Explanation of each question:

What is a risk factor:

A risk factor is anything that increases a person's chance of getting a disease such as cancer. Different cancers have different risk factors. For example, unprotected exposure to strong sunlight is a risk factor for skin cancer. Smoking is a risk factor for cancers of the lung, mouth, throat, kidney, bladder, and several other organs.




Age:

For breast cancer, age is the most significant risk factor, the older a women is the greater her risk

For cervical cancer, risk is greater for young adults, cervical cancer can affect young women in their twenties and even in their teens. Although cervical cancer risk doesn't increase very much after 40, it doesn't get any lower, either. Many older women do not realize that they have the highest risk of developing cervical cancer, and that it is important for them to continue having Pap tests.

For endometrial cancer, ninety-five percent of endometrial cancers occur in women ver age 40. The average age at diagnosis is 60. The chance of any woman developing endometrial cancer increases as she gets older.

For ovarian cancer most cases occur after menopause. Half of all ovarian cancers are found in women over 65.

For vaginal cancer age is a risk factor for squamous cell carcinoma. About half of women are over age 60 years at diagnosis. Most women diagnosed with vaginal cancer are between the ages of 50 and 70.

For vulval cancer about 75% of the women are over age 50, and two-thirds are over age 70 at the time their cancer is first diagnosed. However, about 15% of the cases occur in women under age 40, and the number in this age group is increasing. The average age of women diagnosed with invasive cancer is 65 to 70, while women diagnosed with noninvasive vulvar cancer average about 45 to 50 years.




Ethnicity:

For breast cancer white women are slightly more likely to get breast cancer than African-American women. But African-Americans are more likely to die of this cancer. Asian, Hispanic, and American Indian women have a lower risk of getting breast cancer.

For cervical cancer African-American women and Hispanic women are at increased risk, and have higher death rates from this cancer. The death rate for African Americans is over twice the national average. Hispanics and American Indians also have cervical cancer death rates that are above average.

For endometrial cancer white women and Pacific Islanders have a higher risk compared with other races (African American, Asian , and Hispanic women).

For vaginal and vulvar cancer there do not seem to be and ethnic groups at higher risk.



Religion:

There are some religious groups that are at increased risk for some cancers. For example, Ashkenazi Jewish women are at increased risk of developing breast cancer, and Seventh Day Adventists are at lower risk because of their diet. Religion does not seem to be as risk factor for other female cancers.




Socioeconomic (SES) Factors (Education and Income):

Higher SES is a risk factor for breast, endometrial, and ovarian cancers; and lower SES is a risk factor for cervical cancer.

Many people with low incomes do not have access to adequate health care services, including routine gynecologic examinations. This may be an important factor in explaining the statistical association between low income and increased vulvar cancer risk.




Body Weight (BMI):

Body Mass Index is defined as weight/height (m)² This index refers to the gradiations of body fatness for adults over age 20. For example BMI < 18.5 kg/m2 corresponds to underweight and > 30 kg/m² is obese; a BMI of 18.5 to 25 kg/m² corresponds to normal weight. Obesity increases risk of cancers of the breast (post-menopausal), cervix , endometrium, and ovary.

Obesity increases a woman's risk of endometrial cancer by two to five times, depending on how obese she is. Although most of a woman's estrogen is produced by her ovaries, fat tissue can change some other hormones into estrogens. Having more fat tissue can increase a woman's estrogen levels, and therefore increase her endometrial cancer risk.




PERSONAL MEDICAL HISTORY

Personal History of Cancer:

A history of certain types of cancers can predispose individuals to other cancers. For the cancers we are assessing, a history of breast cancer increases a woman's risk for developing another primary breast cancer and ovarian cancer. If a woman has been been previously diagnosed with colon, endometrium, Hodgkin's disease, or ovarian cancer, she has an increased risk of breast cancer.

A previous history of breast, ovarian and colorectal cancer may increase risk for endometrial cancer.

Having a history of cervical cancer or cervical precancerous conditions (cervical intraepithelial neoplasia or cervical dysplasia) increases a woman's risk of developing vaginal squamous cell cancer. This is because cervical and vaginal cancer have similar risk factors, such as HPV infection.

Up to 15% of women with vulvar cancer also have cervical cancer. The likely reason for this association is the role of HPV infection in causing both of these cancers.




Surgical Removal of the Uterus (Hysterectomy):

Women who have had a hysterectomy (removal of the uterus) may have a lower risk of ovarian, cervical, and endometrial cancers. However, these operations should only be done when there is a valid medical reason, and not simply for their effect on cancer risk.




Surgical Removal of the Ovaries (Oophrectomy):

Women who have had surgical removal of both their ovaries have a reduced risk of breast, endometrial, and ovarian cancers. However, these operations should only be done when there is a valid medical reason, and not simply for their effect on cancer risk.




Tubal ligation (tubes tied):

Women who have had their tubes "tied" to prevent pregnancy may have a lower risk of ovarian cancer.



Breast Biopsies:

A history of breast biopsy and the result of the abnormal biopsy results have been linked to a slightly higher risk of breast cancer. The more biopsies a woman has the higher her risk. The risk is increased when the biopsy result is atypical hyperplasia (an excessive formation of cells).




Abnormal Pap Smear:

A Pap test is the best method of preventing cancer or finding it early. If the result of the Pap test is abnormal a woman's risk is increased for cancers of the cervix, vagina, and vulva. The risk is increased if treatment such as colposcopy, crytherapy, laser therapy, or surgery was necessary




Precancerous Conditions:

Precancerous conditions such as cervical intraepithelial neoplasia (CIN) or vulvar intraepithelial neoplasia (VIN) or vaginal intraepithelial neoplasia can place a woman at increased for cancers of the cervix, vagina, and vulva.




Amenorrhea:

The absence of menstruation in a woman who previously has had regular periods is called secondary amenorrhea. The cause can be as common as pregnancy or as rare as a pituitary tumor. Amenorrhea may be a side effect of a normal condition or a symptom of an underlying problem requiring medical treatment. Amenorrhea may deprive a woman's body of estrogen and progesterone, two important hormones. If untreated, amenorrhea can increase a woman's risk of infertility, osteoporosis, heart disease, and endometrial and ovarian cancers.




Diabetes:

Diabetes is more common in people who are overweight. This connection helps to explain why some doctors think diabetes is a risk factor for endometrial cancer. However, some studies find that endometrial cancer risk is higher in women who are overweight and diabetic compared with women who have neither condition. Women with type I diabetes (who require insulin) have higher rates of endometrial cancer even though their diabetes is not caused by obesity.




Hepatitis A or C:

Hepatitis is a virus that causes the liver makes your liver swell and stops it from working right. There are several different types of this virus that all affect the function of the liver. You can get hepatitis A by eating food that has been prepared by someone with hepatitis A, or drinking water that has been contaminated by hepatitis A (in parts of the world with poor hygiene and sanitary conditions), or exposure from someone who has it from sexual exposure.

Hepatitis C is spread by contact with an infected person's blood. You could get hepatitis C by sharing drug needles, getting pricked with a needle that has infected blood on it (hospital workers can get hepatitis C this way), being born to a mother with hepatitis C, getting a tattoo or body piercing with unsterilized, dirty tools. In rare cases, you could get hepatitis C by having sex with an infected person, especially if you or your partner has other sexually transmitted diseases. You can NOT get hepatitis C by shaking hands with an infected person, hugging an infected person, kissing an infected person, or sitting next to an infected person. Both hepatitis A and C can increase risk of cervical cancer




High Blood Pressure (Hypertension):

Hypertension (high blood pressure) occurs when blood pressure stays elevated over time. The increased pressure of hypertension puts a strain on your circulatory system, which can ultimately lead to serious problems, such as stroke, heart disease, and kidney failure. About 50 million Americans have hypertension. Hypertension has been associated with increased risk of endometrial cancer.




HIV infection (the virus that causes AIDS HIV/AIDS):

AIDS is a chronic, life-threatening condition caused by the human immunodeficiency virus (HIV). By damaging or destroying the cells of your immune system, HIV interferes with your body's ability to effectively fight off viruses, bacteria and fungi that cause disease. This makes you more susceptible to opportunistic infections your body would normally resist, such as pneumonia and meningitis, and to certain types of cancers, including cervical cancer.




History of infertility (inability to become pregnant):

During pregnancy, the hormonal balance shifts toward more progesterone. Therefore, having many pregnancies reduces endometrial cancer risk and women who have not been pregnant have a higher risk.Infertility could also be associated with an increased risk of ovarian cancer.




Kidney Disease (chronic):

There are four types of kidney disease including diabetes which accounts for more than 40% of kidney diseases, high blood pressure (Hypertension) accounts for 26%, and glomerulonephrities and cysts account for the remainder. Chronic kidney disease as with diabetes and hypertension increase risk of endometrial cancer.



Lupus:

Systemic Lupus Erythematosus is a chronic (long-lasting) rheumatic disease which affects joints, muscles and other parts of the body. Lupus involves inflammation (the immune system's response to kill foreign agents, virus, bacteria). Systemic lupus erythematosus involves chronic inflammation that can affect many parts of the body, including the heart, lungs, skin, joints, blood-forming organs, kidneys, and nervous system. Sometimes individuals who are immune compromised have an increased risk of cervical cancer.



Polycystic Ovary Disease:

A common form of hormonal imbalance in women is polycystic ovarian syndrome (PCOS). In this condition a woman has a relatively high and sustained levels of estrogen and androgen, a male hormone, rather than the fluctuating condition seen in the normal menstrual cycle. This results in a decrease in the pituitary hormones that lead to ovulation and menstruation. PCOS often is associated with obesity, amenorrhea or abnormal uterine bleeding. It has been associated with a risk of ovarian cancer.



Rheumatoid Arthritis:

Rheumatoid arthritis is a long-lasting disease that can affect many parts of the body, including the joints. In rheumatoid arthritis, the joint lining swells, invading surrounding tissues, and producing chemical substances that attack and destroy the joint surface. This commonly occurs in joints in the hands and feet. Larger joints such as hips, knees, and elbows also may be involved. Swelling, pain, and stiffness are usually present even when the joint is not used. Rheumatoid arthritis can affect people of all ages, even children. However, more than 70 percent of people with this disease are over 30 years old. Many joints of the body may be involved at the same time. Sometimes individuals who have rheumatoid arthritis have an increased risk of cervical cancer.



Age at First Menstrual Periods:

The ovaries (sex glands on either side of the uterus that produce eggs) normally produce two main types of female hormones - estrogen and progesterone. The balance between these two hormones changes during a woman's menstrual cycle each month. This produces a woman's monthly periods and keeps the endometrium healthy. A shift in the balance of these two hormones toward more estrogen increases a woman's risk for developing endometrial cancer.

Early or late menarche can increase or decrease one's cancer risk. Starting monthly periods before age 12 increases the number of years during which the endometrium is exposed to estrogen and increases endometrial and breast cancer risk.

For ovarian cancer, there seems to be a relationship between the number of menstrual cycles in a woman's lifetime and her risk. The more monthly periods may be linked to an increased risk. Women who started having periods at an early age (before age 12), who go through menopause late, who have no children (or who had their first child after age 30), may have an increased risk of ovarian cancer. Breastfeeding may lower the risk since menstrual periods may not occur during nursing.



Regular Menstrual Cycles:

Women with increased bleeding during perimenopause (the time just before menopause) have an increased risk (four times greater) of endometrial cancer. The greater number of monthly periods a woman has may be linked to an increased risk of breast or ovarian cancer. This has been shown in women who started having periods at an early age (before age 12), who go through menopause late, who have no children (or who had their first child after age 30).



Pregnancy History Including Number of Pregnancies and Number of Live Births, and Age at First Live Birth:

Hormonal influences are important because they encourage cell growth. High levels of hormones during a woman's reproductive years, especially when they are not interrupted by the hormonal changes of pregnancy, appear to increase the chances that genetically damaged cells will grow and cause cancer.

The number a times a woman has been pregnant has been associated with ovarian and breast cancer. The risk of breast cancer is elevated among women who never had children or had their first child after they were 30 years old. However, having many pregnancies reduces endometrial cancer risk and women who have not been pregnant have a higher risk.

There seems to be a relationship between the number of menstrual cycles in a woman's lifetime and her risk of having ovarian or breast cancer. Pregnancy and breastfeeding seem to lower the risk of these cancers, especially when a woman has her first baby before age 30. But choices about when to have a child should not be made just for the purpose of reducing ovarian cancer risk, especially since using birth control pills will have a similar impact.

It is important to remember that while risk factors increase the odds of getting a disease, they do not guarantee it will occur. For example, we know that on the average, women who have their first child after age 30 have a slightly greater risk of developing ovarian or breast cancer than women who had their first child before age 30. This does not mean that most women with these cancers had their first child after age 30 could have prevented the cancer by having that child earlier.



Breast Feeding:

Some studies show that breastfeeding, if kept up for 1 1/2 to two years, may slightly lower breast cancer risk. Other studies found no effect on breast cancer risk.





Menopause (change of life):

When women experience menopause or the change of life after age 50, the number of years during which the endometrium is exposed to estrogen has the same effect on endometrial cancer risk as early menarche. Women with increased bleeding during perimenopause (the time just before menopause) have an increased risk (four times greater) of endometrial cancer.

Total length of menstruation span may be a more important risk factor than age at menarche or menopause. For example, starting periods early is less a risk factor for women with early menopause. Likewise late menopause would not lead to a higher risk in women whose periods began later in their teens.

There seems to be a relationship between the number of menstrual cycles in a woman's lifetime and her risk of having ovarian or breast cancer. More monthly periods may be linked to an increased risk. Women who started having periods at an early age (before age 12), who go through menopause late, who have no children (or who had their first child after age 30), may have an increased risk of ovarian or breast cancer.




Birth Control Pills or Oral Contraceptives:

One of the most important factors that lower a woman's risk of ovarian cancer is birth control pills. Women who have taken birth control pills for at least five years have a significantly lower risk of ovarian cancer. They are also protective for endometrial cancer risk.

For breast cancer the studies are still unclear as to the role birth control pills might play. In a recent study of women from 35 to 64 years of age, current or former oral-contraceptive use was not associated with a significantly increased risk of breast cancer.

An increased risk has been observed for women with cervical cancer.




Fertility Drugs:

Some studies have found that long-time use of the fertility drug clomiphene citrate, without achieving pregnancy, may increase a woman's risk for having a type of tumor called LMP tumor (low malignancy potential). But infertility also increases the risk of ovarian cancer, even without use of fertility drugs. A woman taking this drug should discuss the issues with her doctor.




Hormone Replacement Therapy:

Estrogen replacement therapy (ERT) uses the female hormone, estrogen, to offset the effects of menopause. It once was common to prescribe estrogen alone (without progestins) to treat symptoms of menopause (such as hot flashes) and osteoporosis (softening of the bones). It was also used to reduce the risk of heart disease among post-menopausal women. Doctors have found, however, that the use of estrogen alone increases a woman's risk for developing endometrial cancer. Studies now show that women who take progestins for at least ten days each month along with the estrogens, have no increased risk of endometrial cancer. To avoid increasing the risk of endometrial cancer, doctors almost never prescribe estrogens without progestins in women who have gone through menopause and who still have a uterus.

In a recent report of the results of the Women's Health Initiative, the study was stopped early because of the risk of ovarian and breast cancer. Compared to postmenopausal women not using hormone replacement therapy, users of estrogen-only therapy had a 60 percent greater risk of developing ovarian cancer. For postmenopausal women who used estrogen replacement therapy for 10 or more years were at significantly higher risk of developing ovarian cancer than women who never used hormone replacement therapy.

Although the addition of progestins reduces the risk of endometrial cancer, a new study suggests some of this protection may be lost after long-term (greater than 5-10 years) therapy. (Remember that prolonged use of vaginal creams or rings containing estrogen may also increase estrogen levels in your body. Therefore, it is important to discuss potential risks and follow up with your health care professional if you use these medications.) Any abnormal bleeding or discharge in women receiving estrogen replacement therapy should be immediately evaluated. The Women's Health Initiative data showed that women who took estrogen combined with progestin were not at increased risk for ovarian cancer, only a few women in our study who developed ovarian cancer had used estrogen-progestin therapy for more than four years. At this point, there simply aren't enough data to say whether taking the combined therapy has any effect on ovarian cancer.

Over 90 percent of breast cancer studies throughout the world showed an increased risk in breast cancer for women who used postmenopausal hormones for five years or longer. Progestins increase the risk of breast cancer.




Selective Estrogen Receptor Modulators (SERMs - Tamoxifen and Raloxifen):

Tamoxifen is an antiestrogen drug that is used to treat women with breast cancer. It is also used to reduce the risk of breast cancer in women who are at a high risk of developing it. Although it is called an antiestrogen, it acts like an estrogen in the uterus. It can cause the uterine lining to grow and increases the risk of endometrial cancer in women who take this drug. The relatively small risk of developing endometrial cancer (about 1 in 500) in women taking tamoxifen is more than balanced by the value of this drug in treating breast cancer and reducing the likelihood of cancer in the other breast. However, this is an issue women may want to discuss with their oncologist and gynecologist. If a woman decides to take tamoxifen, she should have yearly gynecologic exams and should be advised to report signs and symptoms of endometrial cancer, such as abnormal bleeding.

The NCI is conducting clinical trials about the use of other SERMs such as Raloxifen in reducing breast cancer risk. The results of this study are not yet complete.




Diethelstilbesterol (DES):

DES is a synthetic form of estrogen that was used between the early 1940s and 1971. Some women took DES during pregnancy to prevent certain complications. Their DES-exposed daughters have an increased chance of developing abnormal cells (dysplasia) in the cervix and vagina. In addition, a rare type of vaginal and cervical cancer can occur in DES-exposed daughters. DES daughters should tell their doctor about their exposure. They should also have pelvic exams by a doctor familiar with conditions related to DES.

Women who took DES during pregnancy may have a slightly higher risk for developing breast cancer. These women should tell their doctor about their exposure. At this time, there does not appear to be an increased risk of breast cancer for daughters who were exposed to DES before birth. However, more studies are needed as these daughters enter the age range when breast cancer is more common.

Age at First Sexual Intercourse and Number of Sexual Partners:

Young women who begin have sexual intercourse are at risk of developing cervical cancer. Women of all ages can protect against HPV by limiting the number of sexual partners and not having sex with people who have had many partners.




Sexually Transmitted Diseases:

Sexually transmitted diseases (STDs), once called venereal diseases, are among the most common infectious diseases in the United States today. More than 20 STDs have now been identified, and they affect more than 13 million men and women in this country each year. Examples of STDs include herpes simplex, chlamydia, gonorrhea, syphillis, hepatititis B, Human papillomavirus, and HIV/AIDS. These infections have been associated with risk of cervical and vaginal and vulvar cancers.




HPV (human papillomavirus)

Human papillomavirus (HPV) can be passed from one person to another during sex. HPVs are a group of more than 70 types of viruses called papilloma viruses because they can cause papillomas (warts). Different HPV types cause different types of warts in different parts of the body. Some types cause common warts on the hands and feet. Other types tend to cause warts on the lips or tongue. Certain HPV types can infect the female and male genital organs and the anal area. These HPV types are passed from one person to another during sexual contact. Having unprotected sex, especially at a young age, makes HPV infection more likely. Also, women who have many sexual partners (or who have sex with men who have had many partners) have a greater chance of getting HPV.

When HPVs infect the skin of the external genital organs and anal area (around the opening of the intestinal tract), or internal genital organs such as the vagina or cervix, they often cause raised bumpy warts. These may be barely visible or they may be several inches across. The medical term for genital warts is condyloma acuminatum. With infections of the vagina or cervix, a wart-like growth may not always be present, but the virus can still cause abnormal cell growth that increases the risk of squamous cell cancer.

Certain types of sexual behavior increase a woman's risk of getting HPV infection. These high-risk sexual behaviors include intercourse at an early age, having many sexual partners, having sex with a person who has had many partners, and having unprotected sex at any age. HPV increases a woman's risk of cervical, vaginal, and vulvar cancers.




Birth Control Practices - Condoms or Diaphragm:

If a woman has protected sex, she may reduce her risk of developing some infections that place her at increased cancer risk.


Family History of Cancer

Endometrial cancer tends to run in some families who also have an inherited tendency to develop colon cancer called hereditary nonpolyposis colon cancer (HNPCC). A small number of endometrial cancers may be due to this inherited factor. Women with colon cancer or endometrial cancer in several family members might consider having genetic counseling and testing. Genetic testing can help determine if you or members of your family have a high risk of developing endometrial cancer.

Family history of ovarian cancer in a mother, sister, or daughter increases the risk, especially if they developed the cancer at a young age. A woman can inherit a higher risk for ovarian cancer from either her mother's or her father's side of the family. About 7% of ovarian cancers result from inherited risks. Gene changes (mutations) are involved in these cancers. Women with a family history of ovarian cancer might want to consider genetic counseling and possibly testing. Before deciding on testing, a woman should discuss the benefits and possible drawbacks with her doctor. Genetic testing can tell if a woman carries certain gene changes (mutations) that cause a higher risk of ovarian cancer.

Family history of breast cancer in a mother, sister, or daughter increases the risk, especially if they developed the cancer at a young age. Having a mother, sister, or daughter with breast cancer almost doubles a woman's risk. About 1 case of breast cancer in 10 is linked to changes (mutations) in certain genes. Studies show that some breast cancers are linked to changes of the BRCA1 and BRCA2 genes, although this number is very small. If a woman has inherited a changed gene from either parent, she is more likely to get breast cancer. About 5 women out of 10 with these gene changes will get breast cancer by the age of 70.




Cigarette Smoking:

While a direct link between smoking and breast cancer has not been found, smoking affects your overall health and increases the risk for many other cancers, as well as heart disease. Smoking is a risk factor for cervical, vaginal and vulvar cancers. Women who smoke are about twice as likely as non-smokers to get cervical cancer. Among women who have a history of genital warts, smoking further increases the risk of developing vulvar cancer. Tobacco smoke can produce chemicals that may damage the DNA in cells of the cervix, vagina, and vulva, and cause cancer to develop. If you smoke, you should make every attempt to quit.




Alcohol Use:

Use of alcohol is clearly linked to an increased risk of getting breast cancer. Women who have one drink a day have a very small increased risk. Those who have 2 to 5 drinks daily have about 1 1/2 times the risk of women who drink no alcohol. We suggest limiting the amount you drink, if you drink at all.




Diet:

Diet could play a part in cancer. Eating more fruits and vegetables may be linked to a lower risk of some cancers.

Being overweight is linked to a higher risk of breast cancer, especially for women after menopause, and if they gain weight in their adult years.The link between weight and breast cancer risk is complex and studies of fat in the diet as it relates to breast cancer risk have often given conflicting results. But, since diet and weight have been shown to affect the risk of getting several other types of cancer and heart disease.

A high-fat diet can increase the risk of endometrial cancer. Because fatty foods are also high-calorie foods, a high fat diet can lead to obesity, which is a well-documented endometrial cancer risk factor. Many scientists think this is the main way in which a high fat diet increases endometrial cancer risk. Some scientists think that fatty foods may also have a direct effect on estrogen metabolism that increases endometrial cancer risk.




Exercise:

Exercise and cancer is a fairly new area of research. Some studies suggest that exercise in youth might give life-long protection against breast cancer. Even a small amount of physical activity as an adult could lower breast cancer risk. More research is being done to confirm these findings. Exercise and a healthy lifestyle is always recommended to reduce risk of all diseases.




Breast Self-Exam:

Checking one's own breasts for lumps or other unusual changes is called breast self-exam (BSE). Studies so far have not shown that BSE alone reduces the numbers of deaths from breast cancer. BSE should not take the place of clinical breast exam and mammography. Mammograms can detect breast cancer that cannot be felt.



Mammograms:

A screening mammogram is an x-ray of the breast used to detect breast changes in women who have no signs or symptoms of breast cancer. It usually involves two x-rays of each breast. With a mammogram, it is possible to detect microcalcifications (tiny deposits of calcium in the breast, which sometimes are a clue to the presence of breast cancer) or a tumor that cannot be felt. The NCI recommends women in their 40s and older should have mammograms every 1 to 2 years.

Women who are at higher than average risk of breast cancer (based on family history of breast cancer) should talk with their health care providers about whether to have mammograms before age 40 and how often to have them.




Clinical Breast Exam:

A high-quality mammogram with a clinical breast exam (an exam done by a health care provider) is the most effective way to detect breast cancer early. Like any test, mammograms have both benefits and limitations. For example, some cancers cannot be detected by mammogram, but may be detectable by breast examination.




Pap Smear and Pelvic Exam:

Abnormal changes in the cervix can often be detected by the Pap test and treated before cancer develops. The American Cancer Society (ACS) guidelines advise women to begin annual screening at age 18 or when they become sexually active but note that they can be screened less frequently after they have three successive normal Pap smears. Although these results suggest that some women can have Pap tests less often than yearly, most should continue to get annual checkups. Annual physical exams done at the same time as the Pap test can detect several types of cancers as well as other health problems.