Upon World Cancer Day on February 4 and throughout the month of February, we will explore the most common cancers and the recommendations for preventing or detecting these cancers at the appropriate time.

Are you wondering if you still need an annual pap smear as you age? Cervical cancer screenings are an important component of women’s health even in midlife. They aid in the prevention and early diagnosis of cervical cancers. Cervical cancer is a type of female cancer that occurs in the cells of the cervix — the lower part of the uterus that connects to the vagina. It is the fourth most common type of cancer for women worldwide but also one of the most preventable.

Cervical cancer occurs most often in midlife and is most frequently diagnosed in women between 35 and 44 years of age. However, Research shows that almost one out of every five new cervical cancer cases between 2009-2018 was in women 65 or older. Many of these were late-stage cancers.

Causes of Cervical Cancer

The majority of cervical cancers are caused by Human Papilloma Virus or HPV. About half of all sexually active women will contract HPV at some point in their lives. Most people exposed to HPV won’t develop cancer. About 10% of people exposed to HPV will develop long-lasting infections that put them at greater risk of developing precancerous lesions or cancer. Significantly fewer will do so.

There are more than 40 known HPV variants, 13 of which can trigger healthy cervical cells to abnormally replicate and mutate. Risk factors that can increase your risk of developing cervical cancer include:

• Sexual Partners – The number of sexual partners you and/or your partner has will increase your odds of getting HPV.
• Early Sexual Activity – Being sexually active at an early age increases the risk of HPV.
• History of Sexually Transmitted Infections – STIs, including, chlamydia, gonorrhea, syphilis and HIV/AIDS, increases your risk of HPV.
• Weakened immune system. If you have HPV and your immune system is weakened.
• Smoking. Smoking is associated with squamous cell cervical cancer.
• Exposure to miscarriage prevention drug. If your mother took a drug called diethylstilbestrol (DES) while pregnant in the 1950s, you may have an increased risk of a certain type of cervical cancer called clear cell adenocarcinoma.

Why is Cervical Cancer Screening Important?

Cervical cancer screening can identify infections, inflammation, precancerous cells, and cancers of the cervix. Identifying these conditions as early as possible gives you the greatest chance of avoiding or successfully treating cancer if you already have it. 

Research shows that regular screening decreases the incidence and mortality of cervical cancer by a whopping 80%. The screening tests are simple to perform and, although sometimes uncomfortable, relatively easy. It seems worth it for such impressive results. 

Do I Still Need to Screen for Cervical Cancer if I’m Not Having Sex?

Yes, you should have regular cervical cancer screenings even if you’re not having sex. Although it’s unlikely you’ll develop cervical cancer, it is not impossible. First, not all cervical cancers are caused by HPV. A minority are caused by run-of-the-mill DNA mutations. Also, HPV has occasionally been found in the vaginal canals of women who have never had penetrative sex. Non-penetrative sexual activity can transmit the virus, so even if you’re not having sex, you can become infected with HPV.     

Do I Still Need to Screen if I Got the HPV Vaccine? 

The HPV vaccine became available in the U.S. in 2006. If you’re young enough to have received it (it’s currently only recommended for those under 26 years old), keep in mind that you still need regular cervical cancer screenings. The HPV vaccine protects against most of the virus strains known to cause cancer, but not all. Also, if you were already sexually active before you got the vaccine, chances are you were already exposed to HPV. 

What Tests Are Performed?

Two tests can be performed to check for cervical cancer. The first is the Papanicolaou test, more commonly known as the Pap smear or Pap test. Your healthcare provider will collect cervical cells by using a speculum to open your vaginal canal and then swabbing your cervix. Those cells will then be checked for any abnormalities. 

The other available test is an HPV test. Cervical cells will be collected just like for a Pap test, but they will only be checked for the presence of HPV. This doesn’t show whether you have precancerous or cancerous cells, but it does show if you are at risk. 

You can also get a combined HPV and Pap test. This is called co-testing, and it is the most thorough cervical cancer screening available. 

How Often Should I Have Cervical Cancer Screenings?

For ages 21 to 65, healthcare providers generally recommend getting a Pap smear every three years. For women 30 to 65, the interval can be lengthened to every five years with a combined Pap smear and HPV test. If you have risk factors, talk to your healthcare provider for the best approach for you.

Over age 65? Read on for the guidelines for women 65+ and when it may make sense to stop screening for cervical cancer.