that cause 70 percent of cervical cancers.
That means that this vaccine does not protect against HPV types that cause the other 30 percent. There's a new HPV vaccine coming down the pike that will cover more types, but it still won't cover all 40.
It's important to understand that just because you've had the HPV vaccine, this doesn't mean that you can be lax about having Pap smears. Even for the vaccinated group of women, Pap smears are still a very important tool for the early diagnosis of pre-cancer and cancer of the cervix.
So, what are the most recent recommendations for cervical cancer screening?
First of all, Pap smear testing should begin at least three years after the onset of sexual activity or at 21 years of age, whichever comes first. After this, Pap smear testing should occur yearly until the age of 30.
At and beyond 30, women can be tested for the HPV virus directly along with their Pap. If you're 30 and older, your Pap and HPV virus test are both negative (normal) and you have had a history of normal Paps for at least 10 years, you can start spreading your Paps out to every 2-3 years.
If you're over 30 and you've had a recent significantly abnormal Pap, high-grade cervical dysplasia or cervical cancer, discuss the best screening schedule with your doctor.
Once you reach 65 to 70 and have no history of cervical cancer or high-grade cervical pre-cancer and your last three Paps have been normal, then you can stop having Paps altogether.
The same applies for women who have had a hysterectomy. If you have had no history of cervical cancer, high-grade pre-cancer or vaginal cancer, you can stop having Pap smears.
But, a very important point to remember is that you still need a pelvic exam yearly. What that means is you still need a doctor to examine the external genitalia (the vulva or lips), the vagina, the cervix and to perform a bimanual exam which consists of palpating (feeling) the uterus and ovaries to make sure they feel normal.
Remember, Pap smear screening is only about detecting cervical cancer and pre-cancer and is not a substitute for a good, yearly pelvic exam.
DON'T GET COMPLACENT
The study data on the HPV vaccine's ability to prevent cervical pre-cancer and cancer are very exciting. Fortunately, positive results are already being born out in real-life reductions in cervical pre-cancers.
But we don't want to cancel the benefits that we are gaining by becoming complacent about Pap smear screening.
Cervical cancer has been dealt a powerful blow, but it's not dead yet, so it's important to continue to protect yourself by following the Pap smear recommendations for your age group and situation.
Dr. Arlene Lewis welcomes reader comments and questions. She can be reached by writing to her at Free Lance-Star, 616 Amelia St., Fredericksburg, Va., 22401 or by e-mail
Email: newsroom@freelancestar.com.
Dr. Arlene Lewis is a gynecologist in private practice at Thrive! Health and Wellness Center for Women in Fredericksburg. |