What You Need To Know Now About Cervical Cancer

JANUARY IS CERVICAL CANCER AWARENESS MONTH.

WHAT CAUSES CERVICAL CANCER AND HOW DO WOMEN GET IT?

Almost all cervical cancer is caused by Human Papilloma Virus or HPV. HPV is an extremely common virus that is passed from person to person through sexual contact. Over 90 million people in the US have been exposed to HPV. But only a small fraction of women who are exposed to HPV get cervical cancer; in most women, their immune system allows them to stop the cancer-causing virus in its tracks.

SO WHY IS IT ONE OF THE MOST COMMON CANCERS AFFECTING BLACK WOMEN IN PARTICULAR?

Cervical cancer is about 1.5 times more common, and 2 times deadlier in Black women than White women in the United States. Black women over 65 years old have the highest death rates from cervical cancer among any group of women.

We don’t know for certain why Black women have higher rates of cervical cancer; but the reason they are more likely to die of their disease is due to lower screening rates and being less likely to having access to treatment by the right type of doctor, a gynecologic oncologist.

CAN IT BE PREVENTED?

Getting vaccinated against Human Papilloma Virus can prevent over 91% of cervical cancers. The HPV vaccine protects against 9 different types of the virus including types that cause anal cancer and head and neck cancer as well as cervical cancer.  All boys and girls in the U.S. should get vaccinated against HPV at age 11 or 12 to prevent them from every getting one of these cancers.  The HPV vaccine was recently approved for men and women up to age 45 years old; so Black women who haven’t yet developed cervical cancer or pre-cancer should get vaccinated.

AT WHAT AGE SHOULD YOU START GETTING REGULAR CERVICAL CANCER SCREENINGS?
Women should get regular cervical cancer screening beginning at age 21; but all girls and women should see a gynecologist and have an exam as soon as they start having sex and should see a gynecologist at least once a year for a pelvic exam.

WHAT ARE SOME OF THE SYMPTOMS OF CERVICAL CANCER?
Bleeding that is outside of your normal pattern is the most common symptom of cervical cancer including spotting after sex, bleeding in between periods or heavy periods. But don’t wait for symptoms; get vaccinated and get screened for cervical cancer on a regular basis.

 IF YOU’VE HAD A HYSTERECTOMY, SHOULD YOU BE CHECKED FOR CERVICAL CANCER?

If you had your cervix removed when you had your hysterectomy then you don’t need to be screened for cervical cancer. But many women don’t know for sure if their cervix was removed; it is best to see your GYN and get examined and she can tell you if you need to be screened after a hysterectomy.

ONCE DIAGNOSED, SHOULD I GET A SECOND OPINION BEFORE CONSIDERING TREATMENT OPTIONS?

If you are diagnosed with cervical cancer, the most important thing is to get an opinion from a GYNECOLOGIC ONCOLOGIST-a specialist who has had many years of training just to be able to take care of women with cervical cancer.

A Gynecologic Oncologist can advise you on all the available options for treatment including clinical trials. To find a Gynecologic Oncologist near you- go to the Society of Gynecologic Oncology website at https://www.sgo.org/seek-a-specialist/ .

WILL TREATMENT AFFECT MY DAILY ACTIVITIES?

Treatment will only affect your daily activities in the if you are diagnosed with a higher stage of cervical cancer that requires radiation treatment.  Most cervical cancers are diagnosed early and are cured with various types of surgical procedures.

WHAT WILL YOU DO IF THE TREATMENT DOESN’T WORK OR IF THE CANCER RECURS?

For early stages of cervical cancer it is very rare for the cancer not to be cured with treatment. But for women with advanced cancer that comes back, there are many options for treatment including precision medicine and immunotherapy. If you have advanced stage cervical cancer or any cervical cancer that has come back; it is critical that you see a Gynecologic Oncologist and ask about clinical trials.

AFTER TREATMENT, WILL YOU STILL BE ABLE TO HAVE CHILDREN?

Since most cervical cancer is diagnosed at an early stage; the option to treat the cancer without having a hysterectomy is becoming more and more common; there are many options to treat cervical cancer that can allow a woman to still have children but you need to see a Gynecologic Oncologist to hear about these  options and find out if you are a candidate.

IF YOUR PAP RESULTS COME BACK IRREGULAR SHOULD YOU BE CONCERNED?

A: If you have an abnormal pap smear; DON’T PANIC!  Most abnormal paps ARE NOT cervical cancer. If your pap comes back abnormal, you will have another test where your doctor will look at your cervix and possibly take some biopsies.  In most cases an irregular pap will not be cervical cancer.

ONCE DIAGNOSED WHAT ABOUT THE COSTS AND INSURANCE COVERAGE FOR TREATMENT —  IS HELP AVAILABLE?

Breast and cervical cancer screening must be covered by all insurance plans with no co-pay thanks to President Obama and the Affordable Care Act. Almost every state in the US has a program for free cervical cancer screening for women with no insurance and there is still a federally funded program that will provide Medicaid coverage for women who are diagnosed with cervical cancer after being screened at one of these federally funded sites.

Dr. Brown answers your “Text Tom” questions on the next page:

Can my 14-year-old son and 18-year-old daughter still get the shot?

Yes, both of your children can get the HPV vaccine from their pediatrician or doctor. Since they are over 14 years old, they will need to get 3 shots over a period of six months to be fully protected. The vaccine is FDA approved and recommended by the Centers for Disease Control and the cost is covered by all insurances and if you don’t have insurance, contact your local health department as there are many programs to provide vaccines for children without insurance at no cost.

If you are over 45 and have had a complete hysterectomy, what are the chances of cervical cancer?

If you have had your cervix removed as part of your hysterectomy, you essentially have no chance to develop cervical cancer because your cervix has been removed. And you don’t need to have PAP smears to screen for cervical cancer after having a hysterectomy – if the reason for your hysterectomy was not related to cervical cancer or pre-cancer.

Did the doctor say you can still get the HPV vaccine if you have HPV BUT don’t have cervical cancer?

Women who have already been exposed to HPV; women who have had abnormal Pap smears; and even women who have already had cervical pre-cancer can and should get the HPV vaccine. This is because the vaccine protects against 9 different types of HPV- so even if you have been exposed to one of the harmful types, getting the vaccine can protect you from getting cervical or other cancers related to the other 8 HPV types.

Dr. Brown, do you recommend the HPV vaccine to someone who has already been diagnosed with HPV years ago that’s never gotten cancer?

Yes. In my practice, I recommend that all women up to age 45 consider getting the HPV vaccine. Even if you have had HPV in the past, the current HPV vaccine protects against 9 different types of the virus, so you could still get protected against other HPV types than the one you had in the past

If you had a hysterectomy, and they left the tip of your cervix do u still have a high probability for cervical cancer?

If any part of your cervix remains in place after having a hysterectomy, you still are at risk for getting cervical cancer. You should still get regular cervical cancer screening and consider the HPV vaccine if you are younger than age 45 years old.

How can a woman have cancer and have her uterus removed?

Having your uterus removed is called a hysterectomy and having cancer of the lining of the uterus, or the cervix, is one of many reasons a woman may have this surgery. There are other, non-cancer related reasons to have a hysterectomy. Most hysterectomies performed in the U.S. are not performed for cancer.

I just had sex with my boyfriend 4 times after being celibate for 12 years. I bled 2 times. Could I have HPV? Or is it normal for bleeding after being celibate for so long?

Unexpected or abnormal bleeding can be a sign of either cervical or uterine cancer. Any woman with abnormal bleeding should consult her gynecologist for an exam and discussion of the possible reasons for the bleeding.

I was diagnosed with HPV but my last Pap came back normal, whereas before it was abnormal. Can I still get the vaccine to prevent it in the future?

Yes, even if you have had an abnormal pap or HPV positive test in the past, you are still a candidate for the current vaccine which protects against infection of 9 different HPV types.

My friend was just told she has HPV, she’s 47. Is she still at risk to get ovarian cancer?
Having HPV is a risk for getting cervical cancer, and the risk of cervical cancer increases with age. HPV infection is not a known risk factor for getting ovarian cancer.

Can you get cervical cancer if you had an ablation?
Yes, if you have had any surgical procedure that has left you with your cervix being present and intact, you still are at risk for getting cervical cancer and should have regular cervical cancer screening performed by your doctor or health care provider.

Where can my sister go for resources for surgery to have both breasts removed?
Women who have a family history of breast cancer should talk with their doctors about whether they should be tested for an inherited change in their DNA or mutation that makes them at very high risk for getting breast cancer. If a woman has such a high risk of getting breast cancer based on an inherited mutation, her doctor will discuss with her all the options available to prevent her getting the disease.

What is HPV?
HPV is a virus that is extremely common and is responsible for diseases that affect us like genital warts, cervical cancer, head and neck cancer, and anal cancer.

HPV virus is extremely common, and millions of people have been exposed to HPV which is generally transmitted through sex, but only a tiny fraction of people exposed to HPV ever get one of the conditions above. Many of the cancers caused by HPV infection can be prevented by getting the HPV vaccine.

Dr. Brown, what about those women that have had like the cryotherapy at the younger ages around 20 are they still at risk for cervical cancer?

Yes, women who have had cryotherapy, or any other treatment for an abnormal Pap smear are still at risk for getting cervical cancer if their cervix is still physically present in their body. All women who have a cervix should get screened for cervical cancer on a regular basis with their gynecologist.

To find a gynecologic oncologist near you please go HERE.

Can I make an appointment with Dr. Carol Brown, please!

Click here to find out more about Dr. Carol Brown including information about making an appointment.

To find out more about cervical and other gynecologic cancers, please visit Blackhealthmatters.com. 

If you have an abnormal pap does that mean you have cervical cancers?

No, having an abnormal pap does not mean you have cervical cancer, but it could be a sign that you have pre-cancer of the cervix which if treated properly will not become cervical cancer. If you have an abnormal pap, you should see your gynecologist who will tell you the next step.

Can you get cervical cancer if you had a hysterectomy?

If you have had your cervix removed as part of your hysterectomy, you essentially have no chance to develop cervical cancer because your cervix has been removed. And you don’t need to have PAP smears to screen for cervical cancer after having a hysterectomy – if the reason for your hysterectomy was not related to cervical cancer or pre-cancer

Can you recommend a cervical doctor in Houston Texas?

To find a gynecologic oncologist near you please go HERE.

Quarte Pap smears are now recommended every 3 years? If so, & health care providers (along with insurance) follow that recommendation, how does that impact early screening of cervical cancer?

The current recommendations for cervical cancer screening have been designed to keep in mind giving the most benefit in protection from cervical cancer to the greatest number of women. However, it is important that every woman is treated as an individual and her individual lifestyle and risks for cervical cancer are considered when deciding how often and what method to use for cervical cancer screening.

Some women may need to be screened more often or less often than every three years depending on their age and individual risk factors. Your gynecologist is the best person to talk to you about options for cervical cancer screening and decide with you what is the appropriate test and interval for your situation.

Since men don’t get cervical cancer, why would we be recommended to get the vaccine?
Although men don’t get cervical cancer, the HPV viruses that cause cervical cancer are transmitted through sex. So, by vaccinating boys before they get HPV, we can prevent them from transmitting HPV to their partners when they become sexually active.

Also, very important is that the current HPV vaccine protects against 9 different types of HPV, including types that prevent head and neck and anal cancer both of which men can get.

Do people diagnosed with HIV without cervical cancer need to seek alternative therapy or can they still get the vaccine?

People who are HIV positive, both men and women, are candidates to get the current HPV vaccine that protects against 9 different types of the virus. Please speak with your doctor about your individual situation.

Can you get the shot if you are pregnant?
The HPV vaccine should not be given to women who are known to be pregnant.

I was diagnosed with HPV by my GYN. I was told my numbers are high but my Pap smear is normal so right now the only thing to do is screen me every year. Is this correct or should I go and see a specialist?

If you have been diagnosed having been exposed to HPV, your doctor will explain what the next steps in your case should be.

There’s nothing else that can be done if I’ve been told I have HPV and I’m 48 (too old for the vaccine)? I’m currently taking AHCC supplements suggested by a nurse practitioner.

The HPV vaccine is not FDA approved for use in men or women older than age 45. Women of all ages should have regular cervical cancer screening by their health care provider- including women who have had HPV vaccine.

My mom took DES due to 3 previous miscarriages. I’ve had most of my cervix removed and there is no access to my uterus because of scar tissue. The doctors at Kaiser use ultrasound to examine my uterus. Is that enough?

If a woman still has a cervix despite undergoing previous surgical procedures, including a hysterectomy, she should still have regular cervical cancer screening.

I’m over 45 and have had a hysterectomy. Can you still have a normal sex life? Can a male partner over 45 still get the HPV vaccine and should a condom always be worn?
The HPV vaccine is approved for males and females from ages 9 to 45 years old.

Doc, I had my uterus removed in 2006. I recently found out I have vaginal ulcers. Is this something I should be concerned about?
To understand whether the problem you are experiencing could be related to any type of gynecologic cancer, you should be examined by your gynecologist.

If you have been treated for cervical cancer and been cleared, but still bleed after having protected sex, can you still have HPV?

Although HPV is the primary cause of most cervical cancers, the treatments for cervical cancer are not designed to treat the HPV. Rather the treatments get rid of the cancer. So, it is still possible for someone who has been treated for cervical cancer to test positive for HPV. For any symptoms of abnormal bleeding, please let your gynecologist know and get an exam.

I’m over 45 and I tested positive for HPV this year. I had a biopsy but no cancer was found. What should be my course of action? Does this automatically mean cervical cancer?

Being tested positive for HPV does not mean a person has cervical cancer. Your gynecologist or doctor who performed the HPV test can best advise you on what are your next steps.

Dr. Carol Brown is  a board-certified gynecologic oncologist which means her specialty is diagnosing and treating cancers that are located on a woman’s reproductive organs. Dr. Brown uses her skills as a surgeon to provide high-quality and compassionate care to women with ovarian, uterine, cervical, and vulvar cancer at memorial sloan kettering cancer center in New York.  Dr. Brown graduated with honors from Harvard university and received her medical degree from Columbia University.

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