Gynecological and Breast Cancer Screenings for Women

Here are the descriptions of the screenings you need, along with guidelines for how often to have them.

Pelvic Exam

A pelvic exam is an examination of external genitals, vagina, uterus and ovaries. You should have a pelvic exam when you have a pap smear. During a pelvic exam, your health care provider will examine you thoroughly. After checking the external genitalia for any abnormalities, your provider will insert an instrument called a speculum. The speculum allows your provider to look at your cervix and also take a Pap smear. The speculum may cause pressure, but it does not usually cause pain. Your provider may then insert one or two fingers into the vagina while pressing on your abdomen with the other hand to detect abnormalities in the shape of the uterus and ovaries, as well as any tenderness that might indicate a problem.

Cervical Cancer: Vaccination and Pap Smears

The cervix is the lower part of the uterus. This organ -- made up of muscle and fibrous tissue -- separates the vagina from the opening to the uterus. Cancer of the cervix is one of the most common cancers diagnosed in women in the United States. It is also one of the most curable when caught at an early stage. 

The FDA has approved the first vaccine to prevent infection with HPV, a major cause of cervical cancer.. Several strains of HPV have been identified. The vaccine protects against strains 16 and 18, which cause about 70 percent of cervical cancers, and against types 6 and 11, which cause about 90 percent of genital warts. The vaccine does not protect against HPV strains 31 or 45, which can also cause cervical cancer. The vaccine is approved for females ages 9 to 26 and women who have Pap smear abnormalities.

The number of deaths from cervical cancer has steadily declined each year, because of the increased use of the Pap test. This test can detect changes in the cells of the cervix that can lead to cancer.  The American Cancer Society (ACS) reports that for women diagnosed in the earliest stages, the five-year survival rate is nearly 100 percent.

The ACS recommends that women have their first Pap test about three years after they begin to have vaginal sexual intercourse, but no later than age 21. How frequently a woman has a Pap test after her first test depends on her risk factors for cervical cancer. You and your health care provider can decide together on a Pap smear schedule that is best for you.

You may need this exam more often if you have any of the following risk factors for cervical cancer:

• You have human papillomavirus (HPV) infection, this virus is the suspected cause of nearly all cervical cancer.

• You have a history of abnormal cervical cell changes that could lead to cancer.

• You have HIV (human immunodeficiency virus) infection.

• You have a current or past chlamydia infection; chlamydia is a common bacteria that infects the reproductive tract and is spread by sexual contact.

• You have had several sex partners; this increases the risk of getting HPV.

• You had intercourse for the first time before you were 18; this increases the risk for getting HPV.

• You smoke.

• Your diet is low in vitamins A and C.

• Your mother took diethylstilbestrol (DES) when she was pregnant with you. DES is a drug that was prescribed between 1940 and 1971 for some women at increased risk for miscarriages.

• You did not have the HPV vaccine before becoming sexually active.

To perform a Pap smear, your health care provider will insert a speculum into the vagina and scrape a few cells from the cervix with a spatula. This procedure is usually painless and does not pose any risk to your health. Your provider will then send the sample to a laboratory that will review the sample for abnormalities.

Because a Pap smear is a screening test (not a diagnostic test), if it shows an abnormal result, your provider may want to you to have other tests to determine if you have a precancerous condition or cervical cancer. He or she will probably recommend that abnormal cells be removed in order to make a definite diagnosis, or as treatment for the condition. Several methods are used to remove the cells from the surface of the cervix, including laser surgery, cryosurgery (freezing abnormal cells with chemicals to destroy them), electrocautery (burning off abnormal cells with electricity) and LEEP (using a heated wire to remove cells). All of these procedures can be done in your provider's office.

Breast Cancer Screenings

Appropriate screening for breast cancer should be a part of your well-woman exam. Depending on your age and other risk factors, there are two well-established methods your provider will use: a clinical breast exam and a mammogram. You may want to examine your breasts each month so you can become familiar with their shape and detect any changes. The ACS recommends that all women ages 40 and older and at average risk for breast cancer have a screening mammogram every year; they should continue to do so for as long as they are in good health. Women at increased risk should talk to their health care provider about when to begin screening and what tests are best. For clinical breast exam, the ACS recommends  that women in their 20s and 30s have a clinical breast examination (CBE) as part of a regular health exam by a health professional, preferably every three years. After age 40, women should have a breast exam by a health professional every year.