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Cervical Cancer is Preventable


Posted on January 27, 2014 by

We’ll be back with our regular posting tomorrow, but today, we’re featuring an op-ed from Dr. Sujatha Prabhakaran, MD, MPH, FACOG, our Senior Vice President of Medical Affairs/Medical Director, to mark Cervical Cancer Awareness Month.

January is Cervical Cancer Awareness Month, and it’s important to know that cervical cancer is preventable.

It is one of the few cancers that has two proven strategies to prevent – not just treat – the disease. In 2011, more than 12,000 women were diagnosed with cervical cancer and over 4,000 women died from it.

Almost all of these cases could have been prevented if these women had had access to either cervical cancer screening via Pap smears or to the HPV vaccination – or both.

One thing may not know is that Pap smears don’t usually detect cervical cancer. What they detect are precancerous cells, cells that aren’t cancer yet but show changes that suggest they could become cancerous. Once we detect precancerous cells, we are able to provide treatments to either destroy or remove these cells and prevent them from ever becoming a cancer.

Women who have regular Pap smears (every 2-3 years is now recommended for most women) have a much lower risk of developing cervical cancer because, if they have an abnormality, it is often detected in the precancerous stage.

Another way to prevent cervical cancer or prevent precancerous cells from ever developing is the HPV vaccination. Most cervical cancers are caused by the HPV virus. Seventy percent of cervical cancer cases are caused by two particular types, 16 and 18, which are included in the vaccine. By getting the HPV vaccine before they are exposed to those viruses, women can significantly reduce the risk of developing cervical cancer.

Access to these types of preventive care is vital for the health of women.

While uninsured or under-insured women do have access to Pap tests and HPV vaccinations at safety net providers like county health departments and Planned Parenthood, this access will improve as women’s preventive health services will now be covered 100 percent under the Affordable Care Act.

I’m certain this will be a welcome change for women all over the country.

My Pap Came Back Abnormal … Now What?


Posted on August 22, 2012 by

Pap testSo you got your annual screening and a few weeks later you get a phone call stating your pap test came back “abnormal.” Don’t freak out! This can mean a couple different things. To be clear, infections like chlamydia or yeast do not count as an abnormal pap! An abnormal pap means atypical cells on your cervix, that is, that the cells have begun to change in such a way that may be or become cancerous. This is called dysplasia.

After a pap smear comes back abnormal, what happens next depends upon a couple of factors, including your age and the severity of the dysplasia.

You may only need to repeat your pap smear in a few months, as often a health immune system can fight off the changes itself. Or you and your provider may opt for a colposcopy, which is a better way of looking at the cervix. A speculum is inserted into the vagina, solution is applied to the cervix with a cotton swab to highlight abnormal areas of tissue, and then a special microscope is used to look at the cervix. This allows the provider to see the dysplasia and, if deemed necessary, take one or more small tissue samples. This biopsy may feel like a small pinch and, while slightly uncomfortable for most women, it is usually tolerated very well. This biopsy allows the pathologist (the person who examines the tissue sample at the lab) to get a more detailed and accurate reading of the cervical cellular changes.

Depending on the colposcopy results, you may need to go back to pap smears every 3-6 months or, if the dysplasia is severe, you may need further treatment to fully remove the abnormal tissue. This treatment may consist of cryotherapy or a LEEP (Loop Electricosurgical Excision Procedure). Cryotherapy uses a freezing chemical to remove abnormal cells, allowing healthy cells to grow back in their place. A LEEP cuts away abnormal cells with a thin wire carrying an electrical current. Though both procedures may sound intimidating, in truth they are not very painful (many patients tell me their LEEP was more comfortable than their colposcopy, because of the numbing solution applied).

Cervical dysplasia is most often caused by HPV, a very common virus transmitted through sexual contact. Here are a few tips on how to avoid HPV and cervical changes:

Don’t smoke! Smoking is not good for your immune system, and you need a healthy immune system to fight the virus.

Consider the Gardasil vaccine, which protects you from 4 strands of HPV, 2 of which cause 75% of cervical cancers.

Use condoms. Though they may not fully protect you from HPV, as HPV is passed through skin to skin contact, because condoms cover parts of sexual anatomy they reduce the chance of transmission. Try female condoms too, which cover more skin.

Practicing abstinence or limiting sexual partners is also helpful, but isn’t foolproof. The CDC sums it up really well: “People can also lower their chances of getting HPV by being in a faithful relationship with one partner; limiting their number of sex partners; and choosing a partner who has had no or few prior sex partners. But even people with only one lifetime sex partner can get HPV. And it may not be possible to determine if a partner who has been sexually active in the past is currently infected. That’s why the only sure way to prevent HPV is to avoid all sexual activity.”

Most of all, if you have a pap come back abnormal, keep these two things in mind: 1) Don’t panic. 2) Don’t ignore it. Cervical dysplasia is treatable and it does not necessarily mean you have or will get cancer. The keyword there is “treatable,” meaning you must see your provider for treatment to avoid detrimental effects to your health!