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This blog was written by Charlotte Gamble MD, MPH and Lauren Damle, MD.
With over 14 million new infections every year, human papillomavirus (HPV) is the most common sexually transmitted infection in the U.S. Our immune system fights off most HPV infections—often without us even knowing—but certain HPV strains can remain and cause abnormal, precancerous cells to form. Unless these cells are identified and removed early, they’ll continue to grow and eventually become cancer.
Cervical cancer is the most common HPV-associated cancer—and the only one caused by HPV that can be detected early. It occurs in the cervix, which is the tissue at the base of the uterus and the top of the vagina.
Cervical cancer is almost 100% preventable, thanks to HPV vaccines and routine Pap smears with HPV testing. Though these advances have reduced cervical cancer rates, over 14,000 new cases are expected to be diagnosed in the U.S. in 2022 and over 4,000 patients will die from cervical cancer.
These numbers would be drastically lower if more young patients—of all genders—received the HPV vaccine at the recommended age (11 or 12) and more adults with a cervix received regular Pap smears throughout their adult lives.
To help decrease future cervical cancer rates, we’re clearing up common misconceptions about these preventive methods. Here are the top five myths we hear—and the truth about the safety and effectiveness of HPV vaccines and screenings.
Related reading: Why is HPV-related Head and Neck Cancer Surging Among Young Adults.
Myth 1: The HPV vaccine is not safe.
Truth: Several studies have verified the vaccine’s safety.
Some parents worry that the HPV vaccine will cause health problems such as infertility later in their child’s life. This is not true—we have excellent safety data from years of clinical studies. Cervical cancer, however, has a much higher likelihood of causing infertility. We only have fertility-preserving treatments for early-stage cervical cancer.
The U.S. Food and Drug Administration approved the HPV vaccine based on research involving several thousand participants over several years. The vaccine protects against nine strains of HPV, including the higher-risk strains that can cause cancer. And since they were first used in 2006, HPV vaccines led to an over 80% drop in infections that can cause cancer and a 40% drop in cervical precancers.
Myth 2: Patients should wait until they’re older to get the HPV vaccine.
Truth: Earlier vaccines offer better protection.
Though the HPV vaccine is approved for use through age 45, it’s recommended at age 11 or 12 and can be given as early as age 9. The vaccine is most effective before exposure to HPV, which often happens in adolescence or young adulthood. Plus, studies have shown that the immune system responds better to the vaccine in preteens than in young adults.
Think of it like the hepatitis B vaccine, which is recommended for infants. Exposure to hepatitis B is more likely to occur later in life than in childhood. Getting vaccinated as a baby prevents them from getting the hepatitis B virus at any point in their life. The earlier they get the vaccine, the longer they’re protected.
Getting the vaccine before age 15 requires only two doses. People who get vaccinated after age 15 require three doses.
Myth 3: Patients who have received the HPV vaccine don’t need regular Pap smears.
Truth: The HPV vaccine protects against most—but not all—high-risk HPV strains. Combining the vaccine with routine Pap smears provides the strongest protection against cervical cancer.
Depending on your age and the results of past screenings, a Pap smear is recommended every three to five years for patients age 21-65 who have a cervix. During a Pap smear, your doctor collects cervix cells to screen for precancer or cancer. The Pap smear can be part of your annual gynecology exam.
At MedStar Health, we follow cervical cancer screening guidelines from the American College of Obstetricians and Gynecologists (ACOG) and American Society for Colposcopy and Cervical Pathology (ASCCP). These include Pap smears every three years for patients ages 21-29 and a Pap smear plus HPV testing every five years for patients ages 30-65. We test for the high-risk HPV strains that can cause cervical cancer.
Many patients with cervical cancer we care for have not had regular Pap smears, and almost none of them have received the HPV vaccine. This is sadly often due to loss of health insurance or employment, though occasionally patients will defer and delay their own health screenings because life gets in the way. Please don’t delay—get scheduled today.
Most types of cervical cancer grow slowly, so we can likely prevent cancer from developing if we find precancerous cells during a routine test. The longer a patient with cervical cancer goes without Pap smears, the more advanced the cancer will be when we find it. At that point, the cancer will likely have spread outside the pelvis and be more difficult to treat.
Related reading: Pap Smears: 8 Frequently Asked Questions.
Myth 4: A Pap smear and a pelvic exam are the same thing.
Truth: Pap smears and pelvic exams are both important aspects of gynecological care, but they check for different conditions.
During a pelvic exam, your doctor checks for general abnormalities in the cervix, fallopian tubes, ovaries, uterus, and vagina. This exam looks for internal and external signs of disease or illness, including cancers, cysts, fibroids, and sexually transmitted diseases. It does not specifically look for signs of cervical cancer unless a Pap smear is performed as part of the pelvic exam.
A screening Pap smear isn’t needed every year for most patients who have had prior normal Pap test results. But we recommend yearly visits with a gynecologist or primary care provider who can review your need for a Pap smear, screen you for any symptoms of cervical cancer, and perform a genital examination.
We have treated patients who developed cervical cancer in their 70s because they didn’t realize they needed to continue to schedule routine exams and monitor their gynecological health. The sooner we find abnormalities, the faster we can diagnose and treat them.
Myth 5: An abnormal Pap smear test means you have cervical cancer.
Truth: An abnormal Pap smear means abnormal cells were found. This does not mean you have cervical cancer. But it does mean your doctor needs to perform a special diagnostic test called a colposcopy to take a closer look at your cervix with a magnifying device and take biopsies of different parts of your cervix.
If the cells taken during this test are very advanced precancer, they’ll need to be removed. If the cells show cancer, you will be referred to a gynecologic oncologist.
If no precancer or cancer is found, you will likely be asked to come back for a Pap smear within 6-12 months. Do not skip this appointment. Careful follow-up after an abnormal Pap smear can help your doctor ensure your immune system is clearing the HPV and resolving the abnormal cervical cells or detect an abnormality sooner.
Remember, most changes in cervix cells are caused by HPV, so an abnormal Pap smear usually means that you have an HPV infection. Fortunately, the immune system is able to clear most HPV infections. Some patients may not be able to do this well, such as those who have HIV or take medications for organ transplants. Smoking also makes it harder for your body to clear the infection, so if you smoke, quitting is the first step toward returning to normal pap smears.
Patient-centered preventive care.
Patients at MedStar Health have access to HPV vaccination and screening tests through both primary care and women's health services.
We want to make sure you know the reasoning for and the results of all your exams. You are always empowered to ask your doctor questions about exams and test results until you have a full understanding—and to seek a second opinion if you’re not comfortable with their recommendations.
MedStar Health providers recognize that gynecological exams can be uncomfortable, especially for patients who have experienced trauma or are part of the transgender community. We welcome open, honest conversation to learn more about your background and experiences. Our goal is to help you feel safe and comfortable as we partner together to reduce your risk of cervical cancer.
