Cervical Cancer Risk Assessment
Cervical cancer was once one of the most common causes of cancer death among women in the U.S. It still is worldwide. But in the U.S., many cervical cancer deaths are prevented through widespread use of the Pap test.
Vaccines are also available to prevent infection by certain strains of human papillomavirus (HPV). HPV causes nearly all cervical cancers. It’s linked to many other cancers, too. Testing for high-risk types of HPV (the types linked to cervical cancer) is a key part of cervical cancer screening.
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 1 in 5 are older than 65. Early cervical cancer and precancer changes of the cervix seldom cause symptoms. This tool will help you find out your relative risk for cervical cancer. This tool 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 that included removing 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. Still, having a risk factor does not mean you will develop a disease. Knowing what your risk factors are helps you and your healthcare provider decide on the best screening schedule. It also helps you find things you can change to help lower your risk for cervical cancer.
For cervical cancer, the primary risk factor is infection with certain high-risk types of HPV (human papillomavirus). Other secondary risk factors also come into play. Based on the answers you provided, 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 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 had this virus. See “Understanding risk factors for cervical cancer” below to learn more about HPV.
Secondary risk factor(s):
Your results show that you have one or more secondary risk factors for cervical cancer. These include:
- You had sexual intercourse before age 18. Intercourse at a young age is considered a risk factor because it increases your chances of getting 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 getting HPV.
- You have HIV or AIDS. HIV infection or any condition that weakens the immune system puts women more at risk of getting HPV and not being able to get rid of it.
- You have a health history of chlamydia.
- You have a family history of cervical cancer or cervical dysplasia. Research shows that certain genes may play a role in the ability to fight off HPV.
- You are years old. The chance of getting cervical cancer increases in midlife and goes down after age 50.
- You smoke. Cancer-causing chemicals have been found in the cervix of women who smoke.
- You need more vegetables and fruits in your diet.
Your results also show the following preventive factors that decrease your risk for 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 getting 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 getting HPV.
- You have had a Pap with an HPV test within the last 3 years. Or you have had an HPV test in the last 5 years. Having regular Pap or HPV tests as recommended by your healthcare provider is the most important preventive measure for cervical cancer. How often you should be tested can vary. 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 HPV (human papillomavirus). Most women diagnosed with cervical cancer have had this virus. HPV is passed on through skin contact with an infected part of the body, usually on or near the sexual organs. Your risk of getting this virus increases if you have sex at an early age, if you have had many sexual partners during your lifetime, or if your partner has had many sex partners.
HPV refers to a group of more than 150 types of viruses. Some of these are low risk. They cause genital warts. But a few HPVs cause cervical cancer. In fact, about two-thirds of all cervical cancer cases are caused by only two types, HPV 16 and HPV 18. Still, most women who are infected with these types of HPV don’t develop cervical cancer. In most people, the body can get rid of the infection on its own.
HPV infection doesn’t often cause warts or other symptoms, so you can have it and pass it to another person without knowing it. Condoms protect against many sexually transmitted infections (STIs), but they don’t offer total protection against HPV. This is because HPV can be passed on by any 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.
A vaccine for HPV is available for people between ages 9 and 65. The CDC advises that all people through age 26 get the vaccine. Ideally, the vaccine should be given before a person becomes sexually active. It’s a preventive vaccine. It does not protect people who have already been exposed to HPV. Still, there may be some benefit in women already exposed to some strains of HPV, because the vaccine is directed against 9 strains and may protect against future exposure to these other strains. People ages 27 to 45 should talk with their healthcare provider about their risk for new HPV infection and the possible benefits of the vaccine.
According to the American Cancer Society (ACS), other factors that increase your risk for cervical cancer are:
- HIV infection or a weak immune system. HIV is the virus that causes AIDS. It damages the body’s immune system. HIV and any other condition that weakens the immune system puts a woman at greater risk for HPV infection. An example of a condition that weakens the immune system is taking medicines to suppress your immune system after organ transplant or to treat autoimmune disease. This may increase the risk for cervical cancer.
- Chlamydia. Chlamydia is a common STD with few symptoms. Recent research suggests that a past or current chlamydia infection may put a woman at greater risk for cervical cancer.
- 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. This may be because some women inherit a condition that makes them less able to fight off HPV infection.
- 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. Some of these chemicals have been found in the cervical mucus of women who smoke.
- Poor diet. Women who eat few fruits and vegetables may be at higher risk for cervical cancer.
- Not getting regular screening. Regular screening with Pap or HPV tests allows cervical cell changes to be found and treated before they become cancer. Most cervical cancers are found in women who never been screened or haven’t been screened regularly.
The importance of screening
The increased use of the Pap test has greatly reduced deaths from cervical cancer. Pap tests find early cancers and changes in the cells of the cervix that could lead to cancer. Cervical cancer develops slowly. It usually takes years to progress from a precancerous change to cancer. For many women, the precancerous changes don’t progress to cancer. Some will go away without any treatment. But precancerous conditions can also be treated. Preventing cancer from developing is key. Routine screening makes this possible.
Here are the ACS guidelines for cervical cancer screening:
- All women at average risk should start screening (testing) at age 25. Talk with your healthcare provider about your risk.
- Women between ages 25 and 65 should have a primary HPV test every 5 years. A primary HPV test is one that has been approved by the FDA to be done by itself for screening. If primary HPV testing isn’t available, screening can be done with either of these:
- Co-testing, which combines an HPV best with a Pap test every 5 years, or
- A Pap test alone every 3 years
- Women older than 65 who have had regular screening with normal results for the last 10 years and no history of serious cervical changes in the last 25 years can stop cervical cancer screening. 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 pre-cancer or cancer can stop screening.
- A woman who has had a hysterectomy without removal of the cervix should continue screening according to the above guidelines.
- A woman who has been vaccinated against HPV should still follow the screening recommendations for her age group.
HPV test, Pap test, and pelvic exam: The difference
A pelvic exam is not an HPV or Pap test, but they are usually done at the same time. The HPV or Pap test is often done first. For the HPV test, the healthcare provider puts a tool called a speculum into the vagina to hold it open, then gently scrapes or brushes the cervix with another tool to remove a small number of cells. This sample is sent to the lab. The Pap test can be done at the same time as the HPV test, and it’s done the same way. During a pelvic exam, a healthcare provider checks the health of a woman’s uterus and ovaries by feeling them through the belly (abdomen). For the exam, the provider puts one or 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.
This information is not intended as a substitute for professional health care. Always consult with a healthcare 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.