This post was written by Dr. Bogna Brzezinska, FACOG, Board Certified Gynecologic Oncologist, Parkview Packnett Family Cancer Institute.
As we roll into the new year, allow me to bring to your attention a cause very near and dear to my heart: cervical cancer prevention. January is Cervical Health Awareness Month. As a gynecologic oncologist, it’s my privilege to take care of hundreds of women every year with cervical cancers or precancers. That said, I want to make sure that you never have to be one of them! (For the gentlemen reading this, stick around. This article is important for you, too.)
What makes cervical cancer different
Cervical cancer is unique among gynecologic cancers because it is nearly completely preventable. Screening for cervical cancers and precancers is readily available, but there are many misconceptions that prevent people from getting the care they need.
Losing the stigma
One of the challenges we face in women’s healthcare is the idea that it is somehow taboo. As a gynecologist, I talk to women every day about their “parts” – both external and internal – and problems they may have related to their reproductive organs. Women may feel shy or ashamed initially, but there is no reason to feel this way. Those of us in women’s health encourage questions and feel passionately that education and building self-awareness are key components of our roles as physicians.
Common terms
In the spirit of breaking the stigma, let’s address some of the common terminology and misconceptions:
The cervix is the lower portion of the uterus (or womb), and the channel through which women give birth.
A pap test, or pap smear, is a screening tool for cervical cancer and precancer. Today it is often a combination of two tests: cytology, where a small brush is used to collect cells from the cervix, which are then examined to determine whether the cells are normal or abnormal; and HPV testing, where the cells are tested for the presence or absence of HPV, the human papillomavirus.
One of the most common misconceptions I often hear, is that every pelvic exam is a pap test. Not true! During a pelvic exam, a healthcare provider examines the vulva (the external visible portion of the female genital tract that consists of the mons pubis, labia majora and labia minora), vagina (the internal canal that leads from the vulva to the cervix) and cervix for visible abnormalities. Adult women of all ages should get a pelvic exam on a regular basis.
The pap test may be done during this exam. It is designed to identify problems while they are still microscopic and easily treatable. The American Society for Colposcopy and Cervical Pathology (ASCCP) provides the most up-to-date, evidence-based guidelines for cervical cancer screening.
Current guidelines recommend the pap test be done every 3-5 years. The pap test primarily identifies cervical cancers and precancers, though it may sometimes detect changes associated with endometrial cancers as well.
A pap test should not hurt. It may be uncomfortable but should not be outright painful. If it is, speak up! Vaginal or vulvar pain during an exam can sometimes be a sign of other problems, including vaginismus and vulvodynia, which are pain syndromes associated with the female genital tract. Additionally, for people with a history of sexual trauma, the anxiety associated with pelvic exams may also contribute to discomfort.
Your doctor does not want to hurt you and may simply need some feedback. Unfortunately, too many women fear gynecologic exams and therefore ignore signs or symptoms that something is wrong. This can have a significant impact on a woman’s health.
HPV is a virus transmitted via sexual contact and is responsible for over 99% of all cervical cancers.
HPV is ubiquitous in humans and transmitted via sexual contact. It is so prevalent, that over 80% of all sexually active people will have an HPV infection at one time or another. Many people will clear these infections and never know they had it, as only certain strains cause long-term problems that lead to cervical cancers, precancers or genital warts. There is also no screening test for men, though growing evidence shows that HPV causes many anal, penile and throat cancers. This means that HPV prevention is important for absolutely everyone.
Understanding risk and prevention
According to data from the Centers for Disease Control (CDC) and the American Cancer Society (ACS), each year over 200,000 women in the US are diagnosed with cervical precancers; nearly 14,000 are diagnosed with cervical cancer; and over 4,000 die annually from this disease. While precancers are relatively easily treatable, thousands of families lose a wife, a mother, a sister, a daughter or a friend each year to cervical cancer.
I mentioned earlier that most of these cancers and precancers can be prevented. How? With a simple vaccine. In 2006, the Food and Drug Administration (FDA) approved the first-ever vaccine against HPV, the causative agent for cervix cancers. This vaccine protects against nine strains of HPV, including those that carry the highest risk of causing cervical cancer. It is extremely safe, and side effects are generally mild and limited to those that patients may experience with any vaccine (muscle soreness, headache, fever and dizziness).
HPV vaccination is recommended for men and women until age 45, though ideally occurs in childhood. This timing offers the most protection for two reasons: the immune system has a more robust response at younger ages and this builds immunity prior to any exposure to the virus. The CDC provides the most up to date recommendations for HPV vaccination.
The tricky thing about HPV is that it can lie dormant for many years and reactivate later in life, like how chickenpox can recur as shingles years after the initial infection. Patients will sometimes tell me they stopped seeing their gynecologist and getting pap tests after they finished having kids, or because they were no longer sexually active. They thought they were in the clear and no longer had to worry about it. Unfortunately, because HPV can hang around for years, this is not safe.
The timeline from HPV infection to cervical precancer (also called dysplasia) to cervical cancer is many years, 5-10 at least. There are truly only two categories of patients who can “age out” of pap tests:
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women age 65+ with at least 10 years of normal results and no history of cervical precancer
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women who have had a hysterectomy and no history of cervical precancer
I want to emphasize that this does not mean you should skip pelvic exams, which are still important to identify other non-cervical problems.
Indiana has the 10th highest incidence by state of cervical cancer in the United States. This number is largely due to poor vaccine uptake and poor screening practices, meaning that people are not getting vaccinated against HPV and are not getting regular pap tests. HPV vaccination rates in the U.S. persistently lag below 40%. By contrast, the Australian Department of Health recently released data projecting they will be the first country to eliminate cervical cancer by 2035. Their vaccination rates are nearly 80%.
Final thoughts
Don’t ever feel shame about protecting yourself or your loved ones against a sexually transmitted infection, especially one that can lead to a life-altering diagnosis like cancer. Sex is a normal part of human relationships that most people experience, but like anything in life, it comes with risks. While you may never be able to fully account for a partner’s personal history, you can take steps to keep yourself healthy and safe.
Prioritize your health! Go visit your gynecologist, make sure your pap test is up to date, get vaccinated, talk to your family doctor about getting your kids vaccinated, and share this with a friend or two! Together, we can eliminate cervical cancer.
