Make Cervical Health a Priority

Make Cervical Health a Priority

January is dedicated to protecting women’s health and working together to put an end to cervical cancer.

As the month of January brings cervical cancer into focus, it’s time to increase public understanding of the disease, including its prevalence, risk factors, and approaches to screening and prevention. Cervical cancer is the fourth most diagnosed cancer in women and the fourth leading cause of cancer-related death. Each year in the United States, more than 13,000 women are diagnosed with cervical cancer, and approximately 4,300 women will die of this disease.

The good news is that thanks to proactive measures, such as regular screening tests, most cases of cervical cancer are now preventable. And when detected at an early stage, treatment is very effective, with a five-year survival rate surpassing 90 percent.

January is Cervical Health Awareness Month, a time when organizations and charities nationwide collaborate to increase understanding and awareness of cervical cancer and encourage women to talk to their doctors and know their risk. This month, we’re putting a spotlight on this disease and stressing the importance of early detection. Together we can combat cervical cancer through prevention, screening, early detection, and treatment. Get involved and use this month as an opportunity to educate yourself and others, empower women, offer hope, and save lives.

Know Your Risk

Cervical cancer is a malignant tumor that arises when the cells lining the cervix — the lower part of the uterus that connects the body of the uterus to the vagina — mutate, grow, and multiply when they should not. Although all women are at risk for cervical cancer, it occurs most often between the ages of 35 and 44, with 50 years being the average age at diagnosis. While the exact cause of cervical cancer remains unclear, certain factors make it more likely to develop, including:

  • Human papillomavirus (HPV) infection: More than 90 percent of all cervical cancers are caused by HPV, a group of more than 150 related viruses that can be passed from one person to another during skin-to-skin contact. Some types of HPV can cause cervical changes that may lead to cervical cancer over time, while others can cause a type of growth called papillomas, more commonly known as warts.
  • Sexual history: Behaviors that increase the chances of exposure to HPV, such as becoming sexually active at a young age, having many sexual partners, or having a partner who is considered high risk (someone with HPV infection or who has many sexual partners), may increase risk.
  • Long-term use of birth control pills: Women who have used oral contraceptives (OCs) for five to nine years have about three times the incidence of invasive cancer, and those who have used them for 10 years or longer have about four times the risk. Research suggests that the risk of cervical cancer increases the longer a woman takes OCs, but the risk goes back down after the OCs are stopped and returns to normal after avoidance for many years.
  • Young age at first full-term pregnancy: Women who were younger than 20 when they had their first full-term pregnancy are more likely to get cervical cancer later in life than those who waited to get pregnant until they were 25 years or older.
  • Having multiple full-term pregnancies: Women who have had three or more full-term pregnancies have an increased risk of cervical cancer.
  • Chlamydia infection, past or current: Some studies show that Chlamydia bacteria may help HPV grow and live on the cervix, which may increase the risk of cervical cancer.

Spot Cervical Cancer Symptoms

Women with pre-cancers and early cervical cancers are usually asymptomatic. As the tumor enlarges and invades surrounding tissues, symptoms may arise. The most common symptoms include:

  • Abnormal vaginal bleeding:
    • Bleeding after intercourse
    • Post-menopausal bleeding
    • Bleeding and spotting between periods
    • Longer or heavier menstrual periods than usual
  • Vaginal discharge: Abnormal foul-smelling discharge that may be pale, watery, brown, or mixed with blood
  • Dyspareunia: Pain during or after sexual intercourse
  • Pain in the pelvic region

Women with more advanced disease may experience heavy vaginal bleeding, lower extremity swelling, or blood in the urine (hematuria), in addition to generalized symptoms such as loss of appetite, weight loss, fatigue, and unexplained, persistent pain in the pelvis, back, and/or legs. As the disease progresses, it may cause problems with urination or having a bowel movement.

Screening Saves Lives

While the presence of the above symptoms can aid in diagnosis, the best way to detect cervical cancer early is to have regular screenings with a Papanicolaou (Pap) test, which may be combined with an HPV test. These two tests help prevent cervical cancer or find it early.

  • Pap test: The physician collects cells from the cervix
    using a small spatula or brush. The sample is sent to a lab
    to be examined for abnormalities indicative of cancer and pre-cancerous changes. An abnormal Pap smear result typically means further testing is needed — colposcopy (with biopsy), endocervical scraping, cone biopsies — to confirm whether cancer or pre-cancer is present.
  • HPV DNA test: This checks for the high-risk (carcinogenic) HPV types that are most likely to cause cervical cancer, by looking for pieces of their DNA in cells collected from the cervix. This test can be done by itself or as part of a co-test, in which the HPV test is performed at the same time as a Pap smear to screen for cancer.

Coding tip: For information on how to code cervical cancer screening tests, visit our Knowledge Center. “Quick Coding for Women’s Preventive Services” and “Medicare Screening Pap Calls for Q0091” explain coding for Pap tests, and “New Medicare Benefit: HPV Screening” covers coding for HPV testing.

Screening Recommendations

Early detection improves the likelihood of successful treatment considerably and can prevent any early cervical cell changes from developing into cancer. The U.S. Preventive Services Task Force (USPSTF) recommends the following screening guidelines for all women:

  • Women younger than 21: Screening is not recommended.
  • Women aged 21 to 29: Screen via Pap test alone (slide or thin prep) every three years starting at age 21, with testing for HPV only in certain cases of abnormal results.
  • Women aged 30 to 65: Testing frequency depends on the type of screening and whether you have a recent history of an abnormal test; talk to your doctor about which option is right for you.
    • Co-testing: A combination of Pap smear and high-risk human papillomavirus (hrHPV) testing every five years.
    • Pap test only: Screen with cervical cytology alone every three years.
    • Primary HPV testing: Screen with hrHPV testing only every five years.
  • Women older than 65: Consult with your doctor about whether you should continue screening, taking into consideration past test results and the level of risk for cervical cancer.

The American Cancer Society’s 2020 recommendations differ slightly. The two major differences are to start screening at 25 with an HPV test alone every five years until age 65 and to preferentially recommend primary screening with an HPV test only. They also state that if primary HPV testing is not available, screening with an HPV/Pap co-test every five years or a Pap test every three years is also acceptable.

5 Ways to Reduce Your Risk

Cervical cancer usually starts with pre-cancerous changes, and there are ways to stop this from developing. The Centers for Disease Control and Prevention recommend:

  • Get screened: The most important thing you can do to help prevent cervical cancer is to have regular screening tests starting at age 21 (or 25, depending on risk and coverage) to look for pre-cancer and cancer. If a pre-cancer is found, it can be treated, keeping it from turning into cervical cancer.
  • Limit exposure to HPV: HPV is passed from one person to another during skin-to-skin contact with an infected area of the body. Limiting your number of sexual partners and avoiding sex with people who have had many sexual partners may lower your risk of exposure to HPV.
  • Practice safer sex: Condoms may provide some protection against HPV infection, but they don’t completely prevent infection. While the effect of condoms in preventing HPV infection is unknown, condom use has been associated with a lower rate of cervical cancer.
  • Inquire about HPV vaccines: Vaccines may help protect against infection from both high-risk HPV types most commonly linked to cervical, vaginal, and vulvar cancers, as well as low-risk types that can cause anal and genital warts. To maximize effectiveness, the HPV vaccine should be given before any exposure to HPV. Discuss the side effects, benefits, and risks with your doctor.
  • Don’t smoke: Carcinogens associated with smoking can lead to early progression of cervical cancer.

Protect Your Health

January — Cervical Health Awareness Month — provides the perfect opportunity to leverage the power of your voice to raise awareness about cervical cancer, HPV, and the importance of early detection through regular screenings. Events and activities are held all month to educate about risk factors and symptoms of cervical cancer; provide greater access to screenings; and advocate for further research into its cause, prevention, diagnosis, treatment, and to ultimately find a cure.

Throughout January, communities, organizations, and healthcare professionals work together to ensure women understand what they need to do to protect themselves and stay healthy. And more importantly, that they translate that understanding into action: screening, vaccination, and well-woman visits. Wear teal and white this month — the symbolic colors for cervical cancer awareness — and help spread the word. Together, we can put an end to this disease.

Stacy Chaplain

About Has 127 Posts

Stacy Chaplain, MD, CPC, is a development editor at AAPC. She has worked in medicine for more than 20 years, with an emphasis on education, writing, and editing since 2015. Chaplain received her Bachelor of Arts in biology from the University of Texas at Austin and her doctorate in medicine from the University of Texas Medical Branch in Galveston. She is a member of the Beaverton, Ore., local chapter.

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