Dr. Amy Banulis is a board-certified ob-gyn with the Mid-Atlantic Permanente Medical Group. She sees patients at the Kaiser Permanente Falls Church Medical Center.
As a board-certified ob-gyn, I know that cervical cancer can be deadly for thousands of women in the United States each year.
I also know that we can prevent most cervical cancers. Cervical cancer takes many years to develop, giving gives us the opportunity to detect and treat precancerous changes. Even if cancer does develop, if diagnosed and treated in its earliest stages, cervical cancer can be cured. In fact, the five-year survival rate for cervical cancer is 92 percent when the cancer has not spread, but it drops to 17 percent if the cancer has spread to other parts of the body.
That is why it is so important to get screened for cervical cancer and get vaccinated for human papillomavirus, the virus that causes almost all cervical cancers.
January is Cervical Cancer Awareness Month. During this time, I encourage women to become familiar with the risk factors and symptoms associated with cervical cancer, and to reach out to their healthcare team with any concerns.
Understanding Cervical Cancer
The cervix is the narrow, lower part of the uterus. Cervical cancer usually begins with abnormal changes (precancer) in cells on the surface of the cervix.
Most cases of cervical cancer are caused by HPV, which can be passed on during sex.
Cervical Cancer Prevention: Vaccination and Screening
One of the best ways to prevent cervical cancer is to get the HPV vaccination. Vaccination against the human papillomavirus before age 17 prevents 90 percent of cervical cancers, meaning we can protect girls and women from this potentially deadly disease. Vaccinating boys is also important to reduce transmission and to reduce the risk of other HPV-associated cancers.
The HPV vaccination — Gardasil 9 — is recommended for all individuals — male or female — aged 9 to 26. People between the ages of 27 and 45 should discuss the vaccine with their doctor. Getting the HPV vaccine when younger is recommended because people develop stronger immunity against the virus at younger ages. We usually give the vaccine when administering other vaccines to preteens, including the tetanus, diphtheria and pertussis booster, and the meningitis vaccine.
Some parents choose to delay HPV vaccination in their adolescents because they think being vaccinated may encourage their preteens and teens to have sex. I reassure all parents that studies show this is not the case. When I talk to parents about the vaccine, I remind them that the vaccine is not about sex but about protecting their children from different forms of cancer, including cervical cancer.
Those who are vaccinated between the ages of 9 and 14 need two doses of the immunization. Those who are vaccinated at age 15 or older need three doses.
Kaiser Permanente’s HPV vaccination rate is more than two times higher than the national average: Our electronic medical record system proactively identifies needed screenings and vaccinations.
In addition to vaccination, screening is a key way to prevent cervical cancer, and to catch it in its earliest stages. Women should be screened even if they have been vaccinated and even if they have never been sexually active. At Kaiser Permanente, nearly 90 percent of eligible patients were screened for cervical cancer — 21 percent above the national average.
The HPV and Pap (cytology) tests are the mainstays of screening. The HPV test looks for the presence of the human papillomavirus. The Pap test looks for precancerous or cancerous cells on the cervix. The tests can be done together (a co-test) or separately.
Kaiser Permanente is now using primary HPV screening, rather than co-testing, for patients ages 30 to 64 at average risk of cervical cancer. A primary HPV test means the test is done by itself, not together with a Pap test. A sample of cells is taken during the cervical screening appointment. The cells are tested for the presence of HPV.
Benefits of the primary HPV test: Women receive their results within two days, in most cases, which is much faster than a traditional Pap. The other advantage to primary HPV testing is that studies show that this method has fewer false positive results
If a patient’s primary HPV screening results are negative, no further testing is needed for five years, as long as the patient does not have other risk factors. If results are positive, the sample is sent to lab for further analysis to see if there are abnormal or precancerous cells. A positive HPV test does not necessarily mean cancer. Oftentimes, testing can detect cervical precancer: abnormal cells on the surface of the cervix. When they are detected, precancers can generally be treated and prevented from becoming cancer.
The Pap test is still preferred for women ages 21 through 29 and should be repeated every three years.
People younger than 21 or older than 65 generally do not need to be screened.
Other ways to help reduce the risk of developing cervical cancer include the following:
- Using a condom while having sexual intercourse to reduce the risk of contracting HPV;
- Limiting your number of sexual partners, and not having sex with people who have had many sexual partners;
- Not smoking and reducing exposure to second-hand smoke. Smoking has been linked with increased risk of cervical cancer.
Symptoms of Cervical Cancer
Screening for cervical cancer is so important because cervical cancer may not cause any symptoms in the earliest, most treatable stages.
Cervical cancer can cause vaginal bleeding between periods or after sex; heavy periods; pelvic pain; bleeding after menopause; and vaginal discharge that is watery, has an unusual odor, or contains blood.
Treating Cervical Cancer
If cancer is detected, patients at Kaiser Permanente benefit from a multidisciplinary team of board-certified physicians, including medical oncologists, radiation oncologists, surgeons, and gynecologic oncologists. Together, the team will develop and coordinate a treatment plan.
Treating cervical cancer may include surgery, radiation therapy, and chemotherapy. The treatment approach is based on the stage and size of the tumor.
Many women are concerned that a cervical cancer diagnosis means they won’t be able to have children. Fortunately, we have treatment options to preserve fertility, particularly when the cancer is diagnosed in the early stages. For the earliest stage of cervical cancer, a cone biopsy to remove tissue from the cervix may be sufficient treatment. For larger cancers, we can remove the cervix, part of the vagina and the pelvic lymph nodes with a fertility-sparing radical trachelectomy, keeping the upper part of the uterus intact.
Learn more about how Kaiser Permanente’s integrated health system works to treat cancer so patients can have the best possible quality of life.
If you haven’t been vaccinated or screened for cervical cancer, or if you have symptoms, reach out to your physician. We have the tools to eliminate cervical cancer. It will someday be a disease of the past if we ensure that everyone is vaccinated and screened.
Feature image, stock.adobe.com
For more expert advice, subscribe to Northern Virginia Magazine’s Health newsletter.
