Taylor Ludden McMaster (Host): Hello listeners, and thanks for tuning in to the Well Within Reach podcast brought to you by Riverside Healthcare. I'm your host, Taylor Ludden McMaster, and joining me today is Dr. Cassandra Lacher, Oncologist and Hematologist at the Riverside Cancer Institute. January is Cervical Health Awareness Month, and today we're going to talk about cervical health and HPV. Before we get into today's episode, we're going to take a quick break for a message about MyChart.

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Host: And we're back. So Dr. Lacher, can you tell us what cervical cancer is and how it forms?

Cassandra Lacher, DO: Absolutely. So, cervical cancer is a cancer that starts within the cells of the cervix. It typically forms slowly over time, initially as abnormal cells or dysplastic cells, and that can progress into invasive cells that grow into the cervix and the surrounding tissues and organs.

Cervical cancer itself is the fourth most common cancer in women. And importantly, cervical cancer is highly preventable and curable when caught early.

Host: Interesting. Okay. So, is there a relationship between HPV and cervical cancer, and if so, what is that relationship?

Cassandra Lacher, DO: Yeah, absolutely. The long term HPV infections are actually one of the most common causes of cervical cancer.

Host: Really? You know about the different types of HPV that can lead to cervical cancer and why is that connection important?

Cassandra Lacher, DO: There are several different types of the HPV virus, which is the human papilloma virus, and the subtypes that are most commonly associated with cervical cancer are the 16 and 18 subtypes, and those can cause 70% of cervical cancers worldwide.

HPV is not only associated with cervical cancer, but it's also associated with anal cancer, penile cancer, head and neck cancers, and genital warts. One of the things with HPV is that we all get exposed to it when we're sexually active, and so almost everybody has been exposed or has contracted an HPV infection in their lives.

Usually our immune system does the effort of controlling the infection and clearing the virus over time, but if that doesn't happen, then the HPV virus can cause changes to the function and structure of the cervical cells, which can ultimately develop into cancer.

Host: Wow. And can this be prevented and what are the effective ways to prevent HPV?

Cassandra Lacher, DO: HPV is very preventable through the HPV vaccine. That vaccine is called Gardasil, and it offers the most protection when we give it prior to somebody becoming sexually active. So right now, the CDC recommends it for girls and boys aged 11 to 12, but it can be given as early as age 9. And now it's even recommended and can be given in people up to age 45, if that discussion with their doctor makes them think it would be a good option for them. The vaccine itself is given in two doses for most children or three doses for those who are 15 and older.

Host: Okay. Well, before we get into more on this subject, we're going to take a moment to talk about the importance of primary care.

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All right. Now we're back to our conversation about cervical cancer and HPV. So I'm curious, Dr. Lacher, how often should cervical screenings take place?

Cassandra Lacher, DO: Absolutely. So we do cervical cancer screening with something called a Pap smear. It's recommended to start this testing in women in their 20s and that test helps us see any abnormal cells or precancerous cells as well as evaluating for cervical cancer itself.

Most pap smears are done every three to five years, but in patients who've maybe tested positive for HPV in the past or who've had abnormal cervical findings in the past, then those patients oftentimes will do once a year for their Pap smears.

Host: Okay, and beyond HPV infection, what are some of the main risk factors for developing cervical cancer?

Cassandra Lacher, DO: Yeah, we have several known risk factors for cervical cancer outside of HPV. One of these is smoking or second hand smoke exposure. We also know people who are immunocompromised, either from something like an HIV infection, or patients who have had organ transplants and they're on immunosuppressive medications, or patients with autoimmune diseases who require immunosuppression can have a higher risk of developing cervical cancer from an HPV infection.

We also know that oral contraception with birth control or people who've had a lot of children also seem to be at a higher risk of cervical cancer, but we don't totally know the mechanism of why that is yet. And then the other couple that we know about, obesity, can cause increased risk of cervical cancer primarily because it can cause a false negative in your testing because it may be difficult to get a good sample at the time of your Pap smear, so we may miss some of those precancerous lesions on the screening. And one of the weird ones that we have for cervical cancer and kind of a different type of cervical cancer is a medication called DES, which was something that was given to women who were pregnant in the mid 1900s and that helped prevent miscarriage and help prevent early labor at that time, but we find it has also caused an increased risk of certain types of cervical cancer, in babies who were in the womb at the time.

Host: That's really interesting. Speaking of treatment for cervical cancer and that aspect, how does that affect fertility and quality of life in the aftermath? Are there options for women who wish to have children afterwards?

Cassandra Lacher, DO: Absolutely. So infertility can be a long term side effect of cancer treatment, particularly in patients who are later stage with their cervical cancer as they oftentimes will require surgery with things like a hysterectomy or they can require radiation and chemotherapy which can contribute to infertility as well.

Women may be offered to undergo fertility preservation before they start treatment with things like freezing their eggs. And that can help them have the option of having children in the future, even if they don't carry them themselves. We also know that other things that can affect quality of life where things like sexual problems can always be a side effect of treatment.

Body changes can be difficult to adjust to especially after surgeries and things like that. And then financial toxicity is another risk that we see with cancer treatment that can be a big proponent for quality of life difficulties for patients. And so in our office in particular, we work with patients to try to help minimize that as much as possible.

Host: Yeah. Speaking to that point, I'm curious, what we as listeners and community members can do to raise awareness about prevention, the vaccine you mentioned, especially in underserved communities, that might be affected by lack of resources.

Cassandra Lacher, DO: That's one of the things I think in the whole medical world that we know is a struggle and trying to access medical care in these communities can be difficult. We know that patients who are certain economic statuses are higher risk primarily because they lack that access to preventative care.

And so being established with a primary care doctor or somebody who can help offer those preventative screenings with things like cervical cancer screening is really important for our patients. We also know that access to certain websites like the American Cancer Society and the National Cancer Institute can provide a lot of information about things like cervical cancer prevention and treatment and screening. Sometimes we can get into the scary parts of Facebook and getting not appropriate information about cancer management.

And so utilizing appropriate websites can give you a lot of good information. I feel like our job as physicians and caretakers is to make sure that we're creating an environment where patients feel safe to come to our offices and talk about things that might be concerning them, like new pelvic pain or pain with intercourse or bleeding in between periods, which can sometimes feel awkward to talk about with somebody maybe you don't have a good relationship with. And so I think that's a big part of what we can do as caretakers and physicians to make sure we're providing an environment where patients can bring the awkward and uncomfortable things to us so that we can identify those problems early.

Host: Absolutely, yeah, and that kind of erases any stigma that comes along with that. And it's always important to be educating ourselves with the right tools, as you mentioned, those websites, so that we know how to prevent and educate others. So that's wonderful. Is there anything else on the subject of either cervical cancer or HPV that you'd like listeners to know about?

Cassandra Lacher, DO: I think the only thing I would say otherwise is just that at our facility here we are able to offer treatments that are front of the line therapies, whether that's chemotherapy or immunotherapy for things like cervical cancer. We've also had some updates to our radiation technology, so we're able to offer some new treatments like brachytherapy for cervical cancer that before patients would have to travel to Chicago to receive.

And so it's exciting to be in a place where we can offer a community that's considered more rural, still totally appropriate and adequate treatment, so it keeps them from having to drive far away to get the treatment that they need.

Host: Yeah, wonderful. Well, thank you so much and thank you all for tuning in to the Well Within Reach podcast with Dr. Cassandra Lacher of the Riverside Cancer Institute and your host, Taylor Ludden McMaster. To learn more about the Riverside Cancer Institute, visit myRHC.net/cancer.