The ISIS Project

What is Cervical Cancer? - FAQ

1. Cervical Cancer Background

1.1.1. What is Cervical Cancer?

1.1.2. What is cancer?
The human body is made up of many cells. Normally, cells divide and grow in an orderly manner. Cancer happens when cells grow out of control. Cancer cells crowd out normal cells and cause health problems.

1.1.3. Where is the cervix?
The cervix is the lower part of the uterus (or womb) that opens into the vagina. During the childbirth, the baby passes through the cervix in order to be born.

2. Cervical Cancer in Women

2.1.1. Who can get cervical cancer?

2.1.2. How common is cervical cancer?
The American Cancer Society (ACS) estimates that 9, 710 women will be diagnosed with cervical cancer in 2006. That’s 1 woman every 54 minutes. The ACS estimates that approximately 3, 700 women will die of cervical cancer in 2006. That’s 1 woman every 142 minutes. The good news is that the number of American women with cervical cancer has decreased about 75 percent in the past 50 years – largely thanks to the Pap test. The bad news is too many women are still getting cervical cancer and are still dying. This, however, can change for the better.

First, all women need to be screened regularly with the Pap test.
Second, there is now a test that can detect HPV (the virus that causes cervical cancer). The HPV test can be combined with a Pap in women 30 years of age and older (those who are most likely to develop cervical cancer). This will increase doctors’ ability to determine which women are at risk.
Third, there is an HPV vaccine to protect young girls and women from the HPV types that cause 70% of cervical cancers.

2.1.3. At what age do most cervical cancers occur?
Women of any age can get cervical cancer. Though, most cervical cancer occurs in women over 30 years old. But it’s clear that new cases of cervical cancer increase with age. New cases of cervical cancer seem to level off at age 40 years old for white women. In African American women, there is a peak of new cases at age 40 years old and there is another peak of new cases after age 80 years old. Deaths from cervical cancer seem to level off at age 50 years old for white women. In African American women, deaths from cervical cancer steadily increase with age and peak in the 80s.

3. Natural History of Cervical Cancer

3.1.1. Could I have cervical cancer and not know it?

Most of the time

Unusual vaginal discharge or bleeding (especially after sexual intercourse)
Lower back pain
Painful urination (particularly when there is also pain in the lower abdomen)
Pain during sex

Remember:

3.1.2. How long does it take for cervical cancer to develop?
Once cervical cells begin to change, it typically takes 10-15 years before cancer develops. As the cells change, they can become "pre-cancerous.” When cells become precancerous this condition is given a scientific name called "dysplasia." Another scientific name for dysplasia is CIN, which stands for cervical intraepithelial neoplasia.

If detected early, dysplasia or pre-cancer can be treated before the cells become cancerous.

4. The Risk Factors for Cervical Cancer

4.1.1. What causes Cervical Cancer?

high

risk

Almost every woman will get HPV at least once in her life. The body’s immune system usually fights off the virus. Therefore, most women with HPV never suffer any problems as a result. In some women, however, the virus does not go away. When the virus stays in the body for a long period of time, cervical cells may begin to change and the risk of cervical cancer increases.

4.1.2. How does HPV lead to cervical cancer?
HPV acts like a carcinogen. A carcinogen is a cancer-causing agent. Other carcinogens you may have heard of include the chemicals in tobacco smoke or asbestos. HPV can lead to cancer by stopping cells from dividing normally. Usually cells divide and grow in an orderly manner. HPV may help cells grow out of control and become cancerous.

4.1.3. What are other factors associated with getting cervical cancer?
HPV is the cause of nearly all cervical cancers (99.7 %). Most women who get HPV don’t develop cancer, however. HPV infection plus other risk factors increase your chances of developing cervical cancer. Other risk factors associated with cervical cancer include:

Not getting screened regularly for cervical cancer
Having sexual intercourse at a young age
Number of sexual partners
Smoking
Having a weakened immune system (for example women with HIV or organ transplants)

5. Modifying Your Risk Factors for Cervical Cancer

5.1.1. Is there anything I can do to prevent from getting cervical cancer?

The number one thing you can do is to get regular screening for cervical cancer. About 6 out of 10 women who are diagnosed with cervical cancer have never had a Pap test or have not had a recent Pap test.

The number one thing you can do for your peace of mind: get routine screening for cervical cancer.

If you are under 30, regular screening for cervical cancer means the Pap test.
If you are 30 years old or over, protect yourself with both a Pap and HPV test. Together, these tests determine if you have or are likely to develop abnormal cells that could become cervical cancer.

You also may be able to reduce your cervical cancer risk by:

Delaying the first time you have sexual intercourse
Limiting the number of sexual partners you have
Using condoms to decrease your chances of infection with HPV
Stop smoking

Delaying intercourse until age 20 may decrease your risk of getting HPV and thus cervical cancer. In teenage girls, the cervix is immature and undergoes normal changes associated with growth. A teenage girl’s cervix may be more sensitive to infection with HPV and at greater risk for abnormal cell changes. Delaying intercourse may also decrease the number of partners a woman has in her lifetime. Limiting the number of sexual partners and using condoms may also reduce your chances of getting HPV and thus cervical cancer.

If you smoke, quit smoking. This is important, as the chemicals in cigarettes have been found in the cervical secretions of smokers. Women who smoke are two times more likely to get cervical cancer as compared to nonsmoking women.

6. Treatments for Cervical Cell Abnormalities and Cervical Cancer

6.1.1. Are there treatments for cervical cell abnormalities?

If the abnormal cell changes are more serious this is called moderate/ severe dysplasia (CIN 2/3). Your healthcare provider will suggest treatment. Treatment involves removing the abnormal cells from the cervix. There are several simple ways to remove the cells:

Cryosurgery-abnormal cells are destroyed by freezing them.
Laser therapy- a powerful beam of light destroys abnormal cells.
LEEP (Loop Electrosurgical Excision Procedure) - a thin, electrically charged wire is used to cut out the abnormal cells.

There is no usually no need for a hysterectomy with cervical dysplasia.

6.1.2. Are there treatments for cervical cancer?
If you have cervical cancer, your physician(s) will discuss the best treatments with you. Treatment options depend on whether the cancer has spread outside the cervix and your personal medical situation. Treatment may involve surgery to remove affected parts of the cervix, surgery to remove the uterus (hysterectomy), radiation and/or chemotherapy.

7. HPV and Definitions:

7.1.1. What is HPV?

7.1.2. What is a virus?
A virus is very small. Viruses are so small the naked eye or most microscopes cannot see them. Viruses can multiply in the body and cause infections. They cannot be killed with antibiotics. Viruses are spread from person to person in many ways.

7.1.3. What is an STI?
STI stands for Sexually Transmitted Infections. HPV is an STI, meaning that it is spread by sexual contact. Other STIs you may have heard of are chlamydia, herpes and HIV. HPV is different from other STIs, however, for a few reasons.

Most women who have been sexually active will have HPV at some point.
Most of the time, HPV does not cause any problems and does not require treatment.
HPV can be spread by skin-to-skin contact and does not need an open sore, blood, semen or other bodily fluids to be transmitted.

8. HPV in the Population:

8.1.1. How common is HPV?

50% (5 out of 10) of sexually active men and women will get HPV at some point in their lives.
80% (8 out of 10) of women will be infected with HPV by the time they reach age 50 years.

8.1.2. Who can get HPV?
Any person (female or male) who has been sexually active can get HPV.

Men carry HPV just like women do. As with women, men usually have no symptoms. However, although HPV infection has been linked to cancer of the penis and anus, these cancers are very rare in men. There currently is no FDA-approved HPV test for men.

You can reduce your risk of getting HPV by using condoms. Condoms help reduce the spread of HPV but they are not 100% effective. This is because condoms can not cover all genital skin that may be infected with HPV.

9. Transmission of HPV:

9.1.1. How do you get HPV?

It is important to know that while having more than one sexual partner may increase the risk of getting HPV, it is possible to get the virus from just one person. In fact, it is estimated that 8 of 10 sexually active women will catch the virus at some time during their lives.

It also is important to remember that even women who have had only one sexual partner for many years need to be screened for cervical cancer. This is because HPV can "hide" in the cervical cells for a long period and not be detected. It is impossible to determine exactly when you acquired an HPV infection or how long you have been infected.

9.1.2. Can you tell when I got HPV or who I got it from?
No. It is really difficult to tell when you got HPV or who you got it from. Most of the time HPV is a “silent infection” with no symptoms. So most people do not know that they have HPV. HPV can be in the body for many years before a woman ever knows she has it.

A diagnosis of HPV does not mean that you or your current partner is cheating. Having a diagnosis of HPV does not mean you are promiscuous or sleeping around.

9.1.3. Can a person get or give HPV through oral sex or from the hands?
Possibly. There is limited evidence that HPV is spread by hand-to- genital contact and oral sex. All available data suggests that these routes of spreading HPV are quite rare. The majority of the time HPV is spread by genital skin to genital skin contact (non penetrative sex), vaginal sex and anal sex.

10. Natural History of HPV Infections:

10.1.1. Could I have HPV and not know it?

10.1.2. What should I tell my partner?
You should explain to your partner that HPV is very common. Most sexually active people will get HPV. Most of the time people will not know whom they got HPV from or when they got HPV. Most people will not know they have it because they often have no symptoms.

10.1.3. Can sexual partners reinfect each other?
Yes. Partners can reinfect each other. You can be infected by another type of HPV. But, once you have one type of HPV you cannot get that type again from your partner.

10.1.4. Do all people who have HPV get cancer?
No. Most of the time, your body’s immune system will clear HPV on its own. Most women clear the virus within 2 years. Women who do not clear the virus (those with a persistent infection) are at increased risk of getting cervical cancer. Just because you have not cleared the virus does not mean you will get cancer. A long lasting HPV infection just means that your doctor will have to follow you to see what is happening in your body which may mean testing more often.

11. Treatments for HPV:

11.1.1. Are there any treatments for HPV?

12. Modifying Your Risk Factors for HPV

12.1.1. Can I prevent getting HPV?

13. Cervical Cancer Screening

13.1.1. What is a Pap test?

13.1.2. How is a Pap test done?
A Pap test is performed during a gynecologic exam. A Pap test is performed when the doctor inserts a tool called a speculum into the vagina. The doctor is able to look at the cervix and uses a tool to scrape off a layer of cervical cells. The cervical cells are then sent to the lab to be examined under a microscope. (A Pap test is not the same as a pelvic exam. A pelvic exam is when the doctor inserts his/her fingers into your vagina and examines your ovaries and uterus).

13.1.3. Why are Pap tests important?
Pap tests are important because women who do not receive routine Pap tests are at increased risk of getting cervical cancer. The most important thing you can do to decrease your risk of getting cervical cancer is to get routine screening. Routine screening allows doctors to look for cervical cell abnormalities. These abnormalities can be treated before they become cervical cancer.

13.1.4. What does a Pap test detect?
The Pap detects changes in the cells of the cervix. It does not detect the HPV virus.

13.1.5. Are all Pap tests the same?
No. There are different types of Pap tests: regular and liquid based. A regular Pap test is when cervical cells are scraped with a small spatula and placed on a glass slide. (The cells are sprayed with a chemical that preserves them and are sent to the lab.) A liquid based Pap test is when cervical cells are scraped with special brushes that are dipped into a tube with preservative chemicals. The tube containing the cervical cells is then sent to the lab. Liquid based Pap tests are more accurate than regular Pap tests.

13.1.6. What is an HPV test?
An HPV test looks for the HPV virus.

13.1.7. How is an HPV test done?
The Pap test and HPV test tests can be performed at the same time during your pelvic exam. The doctor uses a tool to collect a small sample of cervical cells, which are sent to the lab. The sample of cells undergoes a special process that is the HPV test.

13.1.8. What does an HPV test detect?
The test looks for the HPV virus in cervical cells. The test looks for HPV virus by looking for the virus’ DNA. That’s why another name for the HPV test is the HPV DNA test.

13.1.9. Should I get a Pap test and/or an HPV test?
Absolutely. Pap tests are important because women who do not receive routine Pap tests are at increased risk of getting cervical cancer. But the Pap test is not foolproof. So if you are 30 or over, getting an HPV test with a Pap test is a way to get a more accurate picture of your risk for cervical cancer.

13.1.10. Why shouldn't women under 30 get tested for HPV?
HPV is very common in women under 30 years old. If you give women under age 30 the HPV test, chances are it will come back positive. Most of the time, women in this age group fight off the HPV infection. At the same time, cervical cancers are less likely to be found in this age group. Therefore, HPV testing in women under 30 years old doesn’t add much to our ability to identify women at risk for cervical cancer.

13.1.11. Will a Pap test tell me if I have HPV?
No, a Pap test only detects cervical cell abnormalities. Since most cervical abnormalities are caused by HPV, it turn outs that the Pap can indirectly tell whether you have HPV.

13.1.12. What is the difference between a Pap test and an HPV test?
A Pap tests looks for cervical cell abnormalities. The HPV test looks for HPV which causes the cervical cell abnormalities.

13.1.13. How do I prepare for a Pap test or HPV test?
Do not go for cervical cancer screening during your menstrual period.

For 2 days before your exam, do not:

Have vaginal sexual intercourse
Use vaginal creams or medications

13.1.14. How often should I get screened?
The American College of Obstetrics and Gynecology (ACOG) recommends:

Age Group ACOG Screening Recommendations

Under 21 years old
First Pap test within 3 years of having vaginal intercourse OR
no later than 21 years old.

21- 29 years old
Pap test every year

30 years old and over
Pap test and HPV test - if both normal rescreen in 3 years*
Pap test every 2-3 years if there were 3 normal annual Pap tests in a row
Pap test every year

* Women should discuss these options with their healthcare provider.

Note: Women who have had a hysterectomy without removal of the cervix should continue to follow the guidelines above.

13.1.15. If I am not having sex do I still need to get screened?
Yes. Women who are not sexually active should still get routine cervical cancer screening including the Pap test. HPV can hide out in the body for many years after someone has stopped being sexually active. HPV can cause cell changes that can be detected by the Pap test.

13.1.16. If I had a hysterectomy do I still need to get screened for cervical cancer?
The answer to this question depends on what kind or hysterectomy you have had. The answer also depends on the reason you needed to have a hysterectomy. The only way to know whether you need to continue getting screened with the Pap test and HPV test is to talk to your doctor. Remember, to bring the medical records concerning your hysterectomy to your doctor’s visit.

13.1.17. If I have gone through menopause do I still need to get screened for cervical cancer?
Yes, you may. According to the American College of Obstetrics and Gynecology (ACOG), there is no safe age to screening for all women. The decision to stop being screened with the Pap test and HPV test should be made after talking to your healthcare provider. You and your healthcare provider can come up with a plan on when you should stop getting screened for cervical cancer. Your plan will depend on your age, history, and previous Pap test results.

14. Understanding Your Screening Test Results

14.1.1. What do my results mean?

	You are under 30 years old	You are 30 years old or over	You are 30 years old or over
		AND Your HPV Test is Negative	AND Your HPV Test is Positive
You have a normal Pap	Repeat Pap test in 1-2 years, depending on your doctor’s recommendation.	Repeat the Pap and HPV tests in 3 years. You should still see your doctor next year for other important exams, like a breast exam and pelvic exam.	Repeat the Pap and HPV tests in 6-12 months. If the HPV test is still positive, you will probably need a colposcopy*.
You have an inconclusive (ASC-US) Pap	Your doctor will likely suggest HPV testing. Other options include: repeat the Pap at 6 and 12 months or immediate colposcopy*.	Repeat the Pap and HPV tests in 12 months.	A colposcopy* is recommended
You have an abnormal Pap	It is important to understand why your cells look abnormal. Your doctor will perform a colposcopy*. Also your doctor may order additional tests.	It is important to understand why your cells look abnormal. Your doctor will probably perform a colposcopy*.	Your doctor will perform a colposcopy*.

*Based on American College of Obstetrics & Gynecology Practice Guidelines, April and September 2005

14.1.2. My Pap was abnormal and my doctor wants me to have the HPV test, why?
The most common abnormal Pap result is called ASC-US (this stands for Atypical Squamous Cell of Undetermined Significance). This means that cervical cells on the Pap are unclear. The cell may not be clearly abnormal or normal looking. For women of all ages, an HPV test is done when the Pap test result is ASC-US. The HPV test will let you know quickly if you have the virus and thus need further tests.

14.1.3. Why did I get an unclear Pap test result?
There are a few reasons why you may have received an unclear Pap test result.

Not enough cells- this is a very common reason for an unclear Pap results. The sample sent to the lab may not contain enough cells to be examined. Also the sample might not contain enough cells from the part of the cervix usually affected by cell changes.
Cells are clumped together- the sample sent to the lab has too many cells clumped together. Also blood, mucus and other substances may hide cells. That’s why it’s important to not get a Pap test during your period, or within 48 hours of having sex or using vaginal creams/gels.

Having a second Pap test will usually help get a clear result.

14.1.4. I tested positive for HPV. When did I get it and who did I get it from?
It is really difficult to tell when you got HPV or who you got it from. Most of the time HPV is a “silent infection” with no symptoms. So most people do not know that they have HPV . HPV can be in the body for many years before a woman ever knows she has it. A diagnosis of HPV does not mean that you or your current partner is cheating. Having a diagnosis of HPV does not mean you are promiscuous or sleeping around.

14.1.5. What can happen to me if I have HPV?
Almost every woman will get HPV at least once in her life. The body’s immune system usually fights off the virus. So, most women with HPV never suffer any problems as a result. In some women, however, the virus does not go away. When the virus stays in the body for a long period of time, cervical cells may begin to change and the risk of cervical cancer increases.

There is treatment for the abnormal cell changes that HPV may cause. With early treatment of these cell changes, cervical cancer can be prevented before it has a chance to develop. That’s why early detection of abnormal cells on your cervix is so important.

14.1.6. Will I always have the HPV virus?
We do not know. All the evidence says that most women will clear HPV within 2 years. In some women, however, the virus does not go away. When the virus stays in the body for a long period of time, cervical cells may begin to change and the risk of cervical cancer increases. In women who have long lasting infection, we are not sure what will happen. Some women may eventually clear the virus. Other women may clear the virus to a level where it is undetectable or it can’t be found.

14.1.7. If I have HPV and it goes away can I get it again?
If you have one type of HPV and your body gets rid of that HPV- you cannot get that type of HPV again. Your body’s immune system will remember that HPV type. But, a different type of HPV can still infect you.

14.1.8. Will I give HPV to my partner?
Possibly. HPV can be spread by sexual contact including vaginal, anal and possibly oral sex. Sexual partners can reinfect each other with HPV. You can be infected by another type of HPV. But, once you have one type of HPV you cannot get that type again from your partner.

You may be able to reduce spreading HPV by using condoms every time you have sex. Condoms are not 100% effective because HPV can infect parts of the genitals not covered by the condom.

14.1.9. Can my husband or boyfriend be tested for HPV?
No. There currently is no FDA-approved HPV test for men. However, a healthcare provider can examine your husband or boyfriend for cell changes caused by HPV. Although HPV infection has been linked to cancer of the penis and anus, these cancers are very rare in men.

14.1.10. Will HPV affect my pregnancy or my baby?
HPV infection will not affect your ability to get pregnant nor will it affect a pregnancy. However, in very rare cases, it may be passed from mother to baby. Types of HPV that can be passed to the baby are “low risk types” that do not cause cancer. In these cases, babies may be affected by having small growths in the breathing tract.

14.1.11. If I have HPV or cervical cell changes what can I do?
If you have HPV then that means you must keep in close contact with your healthcare provider. Normally your body will try to fight off the infection. You may need repeat HPV and Pap testing. If your HPV test is still positive you may need other testing.

If you have cervical cell changes you must keep in close contact with your healthcare provider. This is no reason to be frightened. Just because you have cervical cell changes does not mean you have cervical cancer. When cervical changes are caught early cervical cancer can be prevented.

Cervical cell changes mean you need additional testing. It is likely you may need to undergo colposcopy. Colposcoy is a special procedure where your doctor more closely examines your cervix. A sample of tissue from the cervix may be taken and sent to the lab. Based on the colposcoy results you may need treatment. Treatment usually includes removing the affected cells in the cervix. It is important that you follow the treatment recommended by your healthcare provider.

14.1.12. Is it okay if I don't repeat my tests right away?
Your body is your temple- so take care of it well. Changes in the cervix happen slowly. A few months delay in repeating your tests will not tip the balance in favor of getting cancer. Serious problems usually result when women do not have routine Pap tests. Serious problems may also result when women delay going back to their doctor after an abnormal Pap test result.

15. Paying for Screening Tests

15.1.1. Does Medicare pay for Pap test and or HPV test?
Medicare covers Pap tests once every 24 months.
Medicare will pay for a Pap test every 12 months, if you are:

of childbearing age
have had an abnormal Pap test within the past 3 years
at high risk for cervical cancer

To learn more about your Medicare benefits, call (800) MEDICARE or (800) 633-4227. Or visit www.medicare.gov.

15.1.2. Does Medicaid pay for Pap and or HPV tests?
Medicaid programs in all 50 states and the District of Columbia cover Pap tests. Nearly all states and the District of Columbia cover HPV testing as well. Please check with your state Medicaid office to learn more about what services you are provided for cervical cancer screening.

15.1.3. Does my private insurance have to pay for my Pap and or HPV test?
Private insurance covers routine screening with the Pap test. Most insurance companies pay for HPV testing for routine screening in women age 30 and older. Insurance benefits vary, so you may want to call your insurance company before your doctor’s visit to find out if your policy covers the test.

15.1.4. I don't have insurance. What can I do to get my Pap and or HPV test?
All states are making cervical cancer screening more available to women without health insurance through the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). For more information on low-cost or free screening, please visit the CDC’s website at www.cdc.gov/cancer or call 1-888-842-6355 and select option 7.

16. The HPV Vaccine Indications

16.1. Who is the HPV vaccine for?
Studies submitted to the FDA have found the HPV vaccine to be effective.
The vaccine has been found:

100% effective in preventing 4 types of HPV infection in girls not previously infected with HPV
effective in young women who have already been exposed to some of the HPV types covered by the vaccine

The vaccine is recommended for girls aged 11- 12 years old and as young as 9 years old. The vaccine is also recommended for girls and women 13 years old to 26 years old who haven’t previously received the vaccine. The vaccine has been widely tested in females from 9 years old to 26 years old. Only recently has testing begun in older women. In the future, the HPV vaccine may be available for older women as well.

16.2. Why is the vaccine for such young girls?
Studies have shown the vaccine is most effective in girls and women who have never been exposed to the HPV types covered by the vaccine. This means to get the full benefit of the vaccine, girls and young women should be vaccinated before they become sexually active. Girls and women who have not yet been infected with HPV will get the full benefit of the vaccine.

16.3. Should I get an HPV test before getting the HPV vaccine?
No. You do not need to get an HPV test before getting the HPV vaccine. An HPV test can tell if you if you have HPV. But currently an HPV test can’t tell you which type of HPV you have. There is no good way to know if you have a type of HPV that the vaccine protects against. Even girls and women who have been exposed to one type of HPV could get some protection from the other types of HPV the vaccine protects against.

16.4. Can I get the vaccine if I have genital warts?
Yes. You can get the vaccine even if you have genital warts. Even girls and women who have been exposed to one type of HPV could get some protection from the other types of HPV the vaccine protects against. So the HPV vaccine could help protect you from the types of HPV you haven’t yet been infected with.

16.5. Can I get the vaccine if I have had an abnormal Pap test?
Yes. You can get the vaccine even if you have had an abnormal Pap test. Even girls and women who have been exposed to one type of HPV could get some protection from the other types of HPV the vaccine protects against

16.6. Can I get the vaccine when I am pregnant?
No. You should not get the vaccine while pregnant. Studies to date suggest that the vaccine has not caused health problems for mother or baby during pregnancy. Pregnant women should complete the pregnancy before getting the HPV vaccine. Women who have started the vaccine and become pregnant should stop taking the vaccine and finish the series after the baby is born.

17. The Safety of the HPV Vaccine

17.1. How safe is the HPV vaccine?
The HPV vaccine is not a live virus. Because the HPV vaccine is not a live virus, there is no chance that you could get an infection from the vaccine. Some common side effects of getting the vaccine include: soreness and itching at the site of injection and headache. The vaccine has been tested and found to be safe in about 11,000 girls and women.

17.2. What are the side effects of the vaccine?
No serious side effects have been found from getting the vaccine. There is no evidence that the vaccine affects fertility or the reproductive tract.

Some common side effects of getting the vaccine include:

Pain or soreness at the site of injection
Itching at the site of injection
Headache

17.3. Can I get an HPV infection from the vaccine?
No. You can not get an HPV infection from the vaccine. The HPV vaccine is not a live virus. Because the HPV vaccine is not a live virus, there is no chance that you could get an infection from the vaccine. The vaccine has been tested and found to be safe in about 11,000 girls and women.

18. The HPV Vaccine and the Future

18.1. Will girls and women who get the vaccine still have to get screened for cervical cancer?
Yes. The vaccine will not protect against all types of HPV that cause cancer. The vaccine protects against 2 of the 13 types of HPV that cause cervical cancer. The 2 types of HPV the vaccine cause 70% of cervical cancers. Therefore, women and girls will still need to get screened with the Pap test to keep healthy.

18.2. How long will the HPV vaccine protect me and will I need a booster shot?
The length of vaccine protection is not known when a vaccine first comes on the market. So it is unclear whether a booster will be needed for the HPV vaccine. For now, studies have shown that the protection from the HPV vaccine lasts at least 5 years. More research is being done to see if a booster for the HPV vaccine will be needed.

19. Paying for the HPV vaccine

19.1. How much does the vaccine cost?
The vaccine is given in 3 doses within a 6-month period. The first shot is given followed by another in 2 months and the third dose at 6 months. The total cost of the vaccine is about $360.

19.2. Will my private insurance pay for the HPV vaccine?
Most private insurance companies should eventually cover the cost of the vaccine.

19.3. I don’t have insurance. What can I do to get the vaccine?
Girls without insurance can get the vaccine through federal health programs. These federal health programs cover vaccines for uninsured children under the age of 19 years old. Some states also provide free or low cost vaccines through public health department clinics to those who can’t afford the cost of the vaccine