Jamie Lewis (Host): Did you know that cervical cancer was once the leading cause of cancer deaths in women in the U.S.? Thanks to prevention and screening, the cervical cancer death rate has dropped by more than half since the 1970s, but it still has a major impact on women's lives. According to the National Cancer Institute, nearly 14,000 women received a diagnosis of cervical cancer in 2023, and over 4,000 died as a result.

Today, I'm talking with Dr. Monique Spillman, Chief Gynecologic Oncologist of the Division of Gynecologic Oncology at the University of Arkansas for Medical Sciences. She'll shed light on what you need to know about cervical cancer, including causes, risk factors, and treatment options.

I'm Jamie Lewis, and this is UAMS Health Talk, a podcast from the University of Arkansas for Medical Sciences. Dr. Spillman, thank you for joining us.

Monique Spillman, MD: Thank you for having me today.

Host: Let's establish some basics. What is cervical cancer?

Monique Spillman, MD: So, cervical cancer is a cancer that develops at the opening to the uterus or the opening to the womb. It's what we detect by doing screening Pap smears.

Host: Do we know what causes it?

Monique Spillman, MD: We do for 99% of cervical cancer. We know that it's caused by a virus called the human papillomavirus, or HPV for short. And we know that most persons who have ever had any form of sexual activity have been exposed to HPV. So, it's a very, very common virus.

Host: I've heard about how common HPV is, but how common is cervical cancer?

Monique Spillman, MD: So, cervical cancer really isn't very common. It only develops in approximately 5% of patients who were exposed to HPV. So, those patients are exposed to a type of HPV that's very high risk of causing cancer. And in those patients, the exposure could have occurred even 20 or 30 years before the cancer developed. So, it's a very long time to develop cancer.

Jamie Lewis (Host): Are there any specific symptoms to look out for?

Monique Spillman, MD: Yes, abnormal bleeding is the most common symptom that patients report to us. This can take the form of a heavier than normal period that continues for several months, or they may find that they bleed in between periods, or even that they bleed after sexual activity. Whatever is not your normal bleeding pattern or your normal menstrual pattern is something that you should report to your doctor because that can be a sign of cervical cancer.

Host: What are some of the risk factors for someone who might get a diagnosis of cervical cancer?

Monique Spillman, MD: One of the biggest risk factors is not having regular Pap smears. So, as I said earlier, it can take up to 20 years for cervical cancer to develop. So, we often find that women haven't had a pap smear or a pelvic exam in over 20 years, if ever. So, the most important thing you can do is get those routine screenings. One of the other risk factors is smoking. And we don't completely understand why cigarette smoking in particular has an effect on the HPV virus and increases the risk of cervical cancer. But what we do know is that stopping all forms of tobacco or nicotine use decreases that risk of cervical cancer.

Host: Is there any way to prevent it?

Monique Spillman, MD: This is one of the big success stories of the last few years. We now have a vaccine that can prevent cancer. In particular, it can prevent cervical cancer, and this vaccine is given to persons from young ages all the way up to almost middle age now, and it can be given to both men and women, because both men and women can contact and become infected with the HPV virus, but this vaccine covers the types of viruses that are the highest risk to cause cancer, as well as the types of virus that sometimes cause warts. So when this vaccine is given, it decreases the risk of both pre-cancers as well as subsequent cancers in both men and women.

Host: That's exciting that there is a vaccine that can help prevent. I know screening has also done a lot for decreasing instances of cervical cancer. How often should women be screened and at what ages?

Monique Spillman, MD: Yes. So, our screening is typically done through a Pap smear, as well as screening for the HPV virus itself. So now, we do something called co-testing, meaning that the regular routine Pap smear checks the cells to make sure they do not look abnormal under the microscope. But we also check to see whether those cells contain the HPV virus.

We have shifted a bit in our recommendations for Pap smear screening, and now we say that younger women under the age of 21 do not need Pap smears. But they do need them once they hit the age of 21 up until about the age of 65. Once women are above the age of 65, if they have had normal Pap smears and have had an adequate number of normal Pap smears, they can discontinue Pap smear screening. We also know that women who have had a hysterectomy previously for non-cancerous conditions may be able to forego Pap smears. But that's an individual discussion for those women to have with their physician.

Host: If I discover I have cervical cancer, what are my treatment options?

Monique Spillman, MD: So, treatment for cervical cancer really depends on how advanced the cancer is when it's found. So if it's found in a very early spread pattern or confined to the cervix, that's called a stage I cancer. And in that case, sometimes a cervical biopsy can be done that can remove that very small early cancer and that will take care of the treatment.

If the cancer has spread beyond the early stages, then we have to talk about doing a hysterectomy and maybe even a radical hysterectomy. And what that means is that extra tissue is taken out beside the cervix, and the cervix, the tissue beside the cervix, as well as the uterus and maybe lymph nodes are removed. This allows us to determine the extent of spread and if any radiation or chemotherapy is needed. If we have the unfortunate circumstance of an advanced cancer, then those are treated with chemotherapy and radiation therapy, but not with surgery.

Host: Well, thank you so much for all of this information and for your time, Dr. Spillman.

Monique Spillman, MD: Thank you. And please, everyone, go get your Pap smear.

Host: I'm Jamie Lewis. And this has been UAMS Health Talk, a podcast from the University of Arkansas for Medical Sciences. For more information about cervical cancer, visit uamshealth.com/condition/cervical-cancer, or call 501-296-1200 to make an appointment.