Scott Webb (Host): Cervical cancer is common and treatable. But much like other forms of cancer, prevention and early diagnosis are essential to survival. I'm joined today by Dr. Derek Jurus. He's a board-certified OB-GYN with SolutionHealth, and he's going to stress the importance of the HPV vaccine and other lifestyle choices that can help people to avoid cervical cancer.

This is Your Wellness Solution, the podcast by Elliot Health System and Southern New Hampshire Health, members of SolutionHealth. I'm Scott Webb. Doctor, thanks so much for your time today. We're going to talk about minimizing risk for cervical cancer. So, let's start there. What is cervical cancer and who's most at risk?

Dr. Derek Jurus: Cervical cancer is a result of changes that we see on the surface of the cervix in the back of the vagina. The cervix is attached to the uterus and is covered in cells that are, in particular, susceptible to HPV infection. If a cancer sets up shop on the cervix, cancer cells can divide rapidly and may even collect to form a mass. Cervical cancer can eventually spread to adjacent tissues or distant organs even.

Host: Yeah. So, let's talk about who's most at risk.

Dr. Derek Jurus: Patients that are most at risk are women in their 40s. They're at the highest risk for a new diagnosis of cervical cancer. It would be rare for anyone younger than 21 to be diagnosed with cervical cancer. Twenty-one is the age at which we begin screening for cervical cancer, and this is also based on sexual history, how strong immune function is, and that sort of thing, which can tend to tell us about who is at risk.

One of the most important risk factors for cervical cancer is an infection with high-risk HPV. There is, of course, very effective vaccination against high-risk HPV, which patients can receive starting at age nine up through the age of 45. In terms of sexual history, multiple partners, being partnered with a male who has had multiple partners, and even the early onset age of intercourse can predispose patients to HPV infection. Generally, early onset age of intercourse should be considered earlier than age 18.

Some other risk factors would include dysplasia in other areas or regions surrounding the cervix, such as the vagina or vulva. Certain genetic conditions might also predispose someone to developing cervical cancer, and this could even lead to a strong family history of developing it.

One of the most important risk factors is smoking. Sexually transmitted infections, such as chlamydia, might also increase one's risk for developing cervical cancer. And though it is less common these days to see a patient whose mother was treated with a medication called diethylstilbestrol, or DES, during their pregnancy, these patients would also be at risk and need to be screened for cervical cancer.

Host: Yeah. So, it sounds like there are some behavior/lifestyle factors. Seemingly then, people would be able to control some of those, right? Though, as you say, smoking, things like that, do I have that right, that there are some lifestyle changes that could be made?

Dr. Derek Jurus: That is absolutely true. Thank you for bringing that up. The lifestyle changes that can be made to reduce the risk for developing cervical cancer would include eliminating the acquiring of HPV in the first place. HPV vaccine, like we mentioned, is available to patients up to age 45. It's no longer for patients only with a cervix. Pediatricians can vaccinate their patients against HPV starting both with boys and girls at age 9 and, ideally, before the onset of sexual intercourse.

Patients can also choose to use barrier methods or condoms to protect themselves against high-risk HPV with onset of intercourse. They can avoid STIs or STDs altogether. And in particular, smoking, reduction or elimination of any smoking behaviors would help to avoid development of cervical dysplasia, which then eventually leads to cervical cancer.

Host: Yeah, it's always good when I host these to know that there are some things that, you know, are within our control, so behavior, lifestyle, quit smoking if possible, and so forth. Let's talk about the importance of early detection in preventing the progression of cervical cancer.

Dr. Derek Jurus: Sure. In order to prevent development of cervical cancer, we really need to focus on preventing the development of a high-risk HPV infection. And it's not very well known, but approximately half of cervical cancers that are detected are in patients who have never had a Pap test to screen for cervical cancer in the first place. So really, getting people vaccinated at an early age before the onset of intercourse and undergoing a regular screening program is essential to preventing cervical cancer from developing.

Host: Yeah. Let's stay there then, let's talk about screening. What are the current guidelines and how often should people be screened?

Dr. Derek Jurus: People should start being screened at the age of 21. And then, there are various schema to do the screening and this can be done either with a Pap test or a high-risk HPV test. The Pap test looks at the cells from a speculum exam and evaluation of the cervix and then the high-risk HPV is evaluated to look at the DNA component of HPV infection.

Host: Yeah. And as seems to be the case with all sort of cancers and things like that, you know, early screening, early detection seems to be key in terms of either curing or surviving, whatever the case might be. And you mentioned a couple of times, the HPV vaccines in preventing cervical cancer. So, how effective are they and who should receive them?

Dr. Derek Jurus: The HPV vaccine has been found to be quite effective, in fact up to 97% effective against developing cervical cancer. The HPV virus itself is transmitted with sexual contact, in particular, sexual intercourse. The HPV can show up on Pap tests from the cervix, but it also develops in other areas such as the vagina, the anus, or the throat. So, other partners are also at risk for developing and transmitting the virus.

Host: Well, this has been good stuff today. Very educational, doctor. As we wrap up here, final thoughts, takeaways, but also how can individuals advocate for themselves?

Dr. Derek Jurus: Sure. Individuals need to be engaged with the vaccination programs that are available to them, either through their family practice doctor, internist, or pediatrician. And then as obstetrician-gynecologists, we are also preparing to administer the vaccine for anyone that's eligible and would like it.

Something important to note is that across the last 30 years, cervical cancer deaths in the United States have dropped by about 50% overall. In the U.S., there's approximately 12,000 new cases of cervical cancer diagnosed each year. And from there, about 4,000 women in the U.S. will die from cervical cancer. Cervical cancer itself takes several years to develop, with dysplasia developing first and then eventually turning into a cervical intraepithelial neoplasia, which is the precursor to cervical cancer. Our goal in the office is to try to detect this early and to deal with it before it progresses.

Host: Yeah. Screening diagnosis sounds to me like a combination of factors have helped to drop those numbers. And good to hear that, that it's the vaccine, the early screening, diagnosis, right?

Dr. Derek Jurus: Absolutely. Early diagnosis is key. And unfortunately, in the last 10 years, our ability to decrease that cervical cancer death number has plateaued. So, we can still do a better job; we can always improve. And there are certain populations that are at higher risk, as we mentioned, and getting people screened early is key to successful prevention of cervical cancer.

Host: Yeah. That's perfect. Well, I appreciate your time today and you stay well.

Dr. Derek Jurus: Thank you. You as well, sir.

Host: And to schedule an appointment, visit snhhealth.org/womenscarenashua. And if you enjoyed this podcast, please be sure to tell a friend and share on social media. This is Your Wellness Solution, the podcast by Elliot Health System and Southern New Hampshire Health, members of SolutionHealth. I'm Scott Webb. Stay well, and we'll talk again next time.