Fourteen thousand women are diagnosed with cervical cancer each year despite the effectiveness of vaccination and screening at preventing the disease. Dr. Huh is joined by Haller Smith, MD, a specialist in gynecologic oncology, to discuss strides in screening that have already reduced cervical cancer by 75%, as well as the obstacles to improving prevention even more. Dr. Smith discusses the latest screening and prevention guidelines, which emphasize the effectiveness of HPV vaccines and testing. The doctors discuss the promise of HPV self-sampling as one screening solution for those with limited access to health care.
Selected Podcast
Cervical Cancer Screening and Prevention
Featuring:
Learn more about Haller Smith, MD
Haller Smith, MD
I grew up in Monroeville, Alabama. I attended Birmingham-Southern College and then completed medical school, residency, and fellowship all at UAB. I am proud to be from Alabama and am passionate about doing all that I can to provide great care to the women of Alabama.Learn more about Haller Smith, MD
Transcription:
Dr Huh (Host): Hello, everyone. Happy New Year. This is Dr. Warner Huh, the Chair of Obstetrics and Gynecology at the University of Alabama Birmingham. And I'd like to welcome you yet again to this monthly episode of Women's Health with Dr. Huh.
So in honor of Cervical Cancer Awareness Month, which is January every year, I'm excited about bringing up a topic that's dear to my heart. I've spent a lot of time, both clinically and academically on this topic, and that topic is cervical cancer prevention and screening. And with me today is Dr. Haller Smith, who's an Assistant Professor in the Division of Gynecologic Oncology in the Department of OB-GYN here at UAB. She did her OB-GYN training and gynecologic oncology training here at UAB. And we are thrilled that she decided to stay with us as a faculty member. She's also the Associate Director of the Gynecologic Oncology Fellowship Program within the department. So, Dr. Smith, welcome to this month's podcast.
Dr Haller Smith: Thanks for having me.
Dr Huh (Host): So, as I mentioned earlier, January is Cervical Cancer Awareness Month, and I thought this would be a phenomenal opportunity to talk about cervical cancer screening and prevention. What's interesting is that Pap smears and screening in women have had a marked impact in the reduction of the new cases and mortality related to cervical cancer. But the question I think our listeners may have is, why is cervical cancer screening still important?
Dr Haller Smith: Yeah. So, I think we are very fortunate to live in a country where the Pap smear has been widely implemented. And so with that, you know, really since that was initially rolled out, there has been about a 75% reduction in the incidence of cervical cancer. But there are still a significant number of women even in this country that are diagnosed with cervical cancer every year. So, currently, about 14,000 women a year are still diagnosed with cervical cancer and that number varies widely based on where you live in this country. And so, there are still parts of the United States where cervical cancer is a major problem and a lot of that is related to access to screening. And so, I do think screening is still really important.
And if you look at the incidence of cervical cancer, that steep decline has really leveled out in the last 15 years or so. And I think that's because we're not reaching some of these women and so a lot of the patients that are getting diagnosed with cervical cancer have not had access to appropriate screening.
Dr Huh (Host): Yeah. Along those lines, Dr. Smith, I think that many of us are concerned that with the COVID pandemic and limited access to screening, that we might actually see a reverse or an uptick in the rates of cervical cancer. And to your point, that's why I think screening is still important. Let me ask you this, your thoughts on when you see a new cervical cancer patient in your practice and their history of screening or lack of screening, what's been your general observation there?
Dr Haller Smith: So, I think there is very good data to suggest that a very high percentage of women who are diagnosed with advanced cervical cancer have had either no screening or inadequate screening. And so, I think very frequently, the patients that come in, especially with advanced cervical cancer, are women who have had really no gynecologic care in years, so often since the birth of their last child. And so, I think that's certainly something that we see in practice, especially in patients who come in with advanced stage cervical cancer.
Dr Huh (Host): Yeah. It's always impressed me that, when I ask this question to women about when their last screening test was when they come in with a diagnosis of cervical cancer, the vast majority of them will tell you that they have not been screened the last five to 10 years. And in fact, you know, I published a study with Dr. Vicki Bernard at the CDC that looked at the rates of screening in women with newly diagnosed cervical cancer. And what we know is still about 50% to 60% of women who come in with cervical cancer have never been screened or underscreened. And that number really hasn't changed in the last 30 years. And so, I still think that we can do much, much better.
So, I think our listeners may be interested in knowing what are the current screening recommendations. I can say this because I've participated in the screening panels, but they seem to be constantly changing. So for today, January 2023, I thought maybe this would be a good time for you to explain to our listeners what are the current screening recommendations.
Dr Haller Smith: Yeah. So, that's a great question, and as you said, it's something that has seemingly been constantly changing. And we're in the midst of yet another shift in the way that we screen for cervical cancer. So, for years, we have been starting screening at age 21 using a Pap smear or cytology, in conjunction with an HPV test. And really, within the last one to two years, there has been a shift from that to what's called primary HPV screening. So, really relying on that HPV test is the primary way to screen for cervical cancer. And there has also been a shift in the age at which that screening starts. And so, I think that the current guidelines and where things are going is that we'll start cervical cancer screening at age 25 with an HPV test every five years, and to continue that until age 65 for women who have had normal screening.
Dr Huh (Host): Yeah. I think there's a lot to discuss and unpack there. Can you just comment for the listener and our audience why primary HPV screening is a better test than cytology or a Pap? Because I think our audience may not quite understand that.
Dr Haller Smith: So, the vast majority of cervical cancer, actually 99.7% of cervical cancer is directly related to the HPV virus. And so, that HPV test is really the best test to know if a patient has a risk of developing a cervical cancer down the road. And so, if HPV is not present, then we can be sure that that patient is at a very low risk of developing a cervical pre-cancer or cancer. Whereas if a patient tests positive for one of the high risk types of HPV, then they are potentially at risk of developing a pre-cancer and ultimately a cancer. And so, that is one reason again that cervical cancer is so highly associated with HPV.
And the other nice thing about the HPV test is that the Pap smear or the cytology really depends on a clinician being able to sample the appropriate cells on the cervix, whereas the HPV test doesn't rely on that. And it's a test that with very high fidelity can be read as positive or negative and there's not really a subjective interpretation unlike a Pap smear or cytology that relies on a pathologist to actually look at that and interpret it.
Dr Huh (Host): Yeah, I want to expand on that because this is an important point for our audience. One is that, in my personal experience, that every single patient that I've take cared for in the last five years who has cervical cancer, who has been screened, all of them have only been screened with cytology. They have not had HPV testing, which kind of goes to show you sort of the false negative rate that's associated with cytology.
The second thing is that for our audiences to recognize that when you do have a negative HPV test, the predictive value of that, of determining whether you get cancer down the road, is so powerful. In fact, what we know is that the risk of getting cervical cancer when you have a negative HPV test over at least a five-year period is infinitesimally small, right? And again, the majority of our patients that we see test negative, not test positive, but as a provider, it kind of gives me sort of that assurance that they're okay leaving the office, whereas I don't have quite the same assurance with cytology or Pap smears.
Dr Haller Smith: Yeah, I would agree with that.
Dr Huh (Host): So along the topic of screening, some of our audience and listeners may have heard the concept of HPV self-sampling. So, I thought maybe you could just comment on what that is briefly.
Dr Haller Smith: Yeah. So, HPV self-sampling is a test that a patient is able to do at home, and there are a variety of ways in which that can be collected. So, through either a swab that the patient inserts into the vagina at home or sometimes there's a lavage or some fluid that is inserted into the vagina and then the washings are collected, and then that test can be sent to the lab.
So, I think that's a really great opportunity for some patients who may not have access to an OB-GYN or someone who's trained to do a Pap smear. And so, I think this could be a game changer for patients in rural areas or in low resource settings, where there may not be a trained provider that can do an appropriate Pap smear or cytology test. And then, there are many women who may avoid visits to the gynecologist because of anxiety or some sort of prior trauma and to actually have a pelvic exam and get a Pap smear maybe difficult for them. And so, this is a way that they can still get appropriate screening without having to have that.
Dr Huh (Host): Yeah. And to go back to a comment that you said earlier in the podcast is that we need to do a better job, getting access to women who really benefit from this screening. And I think self-sampling does that, and it does that really well. What I'm really proud of is that UAB was central to much of the original research related to HPV self-sampling, particularly in the deep south.
Just for our listeners, just so they understand, is the HPV self-sampling FDA approved? Is that currently available to patients?
Dr Haller Smith: It's not yet.
Dr Huh (Host): And I just want to make sure our listeners understand that. I don't want you running out to your gynecologist or the health department saying, "I want self-sampling." But I know that the Alabama Department of Public Health, we've had these conversations with them and they're aware of hopefully the pending FDA approval, which I think would be a game changer for many of the women in the state of Alabama.
So if we're going to got to talk about screening, we just got to talk about prevention and prevention leads us to the topic of HPV vaccination. The HPV vaccine has been approved since 2006. It amazes me that it's already been out for 15 plus years. I think many people don't doubt its effectiveness, but there are constant questions about its safety. And obviously, there were many, many parents out there that were worried about giving this brand new unknown vaccine. But I thought maybe you may comment just on what's the safety profile of the vaccine?
Dr Haller Smith: Yeah. So, the current vaccine is Gardasil 9, which covers nine subtypes of HPV, so two that typically cause genital warts, and then seven strains that are associated with the development of cervical cancer. And prior to Gardasil 9, there were two other iterations of the HPV vaccine, and all three of those vaccines have been extensively studied in very large clinical trials. And I think overwhelmingly have been shown to be extremely safe. So, the common side effects are what you would expect with any vaccine. So, soreness at the injection site, some bruising and soreness the next day. But in terms of serious side effects, that really is something that we haven't seen associated with these vaccines. So, I think they're extremely safe.
Dr Huh (Host): Yeah. And I think probably our audience doesn't recognize us. But I would argue the HPV vaccine has been the most scrutinized vaccine in modern medicine, mainly because of the internet and the way we report our adverse outcomes. But you're right, I mean, it's an extremely, extremely safe vaccine. And so, is HPV vaccination still important? Is that something you recommend to your patients, family, friends, et cetera? I'm just curious.
Dr Haller Smith: Oh, absolutely. I think it is the single most important thing that we can do to protect ourselves and our children from not just cervical cancer, but HPV is associated with many different types of cancer. And I think HPV vaccination has been shown to drastically reduce the risk of developing those cancers. And so, that's really the primary prevention. So, that's the one thing that you can do to protect yourself and your family from ever getting these HPV subtypes that could cause this down the road. So, it's great to get screened and that's really important. But if you can avoid that initial exposure, then I think that's really the best thing that you can do.
Dr Huh (Host): And can you just comment on the age range? What's the age range for individuals who should be vaccinated?
Dr Haller Smith: So, the HPV vaccine is currently approved for boys and girls, or men and women, ages nine to 45. It is typically given around age 11 or 12, and ideally would be given before age 26 because that's where it's most effective, because that's when your chance of being exposed to HPV initially is the highest. And so, if it is given before age 15, it's a two-vaccine series; whereas after age 15, it's a three-vaccine series. But for patients who are older than 26 who have not gotten vaccinated, you can still get the vaccine and may still benefit from it up to age 45. .
Dr Huh (Host): Yeah. And that goes back to that safety question I asked you about earlier, which is when you look at the risk-benefit ratio and there's ever a question, should I get vaccinated or not? Aside from the sore arm and having to come in and get repeat vaccinated, I don't see there being any real downside to it. And that's why I advocate to mid-adult individuals, men and women who are interested in the vaccine just go ahead and get vaccinated. Again, it's hard to quantify the benefit, but the risks are so small. It's hard to tell people don't get vaccinated.
Dr Haller Smith: Absolutely. And, you know, I have patients ask me all the time who come to see me because they have had an abnormal Pap smear or have some sort of HPV-related pre-cancer, if it's too late to get vaccinated. And I think the answer to that is no, because they may have one HPV subtype, but the vaccine could still protect them against future subtypes as well.
Dr Huh (Host): And I think earlier, you and I were talking about every year the American Cancer Society releases data on the number of new cases and predicted deaths related to the dozens and dozens of cancers that we care for in the United States. You want to comment on what we saw in younger age women in terms of the rates of cancer and those women that have been vaccinated?
Dr Haller Smith: So, there's some very exciting data related to HPV vaccination that looked at the rates of cervical pre-cancer in women who had been vaccinated, I believe it was the 21 to 24-year-old age group. and they saw a drastic decrease in the rates of pre-cancer in that population.
Dr Huh (Host): Yeah. And that's really an important takeaway message for the audience, which is the World Health Organization has got this significant campaign to eradicate cervical cancer in the future, and foundational to that is obviously HPV vaccination. And in the country of Australia, which I think is the model country for HPV vaccination, they're already claiming that cervical cancer will be fully eradicated in their country probably in the next 20 years. And that's largely because almost 80% plus of their population is vaccinated.
And so, we're starting to see the same signal. But we're behind Australia because we don't vaccinate the same clip. But I think the takeaway for our audience is to recognize that the vaccine is truly a cancer preventative vaccine that could have a tremendous impact and it wouldn't sadden me at all, and I don't know how you feel, I'm assuming you feel the same way that 20 years from now if we see that rare case of cervical cancer, then we've known that we've done our job in terms of prevention.
Dr Haller Smith: Absolutely. And, you know, I think cervical cancer, especially advanced cervical cancer, is truly a terrible disease, and it tends to affect young women. And so, I would be delighted if I'd never had to tell a 30 or 40-year-old patient that she had an advanced cervical cancer ever again.
Dr Huh (Host): Yeah. I couldn't agree more. Well, I think the takeaway message, not to speak for both of us, is still get screened, get vaccinated or encourage vaccination in your family or community.
Well, again, I'd like to thank Dr. Smith for coming in to discuss the topic of cervical cancer screening and prevention, again in honor of Cervical Cancer Awareness Month, which is always in January.
And, as always, please rate this podcast and we welcome any comments, particularly on topics that you're all interested in. And for more information on our gynecologic cancer care services, screening services, and just general gynecology expertise in clinical services that UAB provides, please check us out at uabmedicine.org. Until next time, thank you and I hope you all have a wonderful day. Take care. Peace out.
Dr Huh (Host): Hello, everyone. Happy New Year. This is Dr. Warner Huh, the Chair of Obstetrics and Gynecology at the University of Alabama Birmingham. And I'd like to welcome you yet again to this monthly episode of Women's Health with Dr. Huh.
So in honor of Cervical Cancer Awareness Month, which is January every year, I'm excited about bringing up a topic that's dear to my heart. I've spent a lot of time, both clinically and academically on this topic, and that topic is cervical cancer prevention and screening. And with me today is Dr. Haller Smith, who's an Assistant Professor in the Division of Gynecologic Oncology in the Department of OB-GYN here at UAB. She did her OB-GYN training and gynecologic oncology training here at UAB. And we are thrilled that she decided to stay with us as a faculty member. She's also the Associate Director of the Gynecologic Oncology Fellowship Program within the department. So, Dr. Smith, welcome to this month's podcast.
Dr Haller Smith: Thanks for having me.
Dr Huh (Host): So, as I mentioned earlier, January is Cervical Cancer Awareness Month, and I thought this would be a phenomenal opportunity to talk about cervical cancer screening and prevention. What's interesting is that Pap smears and screening in women have had a marked impact in the reduction of the new cases and mortality related to cervical cancer. But the question I think our listeners may have is, why is cervical cancer screening still important?
Dr Haller Smith: Yeah. So, I think we are very fortunate to live in a country where the Pap smear has been widely implemented. And so with that, you know, really since that was initially rolled out, there has been about a 75% reduction in the incidence of cervical cancer. But there are still a significant number of women even in this country that are diagnosed with cervical cancer every year. So, currently, about 14,000 women a year are still diagnosed with cervical cancer and that number varies widely based on where you live in this country. And so, there are still parts of the United States where cervical cancer is a major problem and a lot of that is related to access to screening. And so, I do think screening is still really important.
And if you look at the incidence of cervical cancer, that steep decline has really leveled out in the last 15 years or so. And I think that's because we're not reaching some of these women and so a lot of the patients that are getting diagnosed with cervical cancer have not had access to appropriate screening.
Dr Huh (Host): Yeah. Along those lines, Dr. Smith, I think that many of us are concerned that with the COVID pandemic and limited access to screening, that we might actually see a reverse or an uptick in the rates of cervical cancer. And to your point, that's why I think screening is still important. Let me ask you this, your thoughts on when you see a new cervical cancer patient in your practice and their history of screening or lack of screening, what's been your general observation there?
Dr Haller Smith: So, I think there is very good data to suggest that a very high percentage of women who are diagnosed with advanced cervical cancer have had either no screening or inadequate screening. And so, I think very frequently, the patients that come in, especially with advanced cervical cancer, are women who have had really no gynecologic care in years, so often since the birth of their last child. And so, I think that's certainly something that we see in practice, especially in patients who come in with advanced stage cervical cancer.
Dr Huh (Host): Yeah. It's always impressed me that, when I ask this question to women about when their last screening test was when they come in with a diagnosis of cervical cancer, the vast majority of them will tell you that they have not been screened the last five to 10 years. And in fact, you know, I published a study with Dr. Vicki Bernard at the CDC that looked at the rates of screening in women with newly diagnosed cervical cancer. And what we know is still about 50% to 60% of women who come in with cervical cancer have never been screened or underscreened. And that number really hasn't changed in the last 30 years. And so, I still think that we can do much, much better.
So, I think our listeners may be interested in knowing what are the current screening recommendations. I can say this because I've participated in the screening panels, but they seem to be constantly changing. So for today, January 2023, I thought maybe this would be a good time for you to explain to our listeners what are the current screening recommendations.
Dr Haller Smith: Yeah. So, that's a great question, and as you said, it's something that has seemingly been constantly changing. And we're in the midst of yet another shift in the way that we screen for cervical cancer. So, for years, we have been starting screening at age 21 using a Pap smear or cytology, in conjunction with an HPV test. And really, within the last one to two years, there has been a shift from that to what's called primary HPV screening. So, really relying on that HPV test is the primary way to screen for cervical cancer. And there has also been a shift in the age at which that screening starts. And so, I think that the current guidelines and where things are going is that we'll start cervical cancer screening at age 25 with an HPV test every five years, and to continue that until age 65 for women who have had normal screening.
Dr Huh (Host): Yeah. I think there's a lot to discuss and unpack there. Can you just comment for the listener and our audience why primary HPV screening is a better test than cytology or a Pap? Because I think our audience may not quite understand that.
Dr Haller Smith: So, the vast majority of cervical cancer, actually 99.7% of cervical cancer is directly related to the HPV virus. And so, that HPV test is really the best test to know if a patient has a risk of developing a cervical cancer down the road. And so, if HPV is not present, then we can be sure that that patient is at a very low risk of developing a cervical pre-cancer or cancer. Whereas if a patient tests positive for one of the high risk types of HPV, then they are potentially at risk of developing a pre-cancer and ultimately a cancer. And so, that is one reason again that cervical cancer is so highly associated with HPV.
And the other nice thing about the HPV test is that the Pap smear or the cytology really depends on a clinician being able to sample the appropriate cells on the cervix, whereas the HPV test doesn't rely on that. And it's a test that with very high fidelity can be read as positive or negative and there's not really a subjective interpretation unlike a Pap smear or cytology that relies on a pathologist to actually look at that and interpret it.
Dr Huh (Host): Yeah, I want to expand on that because this is an important point for our audience. One is that, in my personal experience, that every single patient that I've take cared for in the last five years who has cervical cancer, who has been screened, all of them have only been screened with cytology. They have not had HPV testing, which kind of goes to show you sort of the false negative rate that's associated with cytology.
The second thing is that for our audiences to recognize that when you do have a negative HPV test, the predictive value of that, of determining whether you get cancer down the road, is so powerful. In fact, what we know is that the risk of getting cervical cancer when you have a negative HPV test over at least a five-year period is infinitesimally small, right? And again, the majority of our patients that we see test negative, not test positive, but as a provider, it kind of gives me sort of that assurance that they're okay leaving the office, whereas I don't have quite the same assurance with cytology or Pap smears.
Dr Haller Smith: Yeah, I would agree with that.
Dr Huh (Host): So along the topic of screening, some of our audience and listeners may have heard the concept of HPV self-sampling. So, I thought maybe you could just comment on what that is briefly.
Dr Haller Smith: Yeah. So, HPV self-sampling is a test that a patient is able to do at home, and there are a variety of ways in which that can be collected. So, through either a swab that the patient inserts into the vagina at home or sometimes there's a lavage or some fluid that is inserted into the vagina and then the washings are collected, and then that test can be sent to the lab.
So, I think that's a really great opportunity for some patients who may not have access to an OB-GYN or someone who's trained to do a Pap smear. And so, I think this could be a game changer for patients in rural areas or in low resource settings, where there may not be a trained provider that can do an appropriate Pap smear or cytology test. And then, there are many women who may avoid visits to the gynecologist because of anxiety or some sort of prior trauma and to actually have a pelvic exam and get a Pap smear maybe difficult for them. And so, this is a way that they can still get appropriate screening without having to have that.
Dr Huh (Host): Yeah. And to go back to a comment that you said earlier in the podcast is that we need to do a better job, getting access to women who really benefit from this screening. And I think self-sampling does that, and it does that really well. What I'm really proud of is that UAB was central to much of the original research related to HPV self-sampling, particularly in the deep south.
Just for our listeners, just so they understand, is the HPV self-sampling FDA approved? Is that currently available to patients?
Dr Haller Smith: It's not yet.
Dr Huh (Host): And I just want to make sure our listeners understand that. I don't want you running out to your gynecologist or the health department saying, "I want self-sampling." But I know that the Alabama Department of Public Health, we've had these conversations with them and they're aware of hopefully the pending FDA approval, which I think would be a game changer for many of the women in the state of Alabama.
So if we're going to got to talk about screening, we just got to talk about prevention and prevention leads us to the topic of HPV vaccination. The HPV vaccine has been approved since 2006. It amazes me that it's already been out for 15 plus years. I think many people don't doubt its effectiveness, but there are constant questions about its safety. And obviously, there were many, many parents out there that were worried about giving this brand new unknown vaccine. But I thought maybe you may comment just on what's the safety profile of the vaccine?
Dr Haller Smith: Yeah. So, the current vaccine is Gardasil 9, which covers nine subtypes of HPV, so two that typically cause genital warts, and then seven strains that are associated with the development of cervical cancer. And prior to Gardasil 9, there were two other iterations of the HPV vaccine, and all three of those vaccines have been extensively studied in very large clinical trials. And I think overwhelmingly have been shown to be extremely safe. So, the common side effects are what you would expect with any vaccine. So, soreness at the injection site, some bruising and soreness the next day. But in terms of serious side effects, that really is something that we haven't seen associated with these vaccines. So, I think they're extremely safe.
Dr Huh (Host): Yeah. And I think probably our audience doesn't recognize us. But I would argue the HPV vaccine has been the most scrutinized vaccine in modern medicine, mainly because of the internet and the way we report our adverse outcomes. But you're right, I mean, it's an extremely, extremely safe vaccine. And so, is HPV vaccination still important? Is that something you recommend to your patients, family, friends, et cetera? I'm just curious.
Dr Haller Smith: Oh, absolutely. I think it is the single most important thing that we can do to protect ourselves and our children from not just cervical cancer, but HPV is associated with many different types of cancer. And I think HPV vaccination has been shown to drastically reduce the risk of developing those cancers. And so, that's really the primary prevention. So, that's the one thing that you can do to protect yourself and your family from ever getting these HPV subtypes that could cause this down the road. So, it's great to get screened and that's really important. But if you can avoid that initial exposure, then I think that's really the best thing that you can do.
Dr Huh (Host): And can you just comment on the age range? What's the age range for individuals who should be vaccinated?
Dr Haller Smith: So, the HPV vaccine is currently approved for boys and girls, or men and women, ages nine to 45. It is typically given around age 11 or 12, and ideally would be given before age 26 because that's where it's most effective, because that's when your chance of being exposed to HPV initially is the highest. And so, if it is given before age 15, it's a two-vaccine series; whereas after age 15, it's a three-vaccine series. But for patients who are older than 26 who have not gotten vaccinated, you can still get the vaccine and may still benefit from it up to age 45. .
Dr Huh (Host): Yeah. And that goes back to that safety question I asked you about earlier, which is when you look at the risk-benefit ratio and there's ever a question, should I get vaccinated or not? Aside from the sore arm and having to come in and get repeat vaccinated, I don't see there being any real downside to it. And that's why I advocate to mid-adult individuals, men and women who are interested in the vaccine just go ahead and get vaccinated. Again, it's hard to quantify the benefit, but the risks are so small. It's hard to tell people don't get vaccinated.
Dr Haller Smith: Absolutely. And, you know, I have patients ask me all the time who come to see me because they have had an abnormal Pap smear or have some sort of HPV-related pre-cancer, if it's too late to get vaccinated. And I think the answer to that is no, because they may have one HPV subtype, but the vaccine could still protect them against future subtypes as well.
Dr Huh (Host): And I think earlier, you and I were talking about every year the American Cancer Society releases data on the number of new cases and predicted deaths related to the dozens and dozens of cancers that we care for in the United States. You want to comment on what we saw in younger age women in terms of the rates of cancer and those women that have been vaccinated?
Dr Haller Smith: So, there's some very exciting data related to HPV vaccination that looked at the rates of cervical pre-cancer in women who had been vaccinated, I believe it was the 21 to 24-year-old age group. and they saw a drastic decrease in the rates of pre-cancer in that population.
Dr Huh (Host): Yeah. And that's really an important takeaway message for the audience, which is the World Health Organization has got this significant campaign to eradicate cervical cancer in the future, and foundational to that is obviously HPV vaccination. And in the country of Australia, which I think is the model country for HPV vaccination, they're already claiming that cervical cancer will be fully eradicated in their country probably in the next 20 years. And that's largely because almost 80% plus of their population is vaccinated.
And so, we're starting to see the same signal. But we're behind Australia because we don't vaccinate the same clip. But I think the takeaway for our audience is to recognize that the vaccine is truly a cancer preventative vaccine that could have a tremendous impact and it wouldn't sadden me at all, and I don't know how you feel, I'm assuming you feel the same way that 20 years from now if we see that rare case of cervical cancer, then we've known that we've done our job in terms of prevention.
Dr Haller Smith: Absolutely. And, you know, I think cervical cancer, especially advanced cervical cancer, is truly a terrible disease, and it tends to affect young women. And so, I would be delighted if I'd never had to tell a 30 or 40-year-old patient that she had an advanced cervical cancer ever again.
Dr Huh (Host): Yeah. I couldn't agree more. Well, I think the takeaway message, not to speak for both of us, is still get screened, get vaccinated or encourage vaccination in your family or community.
Well, again, I'd like to thank Dr. Smith for coming in to discuss the topic of cervical cancer screening and prevention, again in honor of Cervical Cancer Awareness Month, which is always in January.
And, as always, please rate this podcast and we welcome any comments, particularly on topics that you're all interested in. And for more information on our gynecologic cancer care services, screening services, and just general gynecology expertise in clinical services that UAB provides, please check us out at uabmedicine.org. Until next time, thank you and I hope you all have a wonderful day. Take care. Peace out.