Cervical Cancer Risk Assessment
Cervical cancer was once one of the most common causes of cancer death among women in the United States, but today many cases of cervical cancer are prevented through widespread use of the Pap test.
Two vaccines are also available to prevent infection by certain strains of human papillomavirus (HPV), a major cause of cervical cancer. The vaccines are approved for females (and males) ages 9 to 26.
According to the American Cancer Society (ACS), cervical cancer tends to develop in midlife; most women are diagnosed with cervical cancer before the age of 50; about 20 percent are older than 65. Early cervical cancer and precancerous conditions of the cervix have no symptoms. This assessment will help you determine your relative risk for cervical cancer. This assessment is valid for women between the ages of 21 and 69 who have had sexual intercourse at least once and who have not had a hysterectomy with removal of the cervix.
Based on the information you provided, you have one or more risk factors for cervical cancer. A risk factor is any condition or behavior that increases your likelihood of developing a disease. Having a risk factor does not necessarily mean you will develop a disease, however. Knowing what your risk factors are helps your health care provider schedule appropriate screenings and recommend preventive measures.
For cervical cancer, the primary risk factor is infection with certain high-risk types of HPV, or human papillomavirus. Other secondary risk factors also come into play. Based on the answers to your assessment, your risk factors, if any, are listed below.
The information you provided suggests that you have none of the common risk factors for cervical cancer covered in this assessment. Your results show the following preventive factors that decrease your likelihood developing cervical cancer by varying degrees:
Primary risk factor:
- You have a medical history of HPV infection. Infection with certain high-risk types of HPV is the most important risk factor for cervical cancer. Most women diagnosed with cervical cancer have this virus. See "Understanding Risk Factors for Cervical Cancer" below for more information about this risk factor.
Secondary risk factor(s):
Your results indicate you have one or more secondary risk factors for cervical cancer:
- You had sexual intercourse before age 18. Intercourse at a young age is considered a risk factor because it increases your chances of contracting HPV.
- You have had sexual intercourse with more than one partner. Sex with multiple partners is considered a risk factor because it increases your chances of contracting HPV.
- You have HIV or AIDS. HIV infection or any condition that weakens the immune system puts women more at risk of contracting HPV.
- You have a medical history of chlamydia.
- You have been diagnosed with genital herpes. Some studies suggest that HPV may more easily infect the cervix in some women who also have the herpes virus HSV-2.
- You have a family history of cervical cancer or cervical dysplasia. There is evidence that genetic factors are involved in the development of some cervical cancers.
- You are years old. The incidence of cervical cancer increases after age 30.
- You smoke. Cancer-causing chemicals have been found in the cervix of women who smoke.
- Your diet is lacking in fruits and vegetables.
Your results also indicate the following preventive factors that decrease your risk of cervical cancer by varying degrees:
- You did not have sexual intercourse before you were 18 years old. Intercourse at a young age is considered a risk factor because it increases your chances of contracting HPV.
- You have had sexual intercourse with only one partner. Sex with multiple partners is considered a risk factor for cervical cancer because it increases your chances of contracting HPV.
- You have had a Pap test within the last two years. Having Pap tests as recommended by your health care provider is the most important preventive measure for cervical cancer. Recommended frequencies for Pap testing vary according to each woman's circumstances. See "The Importance of Screening" below for specific guidelines.
- You don't smoke.
- You eat a healthy amount of fruits and vegetables.
Understanding risk factors for cervical cancer
The most important risk factor for cervical cancer is being infected with the human papillomavirus (HPV). Most women diagnosed with cervical cancer have this virus. HPV is passed on through skin contact with an infected part of the body, usually on or near the sexual organs, the ACS says. Your risk for getting this virus increases if you have sex at an early age, if you have more than one sexual partner during your lifetime, if your partner has had multiple sex partners, or if you have sex with uncircumcised males.
HPV refers to a group of more than 150 types of viruses. Some of these are low risk and cause genital warts. Only a few HPVs cause cervical cancer. In fact, 70% of all cervical cancer cases are caused by only two types, HPV 16 and HPV 18, the ACS says. Yet most women who are infected with these types of HPV don't develop cervical cancer.
HPV infection does not always cause warts or other symptoms, so you can pass it to another person without knowing it. Although condoms protect against many sexually transmitted diseases (STDs), they don't offer total protection against HPV, the ACS says. This is because HPV can be passed on by skin contact with an infected area of the body that can't be covered with a condom. Even when no warts are present, HPV can stay in the skin and be passed on. HPV vaccines are currently available for people between ages 9 and 26. The vaccines are intended to be given to people before they become sexually active.
According to the American Cancer Society (ACS), other factors that increase your risk for cervical cancer are:
- HIV infection. HIV, the virus that causes AIDS, damages the body's immune system. This and any other condition that weakens the immune system puts a woman at greater risk for HPV infection, which may increase the risk for cervical cancer, the ACS says.
- Chlamydia. Chlamydia is a common sexually transmitted disease with few symptoms. Recent research suggests that a past or current chlamydia infection may put a woman at greater risk for cervical cancer.
- Genital herpes. Some research suggests that infection with HSV-2 in some women may help the human papillomavirus to infect the cervix.
- Family history of cervical cancer or cervical dysplasia. Women whose mother or sisters have had cervical cancer or cervical dysplasia are at greater risk themselves for cervical cancer. It has been suggested by some researchers that some women may not fight off HPV infection as well as others owing to an inherited condition.
- Smoking. Women who smoke are about twice as likely as nonsmokers to get cervical cancer. Tobacco smoke contains many cancer-causing chemicals that are carried throughout the body in the blood. These chemicals have been found in the cervix of women who smoke.
- Poor diet. Women who consume few fruits or vegetables may be at higher risk for cervical cancer.
The importance of screening
The increased use of the Pap test has dramatically reduced deaths from cervical cancer. Pap tests find early cancers or changes in the cells of the cervix that could lead to cancer. Cervical cancer develops slowly, usually taking years to progress from a precancerous condition to cancer. For many women, the precancerous changes will not progress to cancer or will go away without any treatment. Precancerous conditions can also be treated, however, preventing cancer from developing.
The American Cancer Society recommends that:
- All women at average risk should have Pap tests starting at age 21.
- Women between ages 21 and 29 should have a Pap test every 3 years.
- Women between the ages of 30 and 65 should have a Pap test plus an HPV test (called “co-testing”) every 5 years. This is the preferred approach, but it is also acceptable to continue to have Pap tests alone every 3 years.
- Women older than age 65 who have had regular screening with normal results should not be screened for cervical cancer. Once screening is stopped, it should not be started again.
- A woman who has had a hysterectomy (with removal of the cervix) for reasons not related to cervical cancer and who has no history of cervical cancer or serious precancer should not be screened.
- A woman who has been vaccinated against HPV should still follow the screening recommendations for her age group.
Tips for an accurate Pap test
To make sure your Pap test results are accurate, the ACS says to avoid the following:
- Scheduling your test for a time when you are having your menstrual period.
- Douching within two days (48 hours) of your test. In general, douching is not recommended, because it disrupts the natural bacteria and acidity in the vagina. This can irritate the vagina and actually increase the risk for certain infections.
- Having sexual intercourse within two days (48 hours) of your test.
- Using tampons, vaginal medications, foams, creams, or jellies within two days (48 hours) of your test.
Pap test, pelvic exam: The difference
A pelvic exam is not a Pap test, but both are done during the same office visit. The Pap test is usually done first. For the Pap test, the health care provider inserts an instrument called a speculum into the vagina to hold it open, then gently scrapes or brushes the cervix with another instrument to remove a small number of cells. This sample is sent to the laboratory. The HPV test can be done at the same time as the Pap test. During a pelvic exam, a health care provider checks the health of a woman's uterus and ovaries by feeling them through the abdomen. For the exam, the provider inserts two fingers into the vagina and presses to steady the uterus; the other hand pushes on the abdomen to feel the uterus and ovaries. A pelvic exam cannot find cervical cancer in its early stages or abnormal cervical cells.
Treatment of cervical cancer
A health care provider may suggest one of the following treatments for precancerous changes of the cervix or for cancer found only in the outer layer of cells the cervix (cancer that has not invaded deeper tissues):
- Cryosurgery. Abnormal cells in the cervix are killed by freezing them.
- Laser surgery. A laser beam burns off abnormal cells or removes a small piece of tissue for examination.
For more advanced cancers, a cone biopsy may be done first to establish the cancer diagnosis. In a cone biopsy (conization), a cone-shaped piece of tissue is removed from the cervix. Treatment for more advanced cancers may be hysterectomy, internal or external radiation, chemotherapy, or a combination of these.
This information is not intended as a substitute for professional health care. Always consult with a health care provider for advice concerning your health. Only your health care provider can do a thorough disease risk assessment or determine if you have cervical cancer.
References for Cervical CancerNational Cancer Institute
This assessment is not intended to replace the evaluation of a health care professional.
October 15, 2013
Finke, Amy, RN, BSN, MMI board-certified, academically affiliated clinician