Cervical Cancer Can Be Prevented

Ana Tergas, MD, a gynecologic oncologist on the faculty at Columbia University Medical Cancer New York Presbyterian Hospital, is now seeing patients at St. Barnabas Hospital.

Dr. Tergas treats vaginal, cervical, vulvar, endometrial, and ovarian cancers using minimally invasive procedures and radical cytoreductive surgery for advanced cancers. She also performs risk-reducing surgeries for women with hereditary cancer syndromes. In addition, she treats women with precancerous conditions of the lower genital tract, such as cervical and vulvar dysplasia, and endometrial hyperplasia.

She completed a fellowship in gynecologic oncology at Johns Hopkins Medical Hospital and a residency in obstetrics and gynecology at the University of Chicago Hospitals. She is a graduate of the University of Miami Miller School of Medicine.

Dr. Tergas is actively involved in research in both the U.S. and internationally and has an expertise in epidemiology. Her primary research interests include public health issues in gynecologic cancers, particularly improving the quality of gynecologic cancer care for underserved and disadvantaged women. She has worked extensively in international cervical cancer prevention.

Here is an excerpt of a recent podcast she did on SBH Bronx Health Talk on the topic of cervical cancer.

Q. So what makes cervical cancer largely preventable?
A. Almost all cases of cervical cancer are preventable and this is because not only do we have a good screening method, but we also have a vaccine against HPV which is the cause of cervical cancer.

Q. So why is it that an estimated eight million U.S. women between the ages of 21 and 65 have not been screened for cervical cancer in the last five years?
A. I think there’s a lot of reasons for this and many reasons have to do with difficulty accessing the medical system. So that may be either that patients don’t know where to go or how to make an appointment or they may not have health insurance. Women often have competing aspects of their lives that makes it difficult for them to take the time out to get their annual checkups.

Q. What exactly is the relationship between HPV or human papillomavirus and cervical cancer?
A. HPV is a sexually transmitted infection that causes abnormal changes in the cells of the cervix and if untreated can eventually lead to cervical cancer.

Q. Is HPV the only cause of cervical cancer? Is there a genetic component?
A. No, cervical cancer is not a genetic cancer. HPV is the primary cause.

Q. How common is HPV?
A. HPV is actually extremely common. There are several different types of HPV. There’s two broad categories: Low-risk HPV and high-risk HPV. Low-risk HPV does not cause cervical cancer. We know that high-risk HPV causes cervical cancer and within this category there’s actually several different types as well.

Q. A lot has been written about the importance of getting your preteen vaccinated against HPV to prevent cervical cancer. Now with the new recommendation from the FDA raising the age to 45, it also seems to be encouraged for women who are older who may not have been vaccinated when they were younger, right?
A. Very recently the FDA approved the HPV vaccine for women up to age 45 and this is a very exciting development because now we can vaccinate additional women as it used to be that you can receive the vaccine up to age 26. However, having said all of this, the best time to receive the HPV vaccine is whenever someone is young before they’ve actually been exposed. So the
actual age for the recommended age for on is 11 years old.

Q. What about pap smears? How important are those?
A. Pap smears are important as well, even for women that have been vaccinated against HPV. And the reason why that is, is because even though the vaccines work extremely well we still have to make sure that women are screened for any of these abnormal changes. With a pap smear we can actually catch cervical cancer before it develops, when it’s called pre-cancer.

Q. How often should you get a pap smear?
A. It actually depends on your age and your prior history. It’s important to ask your individual doctor for how often you should get the pap smear, but women should know that guidelines have changed a little bit and for the most part you actually don’t need a pap smear every year. But, like I said, it depends a lot on your prior history and your age. It’s important to see your gynecologist and ask them directly because they know that case better than anyone.

Q. If you’re infected by HPV and that causes dysplasia or pre-cancer what do you do then? What’s the treatment?
A. The treatment for this is a very simple office procedure where we simply remove this small area of abnormalities before it can progress to actual cervical cancer. So this is a very simple office procedure that takes about five minutes and you can go home the same day or even go to work because there’s not that much pain associated with it. The good news is that not only do we have the vaccine to prevent HPV infection, but we also have the pap smear to find these abnormal changes and we also have a very simple treatment for this.

Q. So I guess in a perfect world cervical cancer is sort of like colon cancer. If you do the screening it’s largely preventable, right?
A. Yes, absolutely, but actually the situation is even better than colon cancer in that we actually have a vaccine to prevent the majority of the cases based on HPV infection.

Q. Can you do anything to say bolster your immune system to prevent the likelihood of getting HP infection.
A. No, this is a common misconception among women. You know earlier
I discussed how HPV is extremely common. So it’s important to know that 80% of people will have an HPV infection at some point in their life and so there shouldn’t be any stigma behind actually having HPV. Unfortunately,
there’s not much that you can do in terms of helping your immune system other than not smoke. We know that smoking is a significant risk factor for cervical cancer. So once you actually have already been infected with HPV, cigarette smoke can cause changes in your cells that can make it easier for the HPV infection to stick around and cause those abnormal changes. The vast majority of people actually clear the infection on their own. It’s important not to smoke and that’s really the number one thing that you can do in terms of helping your body clear the HPV infection.

Q. If your preteen gets the HPV vaccine, are they immune from getting HPV?
A. The HPV vaccine is 99% effective. This is why it’s still important to get screened for cervical cancer because having the vaccine doesn’t eliminate the risk completely.

Q. What are the signs or symptoms of cervical cancer?
A. Abnormal bleeding is a common sign of cervical cancer. Also back pain,
leg pain, and bleeding specifically after intercourse is a very worrisome sign. However, I should really emphasize that these are symptoms that develop once cervical cancer has actually grown to a fairly decent size

Q. So pre-cancer actually does not really have symptoms?
A. Right. That’s why it’s important to see the gynecologist regularly so she can perform an exam, perform a pap, and try to find these changes before they grow big enough to actually cause symptoms. You know another big issue is that often women think to themselves “Well you know I don’t have any abnormal discharge, I don’t have any abnormal bleeding, I don’t have any pain, so I must be okay.” You know sometimes things can be going on down there without someone being aware of it. That’s why it’s important to be examined by a physician.

Q. What’s the treatment for cervical cancer?
A. Once somebody actually has cervical cancer, the treatment depends on the person’s stage. Options include anything from surgery to chemotherapy to radiation, but again it’s important to get your screening early enough to where we can control the changes before they develop into cervical cancer.

Q. I guess the bottom line is really don’t be afraid to see your gynecologist on a regular basis, right?
A. Absolutely. You know, it’s so important to touch base with your gynecologist. This means taking the time out of your busy schedule to do this as it really can be life-saving and you know science is improving every year and we have more and more treatment options.

Q. And I guess also as a corollary to make sure your preteen is vaccinated as well.
A. Yes. From personal experience I have a very young son. He’s not old enough to receive the vaccine yet, but as soon as he turns 11 I will certainly be vaccinating him against HPV. It’s important to know that it’s both boys and girls that can receive the HPV infection because HPV causes not only cervical cancer, but could also cause head and neck cancer and penile cancer in men.

To listen to the podcast with Dr. Tergas in its entirety visit: sbhbronxhealthtalk.org/e/episode-15-cervical-cancer-is-preventable.”