Cervical Cancer – Canyon View Medical

Preventing Cervical Cancer

Posted on February 2, 2022January 17, 2023 by Avery Dustin

Today, cervical cancer remains a significant cause of cancer morbidity and mortality among women. In fact, in 2020, cervical cancer was the fourth most common cancer in women worldwide. Fortunately, due to access to cervical cancer screening and prevention programs, the U.S experienced a significant decrease in cervical cancer deaths compared to the rest of the world. In the past 50 years, there has been a 75% decrease in cervical cancer incidence and mortality in countries that have implemented screening and prevention programs. For this reason, Canyon View highly encourages regular screening and vaccination against cervical cancer.

You may be wondering, what exactly is cervical cancer? Cervical cancer is cancer of the uterine cervix and thus, occurs only in women. Cervical cancer is almost always caused by human papillomavirus (HPV) infection. On rare occasions, it can be due to other non-HPV causes such as genetics, cigarette smoking, and even oral contraceptive use. Because cervical cancer is so frequently caused by HPV infection, it is essential to understand HPV. HPV is the most common sexually transmitted infection in the United States and is spread by vaginal, anal, or oral intercourse with someone who has HPV. It can cause cervical cancer and cancer of the vulva, vagina, penis, anus, and oropharynx. Different strains of HPV can cause genital warts as well. Because cancer from HPV takes years to develop after getting infected, it is difficult to know when someone got infected if they have had multiple sexual partners over the years.

You may now be wondering, how can I avoid contracting HPV and developing cervical cancer? You can do several things to protect yourself from developing cervical cancer. The first thing you can do is get the HPV vaccine. The CDC and American College of Obstetrics and Gynecology recommend HPV vaccination at age 11-12 and for everyone through the age of 26 if they have not yet been vaccinated. The HPV vaccine is recommended not only for females but also males since they can be carriers of the virus. HPV vaccination has been shown to work exceptionally well, as it is estimated to prevent more than 90% of HPV-attributable cancers.

The second thing you can do to protect yourself is to get screened for cervical cancer. Screening for cervical cancer is recommended for all women ages 21 to 65 years old. Early screening for cervical cancer helps prevent the disease altogether. This can be done by getting a Pap test and/or HPV test. A Pap test checks for precancerous cells or changes of the cells in the cervix that might develop into cervical cancer, while the HPV test checks for the human papillomavirus that often causes those cells to change. Both of these tests can be done in your healthcare provider’s office. An instrument called a speculum is inserted through the vagina so your provider can examine your cervix and collect some cells and mucus from that area.

Screening with a Pap test is recommended every three years from age 21 to 29 years old. From ages 30 to 65, HPV testing is recommended every five years and a Pap test every three years. When both tests are done together, it is called “co-testing.” If your test results are typical for this test, your medical provider may recommend that you wait five years until your next screening. After the age of 65 or for women who have had a hysterectomy with removal of the cervix, screening is not recommended anymore if you have had normal previous results.

Screening for cervical cancer is an effective way to detect precancerous lesions and cancer. Because early cervical cancer is often asymptomatic, regular screening and HPV vaccination are critical aspects of one’s comprehensive reproductive health. Talk to your provider about your recommended screenings and vaccination schedule today.

Erin Tyrrell, FNP

Canyon View Family Medicine

Cervical Cancer: What should I know about screening? (2021). CDC. https://www.cdc.gov/cancer/cervical/basic_info/screening.htm

Invasive cervical cancer: Epidemiology, risk factors, clinical manifestations, and diagnosis. (2021). UpToDate. https://www.uptodate.com/contents/invasive-cervical-cancer-epidemiology-risk-factors-clinical-manifestations-and-diagnosis?search=cervical%20cancer%20&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H1

Updated Cervical Cancer Screening Guidelines. (2021). The American College of Obstetricians and Gynecologists. https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2021/04/updated-cervical-cancer-screening-guidelines

What’s the HAP with the PAP?!

Posted on January 18, 2021January 17, 2023 by Avery Dustin

The time of year has come, you double-check the calendar – once, twice, thrice. You make up a few excuses in your head, and you consider rescheduling (BUT YOU DON’T!). Yes, the time has come for your old frenemy, the Pap smear. To those responsible for giving things terrible names, we salute you.

Whether we have modesty concerns, feeling vulnerable and exposed, fear of discomfort or pain, fear of bad news, it’s just all around not the most fun part of our year (or three years to be more exact, but we will talk about that later). I will echo my parents’ parenting by saying, sometimes in life; we have to suck it up and do hard things when it’s essential. And listen up, my friends, this IS important. Let’s break it down a little and see if we can dispel some nerves and promote the Pap’s many merits.

Why do we need Pap smears? Is it necessary? The answer to that question is a resounding YES! According to the World Health Organization (WHO), cervical cancer is the 4th most common cause of cancer in women. According to the American Cancer Society, it also used to be one of the most common causes of cancer death, but those rates have significantly dropped thanks to the Pap smear.

One might ask, what is the origin of cervical cancer? Human Papillomavirus (HPV) is a sexually transmitted virus, is super common, and is also the cause of cervical cancer 99% of the time (WHO). For many women, HPV, if acquired, will resolve spontaneously, and persistent infection can lead to cervical cancer. When you get a Pap smear, we sample your cervical cells to ensure no abnormalities. A SOFT bristled brush is used to collect the sample, not a scalpel. This sample allows us to find changes in the cervix before cancer even has a chance to develop! Amazing! And if it has developed, we can usually catch it while it is small and much easier to treat. So give a clap for the Pap! Although the clap is a topic for another discussion, so maybe just a round of applause? What’s a cervical discussion without a little sense of humor?

Let’s end with a few guidelines on the when: Happy 21st birthday to you! A world of possibilities just opened up as well as your first Pap smear! Starting at 21 years old and then every three years after (as long as everything comes back normal), you need a Pap smear. Once you turn 30, there is additional testing that can change the frequency to every five years. These recommendations continue until about age 65. Not too bad, right? It used to be annual if that makes you feel any better.

While Pap day maybe isn’t everyone’s favorite day, I hope you can see why it is necessary. Not every cancer is this easy to screen for or prevent, and a Pap smear isn’t that bad. Whatever might be stopping you, it’s time to decide if the risk is worth it. And while some women may be completely comfortable with a male provider performing their Pap smear (remember they do it all the time), if that’s what’s holding you back, remember there are plenty of female providers out there like me. You need to ask for one. Come on in, ladies. Deep breaths. You got this.

The Dreaded Pap Smear – Why It’s Important.

Posted on February 11, 2020January 13, 2023 by Avery Dustin

There are fewer preventative visits a woman detests more than the dreaded Pap smear (a close second is most likely a mammogram, and third would likely be that “puff of air” into your eyes). So, you are in good company when you groan after remembering today is “that wellness visit.” With that said, let’s discuss why we put you through this emotional and physical discomfort.

First, we want to catch any concerns early. Generally, it is easier to treat illness in the early stages, instead of waiting until it is widespread. Some of you may remember when it was recommended that we did annual Pap smears. If you remember those, you are probably wondering if my previous statement is contradictory to our screenings. Surprisingly, it is not. When we did yearly Pap smears, we found we did a lot of unnecessary testing for false positives. (That means you test positive for something concerning, but upon further examination, we find out it was nothing.) Sometimes the body can clear abnormal cells and viruses when given time, hence the birth of our newer guidelines.

Now, what are we looking for with Pap smears? Besides being able to literally look for any abnormalities, we take samples of cells from the cervix looking for two major things. First, abnormal cells (aka cancer). Like I said, some cells we just monitor. With these results, we may do nothing. We may choose to repeat the test in one year to monitor if the body has cleared these out without intervention, or we may need to do further testing. Your provider will be able to explain why they go in one direction or the other. Second, we are also looking for HPV (Human Papillomavirus). HPV has several different strains, but there are some linked to cervical cancer. If you test positive for high-risk HPV, most likely, we will encourage further testing. Again, let’s catch and treat it early.

Finally, what are the guidelines? For normal Pap smears, women between 21-30 years old are recommended to have a Pap smear every three years, despite what age they became sexually active. For women who are in a committed, monogamous relationship, and have low-risk factors, we recommend a Pap smear every three to five years. For those 30-65, we recommend having a PAP/HPV test every five years.

Just remember, every woman dreads “Pap Smear Day.” However, no one ever regrets catching and treating problems early.

Cervical Cancer Screening and Prevention

Posted on June 7, 2018December 20, 2022 by Avery Dustin

A lot has changed since George Papanicolaou first discovered abnormal cells under a microscope while looking at a vaginal smear. In the 1920s, he wasn’t looking for a screening test for cervical cancer. His research was geared toward understanding the cellular changes that occur in response to hormones during the menstrual cycle. It turned out that one of the women that were sampled had uterine cancer and he noticed abnormal cancer cells on the slide he had prepared. This led him to consider the possibility of looking for abnormal cells as a way to detect cervical and uterine cancers. His idea was not taken seriously for several years but as we now know, the “Pap” smear gradually became widely used and has helped save millions of lives and made cervical cancer much less common in countries where screening is widely practiced. Unfortunately, even in the United States, cervical cancer kills 4000 women per year and many more in less developed countries.

For decades no one had any idea that most cervical abnormalities were caused by a virus. Over the past 30 years, the Human Papilloma Virus (HPV) has been proven to be the primary trigger for cellular abnormalities that can lead to cervical cancer. Technology has improved allowing microbiologists to identify more than 100 different strains of HPV. Many strains seem to do little damage, causing minor and transient changes on the cervix and resolve spontaneously. Other types are more likely to cause genital warts. “High Risk” types of HPV are most often associated with precancerous changes known as “high-grade cervical dysplasia”. These types of changes in the cervix can potentially become cancerous and therefore merit closer observation and treatment.

The ability to test for specific types of HPV allows screening and treatment of cervical abnormalities to be more precise and tailored to the findings in each individual. As many women remember, Pap smears used to be recommended every year. With a better understanding of the virus that triggers abnormalities and the progression of the diseases it may cause, several new changes have been made to the recommended schedule for Pap smears and the evaluation of abnormalities.

The current recommendation for screening intervals is in part age-dependent. Pap smears are no longer recommended for women under age 21. This is because most of the infections detected in younger women resolve spontaneously and do not need treatment. Pap smears are recommended starting at age 21. Overtreatment at a young age can lead to problems with fertility and pregnancy in the future.

Women between the ages of 21 and 30 should have Pap smears every three years if normal. If an abnormality is detected then either closer surveillance with additional Pap smears or treatment may be recommended. After age 30 a Pap smear will often be combined with testing for the high-risk types of Human Papilloma Virus (Co-testing ). If the Pap is normal and no HPV is detected, surveillance may be continued every three years. Some gynecologists even suggested as long as five years before co-testing again, although my personal opinion is that this is too long between screenings. A woman over 65 with no history of recent abnormal Pap screening may choose to discontinue them. There are plenty of other things that may be discussed and checked at the time of a gynecology visit so I still recommend regular visits even if a Pap smear is omitted.

Until recently, preventing cervical cancer has relied on early detection and treatment of the cancer precursor known as dysplasia. One of the most important new tools now available is a vaccine against the HPV virus that causes the disease. Although it doesn’t protect against all strains, it does cover the most virulent strains that cause 70% of cervical cancers and 90% of genital warts. The HPV vaccine (Gardasil) is now recommended for adolescents at around age 12. Since HPV is transmitted through sexual intercourse it is ideal to have the vaccine series prior to the onset of sexual activity. Because HPV may be contracted and passed on by either males or females it is recommended for boys and girls.

This is the only vaccine that can prevent cervical cancer and yet it is still underutilized because of the cultural/religious expectations regarding teen sexuality and parental hope that their children will practice abstinence. Although I fully support the notion of abstinence, I have been a parent and gynecologist long enough to understand that the reality is a large percentage of teens have sex before they’re even out of high school. And, even if one individual does abstain until marriage, there is no guarantee that the person they fall in love with has done the same.

Cervical cancer is almost entirely preventable. Every woman I have diagnosed with cervical cancer has gone years without screening. Although no one particularly enjoys a visit for this testing, it may be life-saving. As time goes on and HPV vaccination becomes mainstream and accepted, I hope that the need for me to treat cervical abnormalities will disappear.