“Cervical cancer is highly preventable in most Western countries because screening tests and a vaccine to prevent HPV infections are available. When cervical cancer is found early, it is highly treatable and associated with long survival and good quality of life.”
Cervical cancer is a completely preventable cancer with proper screening. We know so much about how this cancer develops that our screening exams are not designed to look for cancer but to detect the earlier stages that cells go through prior to cervical cancer. Many different treatment options are available for those early stages which would prevent the progression to cancer.
First, understand that 99% of cervical cancer is caused by a sexually transmitted disease. This is not the type of cancer that can genetically run in families where you would worry you were at risk if a relative had it. It is caused by the Human Papilloma Virus. Approximately 75% of the population already has been exposed to this virus. It is transmitted by direct sexual contact either orally, digitally, and even if a condom is used in intercourse. Once you are exposed to this virus, as is the case with any virus, you will always have it. There is no cure or treatment to rid ourselves of this virus. What we can do is detect the presence of the virus and any destruction it is causing in time to prevent it from progressing to a cancer.
Now a vaccine does exist for HPV. It is in fact recommended for both men and women to help control further spread of the virus and ultimately cancer. However, for a vaccine to work, you cannot have been exposed to the strain prior. For this reason, health insurance companies generally cover the vaccine for boys and girls from the ages of 9 – 26. No matter what the age, it will not work if you have been exposed already to the virus. Also, be aware that the vaccine does not cover all the HPV types. There are over 100 types of HPV virus in this family of virus. Our most complete vaccine only covers 4 of these types. Fortunately, they are the 4 most common HPV types we see in the US today.
Within this family of HPV, there are some strains we label ‘high risk’ and others we label ‘low risk’. The reason is that they do not all act the same nor cause the same destruction. Those we call ‘high risk’ have the potential to act aggressively and cause a cancer if not caught in time. Those we call ‘low risk’ are not aggressive enough to change cells toward cancer. However, I can guarantee you that not one of my patients would want these strains either because these can cause genital warts. This is why routine prevention examinations are important for women. These exams specifically look for early evidence of either of these diseases.
When transmitted sexually, the virus prefers to invade the cervix, which is deep in the vagina. Once exposed, the virus can enter and damage any of the cells in its path. It can invade the cells on the skin of the labia, the walls of the vagina, and the cervix. But while it is present in all those areas, it prefers to invade the cervix and cause cervical cancer, before it would ever likely cause a vaginal or a vulvar cancer. The reason I find fascinating. I can best explain it as follows: Viruses are generally lazy. They sleep the majority of their life cycle. We call them dormant in this stage, from ‘dormir’. Yet they want to survive and cause destruction. So if they want to survive, they will prefer to enter cells that are rapidly dividing. In this way, if they do very little work and get into 1 cell, they will be spread further as that cell divides. Compared to the cells in the labia, the vagina, and the cervix, those on the cervix divide the quickest. So that’s where the virus will first choose to invade and we would more likely see a cervical cancer, before any chance of a vaginal or vulvar cancer.
How do you know if you have cervical cancer? There are no symptoms. There is no pain, abnormal discharge, or odor until a tumor already exists. And this never has to happen. Cancer of the genitals is completely preventable with proper screening.
So what are these screening tests?
We have traditionally recommended the pap smear. The pap smear is when a brush is passed along the cervix to essentially exfoliate the cells that are on the surface so we may look at them under a microscope. We want to see that they are not disfigured. Now I’m going to give you some good news and some bad news. The good news is that we know so much about how this virus transforms the cells towards a cancer, that the pap smear can catch those stages that the cell goes through. Based on what stage it is caught in, there are treatments that can get rid of those cells and never allow a cancer to develop.
The bad news is that the pap can be wrong up to half of the time. This means that up to 50% of the results that come back as “normal,” may have missed an underlying abnormality. This is where HPV testing can help. We have the capacity to test for the virus itself from the same pap smear sample. This result will guide us as to whether we should believe what the pap is saying, or investigate further. Now, it is not mandatory for a gynecologist to test for HPV at the time of your pap. There are guidelines that we follow based on the patient’s age and history for testing it. In my office, I do offer it to all my patients. I test not only for the presence of the virus, but which strain you may have. I also test for something called HPV E6/E7. I covered this briefly in an earlier article. It is the latest technology in testing not just if you have been exposed to HPV but how aggressive might that strain be.
If any of the screening exams suggests there may in fact already be some damaged cells on the cervix, the next step is to take an actual sample of the area. This is done by a method called colposcopy. A microscope, called a colposcope, is used to look at the cervix directly. Any areas of concern seen are then biopsied for confirmation. The results will return in stages. Generally, stages 1 – 3. Depending the stage, and how long it may have been there, there are different minimal office procedures that can be done to remove that layer of abnormal cells. In essence, once the damaged layer of skin cells on the cervix are removed, you start from scratch again. This means, your cells are back to normal again. You still have the virus, but you will not develop cancer.
Please schedule your cervical cancer screening exam with your doctor this year. Start the year off right. Cervical cancer is a completely preventable disease. While there is not yet a cure for the virus, there is a cure for what the virus can do.
by CHRISTINA PEÑA, M.D.