This month is Cervical Health Awareness Month. I’m referring here to the opening of your uterus (womb), not to be confused with the part of your spine that is located in your neck.

You may wonder exactly what you need to be “aware” of regarding your cervix, especially at this age if you’re either approaching, are in the midst of, or have completed menopause. It turns out that there’s a lot you still need to know, particularly about the disease, cancer of the cervix. In fact, the US Congress thought this was such an important topic that they’re the ones who actually designated this January as cervical awareness month.

One of the most important things about cervical cancer , and perhaps surprising to many of you, is that it is, in most cases, a preventable disease. Yes – that’s right – it can be prevented. Now, you might say that that is no big deal because we can prevent lung cancer by not smoking cigarettes, and breast cancer by not taking estrogen, but you’d be wrong on both counts. Yes – smoking can cause some lung cancers, but may not be the only thing to do that since not everyone who smokes gets it; neither does smoking cause all lung cancers as there are certain types of lung cancer which occur in people who have never smoked. And yes – taking estrogen may be related to breast cancer, but there are other factors that also may cause it.

We can prevent cervical cancer because we absolutely know what the main cause is – certain types (the “high-risk” types) of the viral infection, Human papillomavirus (HPV). That’s why the vaccine against cervical cancer that you’ve been hearing so much about, Gardasil, works – because it actually prevents infection with several of the high-risk types of HPV that can lead to cervical cancer. So, does every woman who has an HPV infection of her cervix get the cancer? No, because not all types of HPV cause the cells of the cervix to become abnormal and develop into cancer. Even women who are diagnosed with one of the high-risk types of HPV do not necessarily go on to develop cervical cancer.

There’s another way cervical cancer can be prevented: screening. This means that by finding the early, pre-cancerous condition of the cervix, sometimes called cervical dysplasia, and treating it, those abnormal cells should no longer progress on to cancer. How is this done? Simple. By that test that you’ve known about and had done since you were young – the Pap smear. This test, taken at the time that you have your yearly visit with your gynecologist and your pelvic exam, has been a true medical success story; there has been a great decrease in the number of cervical cancer cases, and in the number of deaths from cervical cancer, since the Pap smear began to be routinely used in 1950. Today, death from cervical cancer is rare in women who get regular Pap smears.

And there’s more good news. There is another test that can help to prevent cervical cancer, which is as easily taken at the same time as the Pap smear, called the HPV test. This test takes cells from the cervix, as the Pap smear does, but looks for HPV infection itself within the cells. If the types of HPV that lead to cancer are found, further studies may be done to look for very early cancer of the cervix not seen on the Pap smear. Most gynecologists these days will obtain both a Pap smear and the HPV test in appropriate patients.

Now, here’s what is special about women our age and cervical cancer and the Pap smear. First of all, would it surprise you to know that many postmenopausal women no longer have annual pelvic exams because they think they don’t need them any longer? Studies have shown that the women least likely to get Pap smears and pelvic exams are over 50. And, within that group (our age group), women in their 70’s and 80’s are much less likely to have these exams than are women in their 50’s and 60’s.

If you happen to be one of the women who doesn’t think you need annual or routine pelvic exams, think again. The risk of getting cancers of the reproductive tract organs, like ovarian and uterine cancer, goes up with age; the risk of death from cervical cancer is highest for white women between the ages of 45 and 70 years of age, and for black women in their 70’s. Sometimes, particularly when the cancer has not progressed, these diseases don’t cause any symptoms, and are only found by your clinician. And we all know that the earlier any cancer is found, the better the chance is for a cure. So, if you’re not getting regular exams that screen for these cancers, you are missing the chance to save your own life.

The second thing that some women our age are surprised about is that we still can get sexually transmitted infection (STI). Yes – even after menopause and even if you’ve had a hysterectomy. If you’ve had a new sexual partner recently, you could’ve become infected with an STI, and not even know it. Further, several of the STI’s – HPV, HIV, and herpes virus included can remain silent in the body for years, only showing up and causing disease years later. This means that you might’ve been infected by a prior sexual partner – say, 10 years ago (even earlier for HPV and herpes) – and did not realize it at the time, only to have that infection become active in your body now, after all these years.

Bottom line, you still need to be aware of your cervix and its health. And you still need to get annual pelvic exams from your gynecologist or from your primary care provider. Even though cervical cancer most often shows up in younger women than our age group, it can show up at any age. As you’ve read above, not only can cervical cancer be prevented, but the chances of your dying from cervical cancer are much less if it is caught early. Make that appointment for a pelvic exam and the testing that goes with it today! And make sure all your girlfriends, as well as the younger women in your life, go too!

For more information, go to: http://www.nci.nih.gov/cancertopics/pdq/screening/cervical/Patient/page2 and to: http://www.nccc-online.org/index.html

Also, there is an entire chapter in our book devoted to cancers in women our age, including cervical cancer, and which goes into more detail than the above. There is another entire chapter devoted to the health, and the most common diseases, of the aging organs of the female reproductive tract, other than cancer. The latter chapter talks about the most common symptoms occurring in women of our age group, discusses the Pap smear and the need for us to continue to get annual pelvic exams, and the issue of sexually transmitted infections (remember – we can still get these at this age, but that’s topic for another blog…)  Janet Horn

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