Thomas Besse, M.D., specialist in OB-Gyn at Alegent Health Find out more about Dr. Besse

A:  This year, it is estimated that 13,000 cases of invasive cervical cancer will be diagnosed in the United States and 4,100 women will die of the disease. Cervical cancer was once the number one cause of death from cancer in women. Thanks to the introduction and adoption of the Pap test, it now ranks 13^th in cancer deaths for women. If detected at an early stage, cervical cancer is very curable.

What causes cervical cancer?

Almost all cervical cancers are caused by infection with the human papillomavirus (HPV).

Who is at risk for cervical cancer?

Since almost all cervical cancers are caused by HPV, any woman who is sexually active is at risk for developing the disease. Having multiple sex partners, or partners with many other partners, increases the risk of developing cervical cancer, as does beginning sexual relations at an early age. Women who smoke also increase their risk of cervical cancer. Black women have higher incidence rates of cervical cancer than white women, but this could be due to lower screening rates. Public health officials agree that women who are not currently being screened, or are screened only occasionally, will benefit the most from beginning regular, cervical cytology screenings.

What are the guidelines for the early detection of cervical cancer?

The American Cancer Society has recently updated the guidelines. They are as follows:

• Cervical cancer screening should begin about three years after a woman begins having vaginal intercourse, but not later than 21 years of age.
• Cervical screening should be performed every year with regular (conventional) Pap tests every two years using liquid-based tests. Beginning at age 30, women who have had three normal test results in a row may get screened every two to three years (unless they have other medical conditions that may make it more likely that they will develop cervical cancer).
• Women 70 years of age and older who have had three or more normal Pap tests in a row and no abnormal Pap tests in the last 10 years may choose to stop cervical cancer screening.
• Screening after a total hysterectomy (removal of the uterus and cervix) is not necessary unless the women has had cervical cancer or precancer before. Women who have had a hysterectomy without removal of the cervix should continue cervical cancer screening at least until age 70.

Can cervical cancer screening substitute for pelvic examinations?

No. During a pelvic examination, the healthcare provider visually examines the cervix and vaginal area and manually evaluates the ovaries, the uterus, and the rectum, if a rectal exam is included. Even though a pelvic exam is not a screening test for cervical cancer, it can facilitate the detection of other cancers and gynecologic conditions. Screening for sexually transmitted diseases (STD), and counseling about STD prevention, birth control, or hormone replacement therapy, are also part of routine gynecologic care