Dr. Joia Crear-Perry
Most of us are creatures of habit. Getting a yearly pap and mammogram had become part of our routines to live long healthy lives since it became widely used in the 1950’s. At that time, cervical cancer was the leading cause of cancer death among women in the U.S.
Since the introduction of the test, the rates of cervical cancer in the U.S. decreased by 70%. The test works as an effective screening tool because it can pick up abnormal cells before they turn into cancer cells (precancer cells) and your doctor can treat you prior to them becoming cancerous. Once we discovered the cervical cells are changed by the Human Papilloma Virus (HPV), we then began to look at how long this change takes to occur.
The HPV virus is acquired during sexual intercourse. We now understand that the progression from precancerous cells to cancer can take on average 10 years. A vaccine has been developed to prevent infection with HPV and is recommended by CDC for boys and girls from 9 – 26. http://www.cdc.gov/features/preventhpv/index.html
The goal of this vaccine (as with the Hepatitis or Polio vaccines) is to give something that is similar enough to the virus so that your body will build an immune defense to the HPV if you are exposed without causing you to become sick.
The goal of all screening tests (Mammograms, PSA, Colonoscopy), is to decrease the number of people who have the disease. As the numbers of women with cervical cancer have decreased due to this very critical screening tool, we began to also look at some of the downsides of doing the screening. Since 1997 the conversations within the medical field have been ongoing about who should be screened, when to start, when to end, and how often. This can cause confusion as we try to navigate our health and that of our family members.
According to the American Congress of Obstetrics and Gynecology (ACOG) cervical cancer screening should begin at age 21 regardless of the age of first sexual intercourse. This is a change that occurred due to greater understanding that “earlier screening may increase anxiety, morbidity, and expense and lead to overuse of follow-up procedures like colposcopy and surgery. The emotional effect of labeling an adolescent with a sexually transmitted infection and potential precancer must be considered because adolescence is a time of heightened concern for self-image and emerging sexuality.” Before 21, counseling on safe sex practices and the HPV vaccine are the best strategies for prevention of cervical cancer.
Between the age of 21 and 29, women should receive a pap smear every three years. For women between 30 and 65, a pap smear with an HPV test should be done every five years or pap without HPV test every 3 years. If you are over 65 or if you have had a hysterectomy, cervical cancer screening does not need to be done. If you have risk factors such as history of an abnormal pap smear or HIV, your provider will screen you more frequently. Follow up of abnormal screening will be guided by your provider as well.
These recommendations were made by ACOG in January 2016. In the statement when they released these guidelines, they noted that this is an ever evolving guideline as technology updates and may change again soon.
The Screening mammogram is also another tool that has been under more scrutiny in the last decade. Within the medical community there is disagreement as to when to begin screening. This is crucial for women of color as we are die at higher rates and are diagnosed later than our white counterparts. ACOG continues to maintain that women should be screened yearly beginning at age 40.
Going forward we want to ensure our Women of Color are connected to changes in health policy and guidelines and are part of the conversations when these policies are developed to ensure parity and equity.
Dr. Joia Crear-Perry is CEO of the National Birth Equity Collaborative. She serves on the Board of Trustees for Community Catalyst, National Medical Association and the New Orleans African American Museum. Her love is her family; health equity is her passion; and maternal and child health is her calling.