By Alok Gupta
INDIA New England Columnist
You are probably aware of the recent passing of the country music singer Joey Feek. While her passing is a tragedy for her family, it is also an opportunity to raise awareness of this highly preventable and treatable form of cancer: cervical cancer.
Cervical cancer often has no signs or symptoms in its early stages, with most patients experiencing either no symptoms or vague non-specific symptoms until the disease is fairly advanced. This lack of symptoms makes routine surveillance extremely important for catching the disease in its early stages.
Risk factors for developing cervical cancer include intercourse at a young age, multiple partners, family history of cervical cancer, populations with low rates of screening, and smoking. Regular cervical cancer screening, commonly referred to as the “Pap smear” has long been the standard for detecting changes in cervical cells which could lead to cervical cancer. This test looks for changes in the cells of the cervix under a microscope and can indicate the type of cells involved and stage of the changes from dysplasia, a type of “pre cancer,” to carcinoma.
In some cases, an abnormal Pap result may require monitoring only, as many healthy women’s immune system may be able to reverse these changes on its own. Other abnormal results may require biopsy to determine treatment.
Early stage treatment may include cryotherapy (freezing of abnormal cells), laser therapy, coinization (removal of abnormal cells), or oral medication. According to the American College of Obstetricians and Gynecologists (ACOG), all women should have their first Pap smear at age 21, regardless of sexual activity and continue to have them every 3 years.
A virus, the Human Papilloma Virus (HPV), which is easily spread through sexual contact, is responsible for about 95-99% of all cervical cancers. While there are over 100 strains of HPV, 15 are considered “high-risk” for developing cervical cancer. Both men and women can be infected with HPV, and can lead to genital warts in both men and women or penile cancer in men.
In 2006, the first HPV vaccine was offered to girls aged 11-26 and boys 11-21. The vaccine covers 4 of 15 strains considered “high risk” for developing cervical cancer. Since its introduction the rate of HPV infection with these 4 strains of HPV have dropped by 64% in women aged 14-19 and 34% in the 20-24 age group. A new HPV vaccine, released in 2014, covers an additional 5 strains.
Currently there is no test for men, however at age 30, HPV testing can be performed together with the regular Pap smear and decreases the number of falsely negative Pap smears. After age 30 if both the Pap and HPV tests a normal, ACOG recommends testing be done ever 5 years. While the debate continues on when to stop screening many agree that if all tests have been normal, screening can stop after age 65.
Vaccinating both boys and girls against the HPV virus will continue to decrease the number of women developing cervical cancer. With early and appropriate screening of women, even more cervical cancers can be prevented from progressing beyond the early stages. Talk to your child’s pediatrician about vaccination and see your primary care provider about which screening test is right for you.
For more information on Pap and HPV testing:
(Dr. Alok K. Gupta is an Internist, a doctor for adults. He is a Board Certified in Internal Medicine. He completed his residency in Internal Medicine at Salem Hospital in Salem, Massachusetts. Part of the training was also at Massachusetts General Hospital. Dr. Gupta has been practicing Internal Medicine since 1998. He was in upstate New York for six years. Recently, he had been practicing in Manassas, and now is in practice in Gainesville. Visit him on the web at www.alokguptamd.com )