1. Women’s First Health Center Drs. Sylvester, Youngren, Lo and Sansobrino What You Should Know About Cervical Cancer: Part one in a series of four updates on women’s health screening protocols Created by Megan Blomeyer, St. George’s University, MS-IV

2. Introduction Over the years, there have been many recommendations for the appropriate age and time frame for screening. This series of presentations is designed to update you on the most recent changes to screening protocols so you can be in charge of your health. Although there are specific guidelines for each examination, The American College of Obstetrics and Gynecology recommends that the first visit to an OB/GYN take place between the ages of 13 to 15 years for the purposes of screening and guidance.

3. Pap Smears AgeRecommendation Younger than 21 years No screening 21-29 years Screening every 3 years 30-65 years Screening every 3 years (acceptable) or every 5 years with HPV testing** (preferred) Older than 65 years No screening if adequate screening prior to age 65 and not at a high risk for cervical cancer** After hysterectomy No screening if hysterectomy with removal of cervix or no history of high grade (CIN 2 or 3) or cervical cancer **Further information about cervical cancer risk factors and HPV follows. In 2012, ACOG released new guidelines for cervical cancer screening. Despite new recommendations to increase the amount of time between Pap Smears, a yearly check up is still suggested.

4. Cervical Cancer Risk Factors Multiple sexual partners or a male sexual partner who has had multiple sexual partners First sexual intercourse before age 18 Family history of cervical cancer Tobacco use A personal history of cervical, vaginal or vulval abnormalities

5. The Facts about HPV HPV or Human Papilloma Virus has been proven to cause genital warts and is associated with cervical cancer. There are currently over 100 subtypes of HPV identified, but 70% of cervical cancer is caused by types 16 and 18 and 90% of genital warts are associated with types 6 and 11. The FDA has approved two HPV vaccines which have shown similar effectiveness in protection against HPV types 16 and 18. This vaccine is recommended in females aged 9-26 and is administered in three doses over a six month period. Current research is being conducted to determine the effectiveness of the vaccine in females aged 26 years and older. Please note the HPV vaccine is not treatment for current infection with HPV, if you feel you have contracted HPV, you should consult your physician for further care.

6. Summary In summary, a Pap Smear should be conducted every three years beginning at age 21 years until age 65 years to screen for cervical cancer. The HPV vaccine should be given to all females aged 9-26 years to reduce their risk of developing cervical cancer.

7. Additional Information Visit the American College of Obstetrics and Gynecology, www.acog.org, or ask your doctor for more information on cervical cancer screening recommendations.

8. References Committee on Adolescent Healthcare. Number 467. Human Papilloma Vaccination. 2010 Sept. Web. 25 June 2013.. The American College of Obstetrics and Gynecology. Cancer of the Cervix: Frequently Asked Questions. 2013 Feb. Web. 24 June 2013..http://www.acog.org/~/media/For%20Patients/faq163.pdf?dmc=1&ts=201306 21T1957557194 The American College of Obstetrics and Gynecology. New Cervical Cancer Screening Recommendations from the U. S. Preventative Task Force and the American Cancer Society/American Society for Colposcopy and Cervical Pathology/American Society for Clinical Pathology. 14 March 2012. Web. 25 June 2013..%20Recommendations.aspx>.