The American Cancer Society estimates that in 2009 there will be 11,270 new cases of cervical cancer in the United States and 4,070 deaths. Cervical cancer has been linked to the human papilloma virus (HPV). As a sexually transmitted disease, HPV can be transmitted between two women, as well as between a man and a woman. Therefore, anyone who has sex - especially unprotected sex - with men or women is at risk for HPV infection. Cervical cancer tends to occur in midlife. Most cases are found in women younger than 50.

Risk Factors:

• Sex at an early age
• Sex with multiple partners
• Smoking
• Being overweight

Symptoms include:

• Abnormal vaginal bleeding that happens between periods
• Periods that are heavier or longer than normal
• Bleeding after douching or penetrative sexual contact
• Increased vaginal discharge

Prevention:

• While HPV is connected to cervical cancer, you can be vaccinated against certain strains. Ask your doctor if she or he recommends a vaccine for you.
• Women over age 21 should have a PAP test every one to two years. After age 30, many women who have had 3 normal test results in a row may get the Pap test every 2 to 3 years. Another option for women over 30 is to have a Pap test every 3 years plus the HPV DNA test.
• Women with HIV or other immune deficiencies should have a Pap test every year.
• If you are over 70, or have had a total hysterectomy that was not due to cancer, then you may choose to stop having Pap tests.
• The Pap test is the best way to prevent cervical cancer or to find it early, but it is not perfect. Even good labs can miss some cell changes, so you should have the test regularly. Women who are no longer having children still need to have Pap tests.

Barriers to Care: Not all American women have Pap test screening. The elderly, African-Americans, low-income women, and women who are recent immigrants are less likely to have regular Pap tests. Lesbians are also less likely to have Pap tests, and are even sometimes told by their doctors that, since they do not have sex with men, it is not necessary. However, many lesbians have had, or continue to have, sex with men. Also, HPV can be transmitted between women. Therefore, lesbians need Pap tests as regularly as their heterosexual peers, and need to insist on being screened even if their doctor doesn't feel it's necessary.

Discussing sexual history and identity openly with a physician can be difficult for many lesbians, as they have had or are afraid of having a negative experience with their doctor regarding their sexual orientation. Staff may be judgmental toward LGBT sexuality, or be misinformed/uninformed about LGBT resources. LGBTs may experience discrimination against partners in favor of family of origin. However, it is important to find a doctor you can trust and feel comfortable sharing this important information with. If your doctor is fully aware of your risk factors, she or he will be more effective in getting you the care you need.

References:

• Curry, S. J., Byers, T., Hewitt, M. (Eds). (2003). Fulfilling the potential of cancer prevention and early detection. National Academy Press: Washington, DC.
• American Cancer Society. Overview: Cervical Cancer. http://www.cancer.org/docroot/CRI/CRI_2_1x.asp?dt=8