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June 2010: Cervical Cancer and HPV

31 May 2010

Dr. Suzanne Pham is a board-certified internist at Lakefront Medical Associates, located at Weiss Memorial Hospital. Her areas of expertise lie in women’s health, adolescent medicine, preventive medicine, cancer prevention and chronic disease management.

Suzanne Pham, M.D.
Lakefront Medical Associates
Weiss Memorial Hospital
(773) 564-5355

What is cervical cancer?
Cervical cancer is a cancer that starts in the cervix, the lower part of the uterus. It may present with vaginal bleeding but symptoms are often absent until the cancer is in its advanced stages. In 2009, there were estimated to be 11,000 new cases of invasive cervical cancer in the United States, and this year 4,000 cervical cancer-related deaths are expected.
The most important risk factor for cervical cancer is infection with the human papillomavirus (HPV). There are more than 100 different types of HPV. However, most types of HPV do not cause cancer. At least 80 percent of women are exposed to the HPV virus during their lifetime and, in most instances, the body's immune system eliminates the virus before it does harm. HPV is spread by direct skin-to-skin contact including sexual intercourse, oral sex and anal sex. It is not possible to become infected with HPV by touching an object such as a toilet seat.

Testing for cervical cancer
Cervical cancer is usually a slow-growing cancer and the Pap smear allows for early identification of precancerous changes. Developed by George N. Papanicolaou, a zoologist by training, this technique was originally designed to examine vaginal debris in guinea pigs. Dr. Papanicolaou extended the exam to human volunteers, hence beginning the screening for cervical cancer.

Cervical cancer screening guidelines in the U.S. are issued by three major organizations: the U.S. Preventive Services Task Force (USPSTF), the American Cancer Society (ACS) and the American College of Obstetrics and Gynecology (ACOG).  In the past, experts recommended that every woman have a Pap smear once per year. This has changed, and the need for a yearly test depends more on your age and past medical history. All three organizations strongly recommend screening for cervical cancer in women who have been sexually active and have a cervix. Initiation of screening is recommended at age 21 or three years after the onset of sexual activity, whichever comes first.

Cervical abnormalities
During the Pap smear procedure, a doctor performs a pelvic exam and uses a small brush or spatula to collect cells from the cervix. The cells are smeared on a glass slide (a traditional Pap smear) or added to a preservative fluid (liquid-based, thin layer testing). An HPV test can be done along with a Pap smear. To prepare for your Pap smear, you should not put anything in the vagina (e.g., creams). A Pap smear can be done at any time during your menstrual cycle, but, if you have heavy vaginal bleeding on the day of your appointment, call your doctor or nurse to ask if you should reschedule.

If your Pap smear is abnormal, you may need further testing. If your Pap smear is normal but your HPV test is abnormal (positive), you may need follow-up testing (colposcopy) or secondary Pap smear and HPV test. Two vaccines (Gardasil® and Cervarix®) are available to prevent infection with several types of HPV known to cause cervical cancer. Health officials hope these vaccines will significantly reduce the number of women who develop cervical cancer.

For more information
If you would like more information about cervical cancer and HPV, or would like an appointment, please call Dr. Pham’s office at (773) 564-5355.