1. “Take the Test: Not the Risk” HPV and Cervical Cancer
Cervical Cancer is Preventable

2. What is cervical cancer?
Before we can talk about cervical cancer, we need to talk about the cervix and have a working knowledge of basic female anatomy.
So let’s briefly review the anatomy
NEXT SLIDE
What is cervical cancer?

3. Anatomy Review
The cervix is part of your uterus and extends into the vagina. As you can see it is located at the bottom of the pear-shaped uterine organ and is the opening to the womb. Lets take a closer look at the cervix.
NEXT SLIDE

4. The cervix
The purpose of the cervix is to produce mucous, which bathes and lubricates the vaginal walls as well as also keeps germs out. The downward flow of the mucous helps to keep bacteria out of the uterus. Sperm, however, can get through this mucous.
This is a healthy, normal-appearing cervix. Now let’s take a look at a cervix that has cancer.
NEXT SLIDE

5. Cervix with cancer
The image on the far right is what cervical cancer looks like. Cervical cancer develops when abnormal cells rapidly grow on the surface of the cervix, but these changes do not happen overnight. Take a look at the second image from the left, the abnormal changes in cell growth happen gradually, over time.
The Pap test was developed in 1948 and has made a dramatic difference in our ability to detect abnormal cells earlier. Unfortunately, women are still dying of cervical cancer despite having annual Paps. Why? The Pap test is not foolproof. It’s subject to human error and misinterpretation – either at the time a sample of cervical cells is collected during a pelvic exam, or when the cells are examined under a microscope in the lab.
Do these changes in your cervix cause symptoms to let you know something is wrong? Usually not. So what else can be done? What else do we know to help us improve our ability to prevent cervical cancer?
NEXT SLIDE

6. HPV – human papillomavirus
We now know what causes cervical cancer
“High-risk” types of the HPV virus have been identified as the cause of cervical cancer in women (1). Knowing this allows us to practice cutting-edge medicine.
How do women get the virus? The human papillomavirus is sexually transmitted, and is extremely common. Most of us who are or have been sexually active have been exposed to one or more types of the virus. The good news is for most women the infection is transient. The body fights off or suppresses the virus, and no long-term consequences are experienced. However, for some women, the infection becomes persistent, causing abnormal cell changes on the cervix. These changes can develop into cancer if they are not detected and treated early (1).
Now that we know about the virus, can we detect it before the harm is done?
NEXT SLIDE
HPV – human papillomavirus

7. In conjunction with the Pap
How do we tell if a woman has HPV?
As already mentioned, the Pap is very often effective in catching early cervical disease. However, because it relies on someone looking through a microscope to determine if abnormal cells are present, it can fail to identify some women at risk until cancer is already present. In contrast, the HPV test directly detects the presence of high-risk types of the virus, and can usually be done on the same sample of cells collected for the Pap.
Of course, not all women who have HPV are on their way to developing cervical cancer. In fact, as stated earlier, the infection is harmless in most women. It’s the persistent infections – the ones that stay active over time – we worry about. That’s why it’s recommended if you have HPV but your Pap is normal, you get retested for HPV six months to a year later before deciding whether additional procedures are necessary to look for – and remove – pre-cancerous cells (2, 3).
NEXT SLIDE
The HPV test
In conjunction with the Pap

8. Should all women be test for HPV along with their Pap?
Protect yourself. Get the right combination of tests
The simple answer is “it depends on your age.” Remember, most women who are sexually active have been exposed to HPV and the infection usually goes away or becomes inactive on its own – particularly in younger women under the age of 30. HPV is prevalent, but these women are at less risk for cervical cancer. So, routine HPV testing of young women isn’t considered necessary – rather like mammograms, which aren’t recommended for most women until they are older.
So who should get what test and when?
NEXT SLIDE
Should all women be test for HPV along with their Pap?

9. Guidelines
One recommendation from the American College of Obstetrics and Gynecology is:
All women age 30 or older should get the HPV test along with a Pap (2)
Both the American College of Obstetricians and Gynecologists and the American Cancer Society recommend that (2,3):
Women get their first Pap three years after becoming sexually active or by the age of 21, whichever comes first. Annual Paps are recommended thereafter, up to the age of 30. If a Pap result is inconclusive – which means it’s not clear if the Pap is normal or abnormal – an HPV test should be done as well.
Once women reach the age of 30, when the risk of cervical cancer increases, getting an HPV test along with the Pap offers extra protection. In fact, the HPV test is considered so sensitive to cervical cancer risk that women without the virus only need to be re-tested for HPV every three years.
The goal of both HPV and Pap testing (also called “cervical cancer screening”) is to find pre-cancerous cells on the cervix, and then remove them before they become cancer.
NEXT SLIDE

10. In vaccine development:
The FDA approved the first vaccine to protect against the most common types of HPV infection (4).
In June of 2006, the Food and Drug Administration approved the first HPV vaccine for use in girls and women ages 9 to 26 (4).
NEXT SLIDE

11. What the vaccine can and cannot do
It can:
Protect against two (of approximately 13) types of HPV that most often cause cervical cancer – if you have not yet been exposed through sexual contact (4)
It cannot:
Provide complete protection
Screening with the Pap, and if you are age 30+ the HPV test, is still essential (2,3)
Gardasil, developed by Merck & Co :
Gardasil is designed to protect against HPV types 16 and 18, which account for about 70% of cervical cancer cases, and strains 6 and 11, which account for 90% of genital warts. It must be administered in three separate injections over a six-month period: first dose at elected date, second dose two months after the first dose and the third dose six months after the first dose (4).
NEXT SLIDE

12. Take Action Stay aware and up-to-date on cancer prevention
Ask your nurse or doctor about the HPV test at your next annual visit
Share this information with your friends and family

13. Resources: www.TheHPVtest.com
(visit the site’s National HPV and Cervical Cancer Prevention Resource Center)

14. References
American Cancer Society (2016). What are the Risk Factors for Cervical Cancer?. Available at cancer-risk-factors.html (accessed September 28, 2017).
American College of Obstetricians (2016). Frequently Asked Questions: Cervical Caner Screening. Available at (accessed September 28, 2017)
Saslow, D. et al. (2012), American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. CA: A Cancer Journal for Clinicians 62, 147–172.
U.S. Food & Drug Administration (2017). Gardasil. Available at (accessed September 28, 2017).