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Jaime Lewis (Host): Cervical cancer affects thousands of women each year, yet it's one of the most preventable cancers when caught early through regular screening. Here to help us understand more about cervical cancer prevention and the importance of regular screening is Angie Lewis, a women's health nurse practitioner with Skagit Regional Health. Angie brings extensive expertise in women's preventative care and is passionate about empowering women to take charge of their health through education and early detection.

This is Be Well with Skagit Regional Health. I'm your host, Jamie Lewis. Angie, welcome to the program.

Angie Lewis: Thank you, Jamie.

Host: Well, let's start with some very foundational basics. What are Pap smears and who needs one?

Angie Lewis: Yeah. Pap smears are a screening tool that's used for all women. This is starting with women of 21 years of age. And ideally, if you've been having normal Pap smears throughout your lifespan, you will complete that at 65 years of age.

Host: Okay. And how often are they recommended in that window?

Angie Lewis: Yeah. Once you're 21 years of age, they're recommended every three years until you're 30 years of age. And then, as you hit 30, they're recommended every three to five years. Depending on if they're normal, we co-test for two different parts of a Pap smear. At 30 years of age, it's a Pap plus HPV. So, if those are normal, it would be considered routine every five years until you're 65 years of age if those are normal.

Host: I want to get to the link between what you're screening for and cervical cancer. That was what we're getting to. But I do want to ask, I mean, a lot of women, myself included, I don't think we look forward to Pap smears necessarily. Do you have any tips for how to make those more comfortable or more, I don't know, get-throughable?

Angie Lewis: Right, right. That's often a really good question. It brings a lot of anxiety for so many women, especially younger women. I think the most important thing is having a really good relationship with the provider that will be providing your Pap smear. This is where specialty, I think, is a wonderful add-on to healthcare. Women's health, specifically at Skagit Valley, there are OB-GYN physicians and we have nurse practitioners that do a really nice job of providing excellent care. And this is what we do all day long. So, I feel like we're really good at it.

With that also being said, the importance of screening is really, really important. So, if it's your primary care, that is just wonderful too. But additional things that can be helpful are, first of all, having a good relationship with your provider. Again, there are different aspects of when you come to an OB-GYN office, we have different speculums, which are part of the Pap smear of how we obtain that. It's a device that goes in the vagina. And we have many different choices at an OB-GYN office compared to a primary care office. So, I think it just makes it a little bit more comfortable and less worrisome, I think, for patients to have different options.

Host: Yeah. And I'm always pleasantly surprised at how quick it is, really. It's not a long process. It's very, very quick and manageable.

Angie Lewis: Right. It is, and it should be. It should be comfortable and it should just be fairly quick. So, absolutely.

Host: Well, let's talk a little bit about the link between HPV disease and cervical cancer. What is that link exactly?

Angie Lewis: Yeah. So, we know, HPV is what drives cervical cancer. Specifically, we've been able to pull out about nine HPVs, which I know we're going to talk about HPV vaccine, but two particularly that we know drive cervical cancer, 16 and 18, cover about 70% of cervical cancer relationships. So, the importance of having the vaccine, Gardasil 9 is the HPV vaccine that we offer to people these days is so important.

Host: Human papillomavirus, does it evolve into cervical cancer? Is that how that works?

Angie Lewis: That's a good question. I don't know that it evolves, but it definitely drives,

Host: It leads to it.

Angie Lewis: Yep. It drives the cervical cancer for like precursors or there's a great 70% increased risk of a likelihood of an abnormal Pap smear leading to cervical cancer, with specifically 16 and 18.

Host: Well, so is cervical cancer preventable then?

Angie Lewis: Absolutely, with screening and early detection, again, having your regular Pap smears based on your age. So, speaking with your primary care provider or your OB-GYN provider. Having the HPV vaccine is just such a wonderful protection against these known causes of HPV that derive cervical cancer. Good sex practices using condoms. Condoms give about a 70% protection from an HPV because it is skin to skin contact. But also, having a healthy lifestyle. So, low stress, not smoking, having a really balanced diet, exercising regularly. Limiting the number of sexual partners is super important as well.

Host: Yeah, I know that HPV is more prevalent than a lot of people realize. So, limiting contact would definitely help. Well, let me ask you, let's say somebody winds up, they do test positive for cervical cancer. How is it treatable at that point?

Angie Lewis: Yeah. So, when you're doing your screening tests, whether it's primary care or an OB-GYN provider, if you come back with a regular Pap smear, there's guidelines that we follow to direct care with like a colposcopy, which is an another closer look at cervix. It's another testing. And then, there's a few other procedures that we would do in the office. And then, if it was a cervical cancer, we would send you to a gynecologic oncologist. And we've got some of the greatest gynecologic oncologist physicians, I think, in the Pacific Northwest. And they are located down at Providence Swedish. And what happens is you get referred to that specialty, and they will kind of discuss your kind of treatment plan and what that looks like.

Host: Great. Well, let's talk a little more about the Gardasil HPV vaccination. Who is it recommended for and when can a person get it?

Angie Lewis: Yeah, Gardasil vaccination is recommended as early as nine years of age. You can start it, and up to 45 years of age. So, this is really for specifically encouraging both male and female nine-year-olds, young folks, to get this vaccination, is really, really important. And it initially was just until you're 26 years old, nine years old until 26 years of age. And then, in the last few years, they looked at even if you've been sexually active, having the Gardasil-9 does give you protection of the particular HPV viruses that either maybe you've tested positive for HPV, or you've not, you're going to be having protection over specific variants that you've not tested positive for or completely protected against cervical cancer strains. And it's roughly about 98 percentile for protection. It's not a hundred percent, but it's right up there for close to a hundred percent, which is so amazing.

Host: I think that's amazing too. Why is it so important to catch cervical cancer as early as, I mean, nine years old will probably sound pretty young to a lot of people, but why? I mean, there has to be some kind of a correlation between catching it and the severity of the disease.

Angie Lewis: Yeah. So, starting the vaccine at nine years of age, the thought is as young people are becoming sexually active, that they have, I want to say immunity, but it's not immunity, it's protection up to like 98 percentile, as they're entering their sexuality. So, it really is changing the way that women are coming specifically that we see in clinic that are coming into the clinic, if they've been vaccinated, the likelihood of developing a cervical cancer, it's really impressive.

I know recently there's a study out in Denmark that it is, I believe, a requirement to have the HPV vaccine in Denmark, and they've almost eradicated cervical cancer because of that. It's pretty impressive. And I think our statistics are running at about 38% for vaccination for folks so we could do better, getting the word out is really important.

Host: Well, I mean, with 2% margin of error, how many can you prevent? I mean, this feels like one that we could do better, for sure.

Angie Lewis: Yeah. Absolutely.

Host: Well, thank you for all that information, Angie, and for sharing your expertise with us today.

Angie Lewis: Absolutely. Thank you for me on for such an important topic. I appreciate your time as well.

Host: You bet. Well, that was Angie Lewis, a women's health nurse practitioner at Skagit Regional Health. To learn more about women's health services and cervical cancer screening at Skagit Regional Health, visit skagitregionalhealth.org. And if you found this podcast helpful, please share it on your social media channels, and don't forget to check out our full library of health-focused episodes. Thanks for listening.