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Regular screening and vaccination are best defense against cervical cancer, MUSC Health specialist says

December 22, 2021
Dr. Ashlyn Savage

Every year, more than 12,000 women get cervical cancer, according to the American Cancer Society. Of those cases, up to 93% are preventable.

That's encouraging news about a cancer that, just decades years ago, was a common cause of death for women in the United States.

Dr. Ashlyn Savage, a professor of obstetrics and gynecology and the division director of ObGyn Specialists at MUSC Health, says screening and vaccination are a woman's strongest defense against cervical cancer.

Cervical cancer is linked to exposure to the human papilloma virus (HPV), which is acquired through sexual activity. Over years, a persistent infection with HPV can cause the cells of the cervix to become abnormal. If left untreated, these abnormal cells can progress to cancer.

"Both the HPV vaccine and the Pap test are life-saving measures for women and should not be ignored," Savage says. "We have a sound understanding that infection by HPV is a necessary prerequisite for developing cervical cancer. Other risk factors can further increase the likelihood of cervical cancer, but that critical first step is infection with HPV."

About 80 percent of the population acquire HPV at some point in their lives, but most people clear the virus without ever knowing they had it. "By the time a person has had two partners, they've almost certainly been exposed to HPV," Savage says. "Most of us have had it, but a small portion of us acquire HPV and can't fight it off."

Cervical cancer is serious and life-threatening. Fortunately, screening allows providers to catch this disease in the pre-cancer phase, Savage says.

Precancerous cells, known as dysplasia, can be treated with a minor, in-office procedure. If diagnosed with a very early-stage cervical cancer, some women can be treated with hysterectomy alone.

Advanced stages of cervical cancer require chemotherapy, radiation or surgery or a combination of all three.

The biggest risk factor for cervical cancer is not getting screened, Savage says.

"The value of screening cannot be overstated because it is such an effective way to prevent this cancer," Savage says. "Cancer is always serious, but the encouraging news is that cervical disease progresses slowly. It has a predicable progression that takes years for a mild pre-cancer to progress to a more severe precancer and ultimately to true invasive cancer. As long as a woman is getting screened at recommended intervals, dysplasia or cervical cancer will be picked up."

For decades, a Pap test, which was developed in 1941, was the central way of screening for cervical cancer. In the early 2000s, when the medical community began to understand the link between HPV and cervical cancer, HPV testing was combined with the Pap.

"For women over 30, a Pap smear should be routinely combined with HPV testing," Savage says. "We scrape cells from the cervix, put the cells in a fluid and examine them under a microscope. Then we examine the fluid for the HPV virus."

A woman should begin getting a Pap test at age 21 and every 3 years thereafter until age 30. At age 30, providers begin co-testing. If results are normal, the Pap test and HPV test are done every 5 years until age 65 unless test results are abnormal.

"Co-testing has made the Pap smear so much more accurate, and that is a key part of increasing the safety," Savage says. "People are skeptical of the extended interval for testing, but the guidelines reflect the natural history of the disease, which is a disease of slow progression."

The HPV vaccine is also an essential defense against cervical cancer, Savage says.

A two-dose vaccine is generally recommended for boys and girls at age 12, but can be given as early as age 9. There are many strains of HPV, and the HPV vaccine protects against the 9 most common strains.

"It is critically important that the vaccine be given to people before they become sexually active," Savage says. The FDA has approved the vaccine for women up to age 45, but it is most effective in those who have not yet had the opportunity to acquire the virus.

Although cervical cancer statistics have improved over the years, about 4,000 women die each year from cervical cancer, according to the CDC, a number that is still too high, Savage says.

"Many of these deaths are preventable, with early detection and now the vaccine," Savage says. "I urge every women to get screened and every parent to get their child vaccinated."

To make an appointment with Dr. Savage or to learn more about cervical cancer and HPV, call 843-792-5300.