Cervical cancer is almost always linked to the human papillomavirus (HPV), which is spread through genital skin to genital skin contact during sexual activity. A recent study of women aged 35-60 found that HPV in women at, or after, menopause may have been acquired years earlier. In fact, menopause may occur at a time of higher risk for reactivation of the virus.
There are many types of HPV, with some strains known to be more highly associated with cervical cancer than others. Some strains cause warts on the hands; others cause papillomas on the feet. While HPV is very common (affecting about 80 per cent of sexually active people at some point), most people never know they have it as they may not experience symptoms or symptoms may not appear for months or years down the track.
Older women often mistakenly believe their risk of cervical cancer is low, perhaps because they have had a hysterectomy, are widowed or are no longer sexually active. This belief is far from the reality that most cases of cervical cancer occur in women over 50. This is a consequence of an approximate 10 year delay in the development of cervical cancer after being exposed to the HPV virus.
The recurrence rate in older women highlights the need to continue to have regular Pap tests, even after stopping being sexually active.
One of the biggest risk factors for cervical cancer is the number of sexual partners a woman has had. For baby boomers, many of whom enjoyed their sexual liberation in the sexual revolution of the ‘60s and ‘70s, may be at a significantly higher risk of HPV than women from previous generations.
The best advice for knowing whether you have HPV
The best way to detect HPV is by having regular Pap tests, even if you are no longer sexually active.
For more accurate testing, a colposcopy or HPV DNA test can be done. These are usually only done with women who have a history of abnormal cervical changes.
The HPV vaccine is highly effective in reducing the risk of cervical cancer; however, it must be administered before any sexual activity. If it was given after the commencement of sexual activity, it is recommended that you have regular pap screening.
Pap tests are recommended every two years for women, even if they have had the HPV vaccine.
The future of Pap screening
There is currently an important research project being conducted called COMPASS, which is a joint project between the Victorian Cytology Service and the University of NSW. This trial is looking at ways of screening for cervical cancer using HPV testing, as an alternative to Pap screening. The trial is also looking at increasing the length of time between Pap tests. The trial results will show if this new approach, coupled with the highly effective vaccination program, is more effective in cervical cancer prevention.
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