Amanda Wilde (Host): One-On-One With Regional One Health is your inside look at how we're building healthier tomorrows for our patients and our community. Join us for expert insight that empowers you to achieve a lifetime of better health. Today we're talking to Dr. Marina Santa Cruz Terrazas, an OBGYN and Director of Regional One Health's Center for HPV and Dysplasia. She's here to talk about the care her clinic provides, including what patients can expect if they have an abnormal PAP test. I'm Amanda Wilde and Dr. Santa Cruz, as you are known, it's a pleasure to welcome you to the podcast.

Marina Santa Cruz, MD: Thank you Amanda. I'm very excited to be here. I'm excited to talk about HPV, something that I am passionate about. So, more than happy to be here.

Host: Well, let's start with the PAP test, which is possibly the most common screening exam, if it comes back abnormal, what does that mean for the patient? What happens next?

Marina Santa Cruz, MD: Okay. Just to start, like the PAP smear, as you mentioned, is one of the screening tests that we have to catch any abnormal cells, in this case on the cervix to prevent cervical cancer. And it is important to follow the guidelines and when to start and talk to your Doctor or practitioner about this. So what happens after we have an abnormal pap smear. I tend to tell my patient that it's just giving us some information. It's giving us like a red flag, saying like, okay, there's something that is abnormal on your cells. Or if they have, sometimes another way is just that the HPV, that is Human Papillomavirus, that is the agent or the cause that it will produce the abnormal cells, is abnormal. So we have to go ahead and go for the second step that it will be a more thorough test that is called a procedure called colposcopy. That's a procedure that we do in the office where we use a microscope in order to visualize inside of the vagina and look in the directly to the cervix and see if we see any lesions.

And if we see any lesions we will need to do some sampling of the tissue there, and to have a diagnosis, to have better information, to know better what's the process and what's happening at that time.

Host: Besides presenting abnormal cells, are HPV, dysplasia and cervical cancer related?

Marina Santa Cruz, MD: Yes. So, HPV, as I said, is a virus that is very, very common, is sexually transmitted. Okay. And unfortunately we don't talk about enough about this, is the most common STI in United States and worldwide. And we don't have symptoms like, unfortunately we don't have symptoms when we have this infection, but we want to know that and we're trying to get away of stigmatize this 90% or more than 90% of people who going to be sexually active are going to be exposed at least once in their lifetime. So it is as common as having common cold. The important thing is that with the PAP smear, the PAP test and now HPV testing, we can screen and check to see if you are exposed, if you have the virus present on the cervix in this case, and see what is the degree of damage, if there's any. Gladly, most of people, even though they're exposed, even one time in their life, they're going to be able to clear the infection. Okay? It takes between eight to 24 months to clear the infection, but then you can be reinfected, that's why it's important, even if you have cleared the infection once in your life, to continue to being tested.

And, our biggest friend is the PAP test and HPV testing, yes.

Host: So you were saying HPV may have no symptoms. So that is of course why it's important to get the PAP and see a specialist to prevent serious health problems. Is that also true for dysplasia and cervical cancer that they may have no symptoms?

Marina Santa Cruz, MD: Dysplasia will not have, most of the time you don't have any symptoms. Now cervical cancer, unfortunately, when it's already advanced, then yes, patients can have what we call post-coital bleeding. What it means is, having bleeding after intercourse or after having sex, sometimes people can have some very foul smelling discharge, abdominal pain. But this is, as I said, in a late stage of cervical cancer when it's too unfortunately late, right? Because then you're going to need to be treated and chemotherapy, radiotherapy, sometimes even if it's, advanced surgical management is not an option. So, that's why it's so important for our community to know about the ways of preventing cervical cancer.

 And gladly we have primary prevention and secondary prevention. So let me talk to you about like the most important one that is the primary, before even getting the HPV exposed. We have the HPV vaccine, it is called Gardasil. It is FDA approved here in United States.

It is given between 11 to 12 years old to girls and boys. It can be given as early as nine years old. Patients will need to receive two doses before the age of 15, or if they haven't get any vaccine before the age of 15, then they will have to get three doses.

It's a vaccine that is almost a hundred percent efficient, meaning that it will prevent more than 90% of cervical cancer and not only cervical cancer because HPV is related with six types of cancer that is cervical, vaginal, anal, penile and oropharyngeal. So the benefit is so greatly for prevention and as I mentioned before, the second type of prevention will be with the testing, the screening with HPV and a PAP test.

Host: Is there prevention you can do in terms of lifestyle?

Marina Santa Cruz, MD: Yes, there is. Of course, using condoms can prevent some, keeping your screening on time. Keeping your immune system strong. We used to say like, of course the more partners you have, the more risk you have to be exposed to different types of HPVs. Smoking cessation is very important because tobacco has chemicals. There are more than 300 chemicals that can help the virus to replicate.

So even that your immune system naturally is trying to clear an infection, people who smoke is kind of feeding the virus, letting the virus to continue to multiply on that mucosa. So a smoking cessation is one of the main recommendations that I give to my patients for sure.

Host: So there are ways to prevent HPV through lifestyle and vaccination. What is your best advice to patients in terms of prevention?

Marina Santa Cruz, MD: My best advice, get vaccine. The vaccine can be given up to 45 years. It is covered until the age of 26. Then some insurance can cover or not, depending on the insurance. But, yes, get vaccinated and get screened. Have a conversation with your provider. We are excited because HPV and cervical cancer prevention is a movement around the world that is continually looking into the future, new technologies, new options for patient, for example. We're super excited that FDA has approved for a self-sampling HPV test where the patient goes to the clinic and we give them the supply, like the kit, and they can in a private environment in the clinic, take their own sample without having the speculum.

Sometimes it, that's a little bit uncomfortable. So for some patients that they don't tolerate that, they have the option of getting their own HPV testing. Now, this is not the PAP. This is not going to show us if there's abnormal cells or not. This is just going to show us if there is HPV, yes or no.

If the answer is no, you will continue with your screening test as a schedule, like depending on your age. But if it's positive, if you have HPV, and it will depend which type of HPV, the next step will be to get a PAP test or if the HPV type is the most aggressive one, you will go ahead and get set up for the colposcopy, the procedure that I was mentioned before where we look into your cervix with that microscope.

Host: And at your clinic, you will walk patients through that process.

Marina Santa Cruz, MD: Yes, as I said that this is my baby, the clinic. It is a safe space, not only for women, but for any individual with a cervix and also for male patients who have intercourse with men, patients with HIV, patients who had solid transplant organs, patients who had immunodeficiencies.

 So we offer most of prevention for anogenital HPV related conditions. Unfortunately we are not expanded to the oralpharyngeal yet, but that's something that in the future we're looking to have, also the collaboration of like ENTs or dentist school in order to have that part also covered.

Host: And you also see patients for a wide variety of OBGYN healthcare needs also at the clinic. What about that aspect of your practice?

Marina Santa Cruz, MD: Well, yes. Uh, so the CHAD clinic, the center for HPV and dysplasia is kind of like just for HPV and, and abnormal PAP smears and all that. But, in Regional One, I also have a variety of patients that I see. For example, I see at the east location, I see GYN patients. So patients who have PCOS or they want to just establish GYN care, preventive care, vaginal discharge, any like sexual health, distress, or conditions, menopausal symptoms. So, I try to help everybody from the age of 18 and beyond. And then, in the main campus, I also see a lot of OB patients, obstetrical patients. So, I love this part because here in Memphis we have high risk populations for, high risk pregnancies. So I have the opportunity to work closely with the maternal fetal medicine peers that in conjunction we help and we support our patients in o bstetrics and prenatal care.

Host: Just knowing the focus and the variety of expertise and services you provide makes me feel comfortable. But what do you do, so that you can build trust with your patients? And just tell me a little bit about your patient care philosophy that you work from.

Marina Santa Cruz, MD: Sure. I always tell my patients that I treat them as, I will treat my mom, as I will treat my family or my loved ones. I'm passionate about this. I, I am passionate about preventing cervical cancer because it could be prevented. This is not, it's not a fantasy. It is a goal to prevent cervical cancer in the future.

And I feel like educating the patient, having this open conversation, sometimes they come to the clinic full of fear. Unfortunately, on the internet, sometimes when you Google Dr. Google, it will give you the worst scenario, and that is not always the case, right? So I want them to feel comfortable and I want them to be able to speak for themself, empower them to be able to be responsible for their health and, yeah, so, very down to earth. I don't like to use fancy medical words. I try to use different things to teach them. For example, I like to draw, I like to show pictures. I also have some of the unique things that we have in the clinic is that the patient can actually see live on a screen, the entire procedure. Like, so when I'm using the microscope and when I'm evaluating the cervix, they're able, if they want to see, what I'm looking. Okay. So, I think that that information gives them the opportunity to know more about themselves. Right. And also to say that it's okay, it's okay to be afraid.

It's okay, but it is more important to be present in the clinic. So the fact that the patient come to the clinic for me is 90% like, you're winning already. So that's for me, priority to make them feel in a safe space.

Host: Which you really create at your clinic. Dr. Santa Cruz, thank you for this wealth of women's health information you've shared today and for the work of your clinic. I appreciate your passion and looking forward to the future of this endeavor.

Marina Santa Cruz, MD: Thank you, Amanda. It was my pleasure, and I hope we continue to spread the word that we can prevent cervical cancer.

Host: You can learn more about Regional One Health's Center for HPV and Dysplasia at regionalhealth.org/women'sservices. For an appointment, call 901-515-3800. Thanks for making One-On-One With Regional One Health, part of your journey to better health. Join us next time as we cover another topic to keep you on the path to a healthier tomorrow.