375th MDG recommends vaccination, screening for cervical cancer Published Jan. 22, 2014 By Capt. Christopher Meinhart, MD 375th Medical Group SCOTTS AIR FORCE BASE, Ill. -- Cervical cancer is the third most common gynecologic cancer in the United States. The incidence of cervical cancer has seen a dramatic decrease over the past 30 years. In fact, a 50 percent reduction in the number of cases has been noted since 1975. As a result, deaths from this disease have also decreased. This effect is largely due to cervical cancer screening programs that have evolved since inception of the original Pap smear screening test. Dr. George Papanicolaou was a pioneering figure in developing Pap smear screening techniques. While his research began around 1915, it wasn't until the 1940s that the Pap smear was first introduced. At that time, cervical cancer was the number one killer of women. Since that time, rates of cervical cancer and cervical cancer deaths have been reduced significantly. While the process for obtaining and evaluating Pap smears has changed over the last 20-30 years, the basic concept of the Pap smear has remained the same. Cells are gently scraped from the cervix and examined under a microscope to determine if any abnormal cells are present. This technique allows for the earlier detection of cervical cancer, but more importantly, the detection of abnormal cells before cancer develops. In recent years, it has become clear that human papillomavirus infection can cause cervical dysplasia (abnormal cells that may be precursors to cancer) as well as cervical cancer. HPV is the most commonly diagnosed sexually transmitted infection in the United States. While there are hundreds of strains or types of HPV, they are generally split into "high-risk" or "low-risk" groups. Low-risk types of HPV are primarily responsible for causing genital warts and mild cervical dysplasia while high-risk groups are associated with severe dysplasia and cervical cancer. Seventy percent of cervical cancers are linked to just two separate strains of HPV; types 16 and 18. As understanding of this virus and its association with cervical cancer has grown, new screening strategies have been developed to detect not only abnormal cells, but ongoing HPV infection. This information has led to the development of several vaccines aimed at inhibiting or stopping the spread of this virus. There are two types of HPV vaccine currently available. The one used at the 375th Medical Group at Scott AFB is a three-shot series. It is meant to protect patients from the four most common types of HPV associated with genital warts, cervical dysplasia, and cancer. In patients who have never been exposed to HPV, the vaccine prevents severe cervical dysplasia and cancer by as much as 97 percent. In women who might have been previously exposed to HPV virus, the vaccine works approximately 44 percent of the time. The FDA has approved the vaccine for use in female patients between the age of 9 and 26. The World Health Organization suggests that vaccinations for girls ages 9 to 13, prior to sexual contact, is most beneficial. The American Cancer Society, the American Society for Colposcopy and Cervical Pathology, and the American Society for Clinical Pathology have recently updated their guidelines for cervical cancer screening. In response, the American College of Obstetricians and Gynecologists revised their 2009 Practice Bulletin regarding screening for cervical cancer and published new recommendations in November 2012. In this new bulletin, as well as with ASCCP guidelines, both Pap smear and HPV testing are recommended. The 375th Medical Group uses these updated recommendations and guidelines for screening, evaluating and treating cervical dysplasia and cervical cancer for all active duty members and their families. Based on these new screening guidelines, we recommend the following vaccination, screening and education: · All young women should be vaccinated for HPV between ages 9 and 26. · All women should be counseled regarding risk factors for cervical cancer including smoking cessation. · All women should undergo yearly well-woman exams. · Women ages 21-29 should undergo a Pap smear every 2-3 years. HPV testing should be done only in certain situations. · Women ages 30-65 should undergo a Pap smear every three years; alternatively a Pap smear and HPV test can be done every five years. For more information, contact your primary care manager by calling 256-WELL (9355).