Amanda Wilde (Host): Welcome to Expert Insights with the Carle Foundation Hospital. I'm Amanda Wilde. Dr. Beverly London is here to discuss cervical health awareness. Dr. London is a Gynecologist at Carle Foundation Hospital and Dr. London, thank you so much for being here. Appreciate the time.

Beverly London, MD: Thank you for having me.

Host: Can you explain what cervical health awareness means and why it's important?

Beverly London, MD: Well, I'm very excited to talk about cervical health awareness this year because there's a lot of things that have changed, just in the last year. We have the ability to begin offering women cervical cancer screening at home and at the doctor's office where they can swab themselves for their PAP screening.

Host: That's crazy. Can you talk about that cervical self-collection program at Carle and how that benefits patients?

Beverly London, MD: So we're implementing it in the next six months. We have to, it's a matter of getting supplies and getting the ordering set up and doing an awareness campaign for both providers and for patients. But it's a swab where women can come into the office, just use a small, vaginal swab and collect the HPV virus testing. And that allows us to see if they're at higher risk for cervical cancer without placing a speculum inside. So for those women that were very anxious about doing cervical cancer screening because they were a concern, they felt awkward because of their weight, or they have a history of trauma, or just felt that they had an uncomfortable PAP experience before, this gives them an option for a cervical cancer screening.

Host: So less trauma and just more comfortable overall.

Beverly London, MD: Yes. So in addition to doing it at the doctor's office, women will have the capability from their insurance plan to have a kit sent to their home and have insurance cover them for them to do it in the privacy of their home as well. So it's going to be a game-changer in terms of getting more women to get screened because there's not that barrier to access and to discomfort.

Host: And screening is really important in cervical health awareness, isn't it?

Beverly London, MD: Absolutely. More than a hundred thousand women have abnormal PAPs, and up to 4,000 women will die of cervical cancer yearly, despite all of the screening methods that we have now, and despite having the Gardasil vaccine. So this will really help those women that were delayed in getting screening or not getting screened that often. Hopefully that will bridge that gap.

Host: Right? So this will actually save lives.

Beverly London, MD: Absolutely.

Host: And on the subject of HPV, we should point out too that there are new guidelines for primary HPV testing. What are those guidelines? How do they impact screenings?

Beverly London, MD: So this impacts women age 30 to 65, and that's why the self-swab is also part of that HPV testing. So we don't have to just look at cells under the microscope. We can test for the 13 high-risk HPV types that can potentially cause cervical cancer, So, it makes screening easier, less expensive, and hopefully more accurate because we're strictly looking for the virus. We're not trying to interpret cells. So, it should be helpful in that way, and doing HPV screening from a woman between age 30 to 65, she can do that every five years. If they do self-swab, they need to do it every three years.

Host: I was just going to ask that, how often should women schedule cervical health checkups?

Beverly London, MD: If they're 30 and over, they should have a cervical cancer screen every five years. But they should still see their primary or their gynecologist yearly because the PAP is just part of the annual exam for women's health. So there is other things that we go over, but a cervical cancer screen, they can do every five years if they're over 30 and up until age 65.

Host: And then can you talk a little bit Dr. London, about symptomatic versus asymptomatic PAP screening?

Beverly London, MD: Absolutely. So have screening is for routine risk. We consider symptomatic screening for, women that have a weakened immune system and they can have a weakened immune system due to HIV or because they had a transplant. Or because they're on medications that weaken their immune system. For instance, you might have a patient that has rheumatoid arthritis and she's on two immunosuppressant medications.

She would be considered a higher risk patient that needs to have PAP screening more often. Or if a patient has abnormal uterine bleeding, they should have an updated PAP. It doesn't matter when they had their last PAP done. Anytime you have abnormal bleeding, you need to have an updated PAP screen because cervical cancer can cause bleeding. And then, patients that have cervix when they come in for an exam, if their cervix looks inflamed, that's considered a symptomatic screen that we're doing. So even if they had a normal PAP last year, if their cervix visually looks abnormal, they need to be screened again.

Host: And when we're talking about the self-collection program, can that all be done through self-collection? Once you've seen some abnormal cells, I imagine, then it's time to come in.

Beverly London, MD: Yeah, so if they have an abnormal screen with a self-swab, then they're considered higher risk and we can't do self-swabs anymore, and they need to be screened in the office and have a PAP with a speculum. So if that test is abnormal, we need to do further investigation.

Host: Yeah. But the self-collection is, often the first and only step for a lot of women. How else does the Carle Foundation Hospital support patients in maintaining cervical health?

Beverly London, MD: So we are very proud of our record in terms of HPV vaccination. We're giving that to boys and girls starting at age nine. And we do catch-up screening. The vaccination is now approved for adults up until age 45. So this is something that's been a, an active goal of ours to make sure we get not only children the vaccination, but also adults because getting vaccinated can prevent five cancers, including cervical, vulvar, vaginal, penile cancer in men. And a lot of HPV cancers of the throat, are now the main cause of throat cancer.

Host: Wow. So this is a big step forward in protecting us from all those kinds of cancers?

Beverly London, MD: Yes. And all available at Carle, all covered by insurance.

Host: Wow. And are there specific lifestyle changes you recommend for better cervical health?

Beverly London, MD: The most important thing you can do to prevent cervical cancer is to get vaccinated, but the risk factors for cervical cancer are the number of partners that you have. Smoking is a big risk factor. So those are the two modifiable risks that you can address.

Host: Okay. And, how do you address a patient's anxiety around cervical screenings? A lot of us have it.

Beverly London, MD: Yes. So we talk about cervical cancer is a very preventable cancer if we catch it early. So the same time that I talk to a patient about how we do cervical cancer screening, what to expect in terms of discomfort; I'm talking to them about the vaccination as well. And when you have an experienced person doing the PAP, we use a small speculum or, we can in the next few months talk about self-swabs.

So there's no barriers anymore for a patient to get screened, so really you can reassure them that it's not going to be a traumatic experience at all.

Host: So it's really accessible for everyone who needs it, and I think it's a big takeaway for me that you've just said cervical cancer is often preventable.

Beverly London, MD: Yes, absolutely. Absolutely. The patients that we see they get cervical cancer are the ones that aren't getting PAPs.

Host: So, I want to emphasize that it is these simple screening techniques and vaccines that really can significantly lower your risk of cervical cancer. That's amazing.

Beverly London, MD: Yes. I'm glad you said that. Yes.

Host: Well, Dr. Beverly London, thank you so much for this information, your insights and pointing us in the direction to be proactive about our cervical health.

Beverly London, MD: Yes. I hope to see all the patients that haven't had PAPs in the next year with, with the self-swab.

Host: It's really a wonderful step forward and we'll look for great progress in the field from here.

Beverly London, MD: Yes. I think it's going to change the field completely.

Host: That was gynecologist, Dr. Beverly London. For more information and to get connected with one of our providers, to view Carle-sponsored educational activities, go to carle.org.

 That wraps up this episode of Expert Insights with the Carle Foundation Hospital. Thanks for listening.