Cervical cancer is one of the most common cancers in women worldwide.
Most cervical cancer is caused by a virus called human papillomavirus, or HPV.
An HPV test recently approved by U.S. health officials is an effective way to check for cervical cancer.
Recent studies suggest that this HPV test is an effective, one-test alternative to the current recommendation of screening with either a Pap test alone or a combination of the HPV test and a Pap test.
Tune in to SMG radio to hear women’s health expert Dr. Kara Goldman discuss HPV and cervical cancer screenings.
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HPV and Cervical Cancer Screening
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Learn more about Kara J. Goldman, MD
Kara Goldman, MD
Kara J. Goldman, MD specializes in obstetrics, gynecology, and women's health at Summit Medical Group.Learn more about Kara J. Goldman, MD
Transcription:
HPV and Cervical Cancer Screening
Melanie Cole (Host): Cervical is one of the most common cancers in women worldwide. Most cervical cancer, however, is caused by a virus called “human papilloma virus” or HPV. An HPV test recently was approved by U.S. Health officials as an effective way to check for cervical cancer. My guest today is Dr. Karen Goldman. She specializes in obstetrics and gynecology and women's health at Summit Medical Group. Welcome to the show, Dr. Goldman. So, tell us about cervical cancer. What’s going on in the world of cervical cancer today?
Dr. Karen Goldman (Guest): So, in the United States, the rate of cervical cancer is about 6.5 cases per 100,000 women. This is in contrast to what we see worldwide where it is a more significant cause of cancer. Thankfully, in the United States where women, generally, have good access to medical care and cervical cancer screening, that is not one of the most worrisome cancers for women.
Melanie: So, we hear about that link to HPV—human papilloma virus. How are they linked?
Dr. Goldman: Right. So, almost all cervical cancers are HPV associated. So, HPV is human papilloma virus. It is the virus that causes abnormal cells to grow on the cervix. So, it changes our normal cervical cells and if left untreated or undetected, over a long period of time, it can turn into a cancer.
Melanie: Okay. So, how is this virus contracted?
Dr. Goldman: HPV is probably the most commonly sexually transmitted infection. It is not one that we hear about all that much. We talk a lot about chlamydia and gonorrhea and HIV. Unfortunately, we’re not talking a lot about HPV. It is sexually transmitted so for most men, they are asymptomatic. For HPV, there are several different strains—viruses—and they can mostly be categorized into low-risk strains and those are the strains that cause genital warts. Then, there are high-risk strains. So, we’re talking here about the high-risk strain. Those are the ones that can cause cervical cancer. For men with high risk strains of HPV, they are largely asymptomatic, and the only way that they would know that they would have it would be that a previous partner has tested positive for HPV and then told them.
Melanie: Okay. So, the tests for HPV—are we just automatically giving tests? And, at what age?
Dr. Goldman: Right. So, screening guidelines over the last few years have changed a lot for cervical cancer. We start screening young women when they are 21 year of age. There are very few exceptions for testing sooner but, by and large, we’re talking about 21-year-olds. We stratify our screening by age, so women between the age of 21 and 29 are screened different from women who are 30 and older. So, in the younger women, 21-29, they are screened with a PAP screen which in an examination of the cells or the cytology of the cells, how they appear in a microscope and every 3 years, if their cells do appear abnormal, that specimen is reflex checked for an HPV virus. This is in contrast to women over the age of 30 who are screened every 3-5 years with a PAP and an HPV test. We call that co-testing. Depending on the results of the tests, that will dictate additional screening or testing needed. That screening is assuming that patient has not had abnormal PAP smears to begin with.
Melanie: So, now, the PAP smear was a standard of care. Everybody got one every year just like a mammogram but now, if you test negative for HPV, how often are you giving PAP smears, if at all.
Dr. Goldman: Right. As I said before, in the younger patients, every year. So, they’re not having HPV testing unless there’s a cellular abnormality. In our patients 30 and older, the screening is—if you’re doing it with HPV testing and they’re both negative and they have previously negative PAP smears, then screening is every 5 years and we’re also not screening women over the age of 65. Again, with the rare exception of women over the age of 65 with a previous history of normal PAP and HPV testing over the past 10 years do not need to be screened.
Melanie: Now, children are getting three doses of the HPV vaccine as recommended by the American academy of pediatrics, Dr. Goldman. What do you see Gardasil doing for your practice in the coming years for women in their twenties that got the vaccine or, in another 10 years, women who have gotten this vaccine? What you see changing?
Dr. Goldman: Yes. So, fortunately, the upcoming young women have mostly been vaccinated. I should mention that there are 3 types of HPV vaccines. There is the Cervarix vaccine that covers 2 high-risk strains of HPV; there’s Gardasil 4 which is going to cover with the low-risk or genital warts viruses and the 2 oncogenic or high-risk strains of HPV and, recently, we are now offering Gardasil 9 which is going to cover against those 2 low-strains and 7 of the most high-risk strains. What we are seeing, fortunately, is that there’s been a decrease in cervical cancers that we’re detecting and also a decrease in the number of abnormal PAP smears.
Melanie: How late in someone's life can they get this vaccine? If you've already turned 25, is it too late?
Dr. Goldman: It’s not, actually. You can get it through the age of 26. So, I tell my patients, “If you’re 26.5 and you are not yet 27 years old, you can complete the series.” It takes 6 months to complete a series, so depending on which vaccine you’re doing, Cervarix is slightly different. They’re all complete within 6 months, so the first vaccine is followed up by a second one at 2 months and then a booster at 6 months. So, you can get it up through the age of 26. So, before the age of 27, it should be covered by most insurance carriers.
Melanie: Dr. Goldman, the oral/pharyngeal cancers—throat and tongue. People hear about head and neck cancers these days. Is HPV affecting those cancers as well? Is the vaccine going to prevent some of those as well as cervical cancer?
Dr. Goldman: Yes. That’s actually a really good point to mention. I will also mention that, in addition to the oral/pharyngeal head and neck cancers, we’re also seeing anal cancers. So, men who participate in high risk behavior might want to consider and talk to their physicians about doing anal PAP smears. Yes, head and neck cancers are associated with HPV. A lot of throat cancers have been. This is being transmitted by the oral/genital route. So, my hope—and I haven’t seen the data on this—as of yet, I don’t know that there is any great data at this point. But, we are going to decrease all of our HPV associated cancers as we encourage our young patients, male and female, to be completely vaccinated.
Melanie: Now, just for a second, speak about transmission. Oral HPV or genital, are these the same? And, can they be transmitted to each other if people engage in oral sexual relations? Can you then transmit the virus that way, too?
Dr. Goldman: Yes, absolutely. So, this is a sexually transmitted virus so, it is transmitted through mucous membranes. That’s either through male/female partners; male to male partners; oral sex. That’s how it can be transmitted. The good news about HPV is that for most young, healthy women who eat a well-rounded diet, don’t smoke cigarettes, most HPV viruses are most resolved spontaneously in about 2 years. So, for the majority of people, this is going to be nothing. It’s going to go away and they’re never going to have to worry about it again. But, unfortunately, there are a few cases or a few instances, where the virus is one of the much higher-risk strains. We can think of that as being HP-16 and virus 18. They can be a little more virulent and harder to get rid of.
Melanie: In just the last few minutes—and what great information, Dr. Goldman—give your best advice about cervical cancers. The question about all women have about whether they should get their PAP smears or not and the HPV virus and vaccine and why they should come to Summit Medical Group for their care.
Dr. Goldman: Great. So, I think one of the most common questions I get is, “I’m 24 years old. I’ve already had an abnormal PAP smear. Why should I get Gardasil?” I think the reason is because we, typically, don’t know what virus caused your abnormal pap smear. So, we only test for certain viruses in a few instances. So, because we don’t know what virus you may have been exposed to, getting the vaccine will help prevent a new infection. Screening should begin, like we said, at age 21. It’s a conversation with your doctor about how you want to handle the screening. Some patients are uncomfortable feeling like they don’t need a PAP for 5 years. That’s a conversation you can have with your physician. So, I think here at Summit Medical Group, we, of course, are on top of all of the most up-to-date and recent guidelines but we also individualize our care. So, if there is a concern that you have with your abnormal PAP smear or normal PAP smear, that’s really a conversation to have with your physician. We can, hopefully, individualize some treatment for you.
Melanie: Thank you so much. What great information. You're listening to us SMG Radio. For more information, you can go to SummitMedicalGroup.com. That’s SummitMedicalGroup.com. This is Melanie Cole. Thanks so much for listening.
HPV and Cervical Cancer Screening
Melanie Cole (Host): Cervical is one of the most common cancers in women worldwide. Most cervical cancer, however, is caused by a virus called “human papilloma virus” or HPV. An HPV test recently was approved by U.S. Health officials as an effective way to check for cervical cancer. My guest today is Dr. Karen Goldman. She specializes in obstetrics and gynecology and women's health at Summit Medical Group. Welcome to the show, Dr. Goldman. So, tell us about cervical cancer. What’s going on in the world of cervical cancer today?
Dr. Karen Goldman (Guest): So, in the United States, the rate of cervical cancer is about 6.5 cases per 100,000 women. This is in contrast to what we see worldwide where it is a more significant cause of cancer. Thankfully, in the United States where women, generally, have good access to medical care and cervical cancer screening, that is not one of the most worrisome cancers for women.
Melanie: So, we hear about that link to HPV—human papilloma virus. How are they linked?
Dr. Goldman: Right. So, almost all cervical cancers are HPV associated. So, HPV is human papilloma virus. It is the virus that causes abnormal cells to grow on the cervix. So, it changes our normal cervical cells and if left untreated or undetected, over a long period of time, it can turn into a cancer.
Melanie: Okay. So, how is this virus contracted?
Dr. Goldman: HPV is probably the most commonly sexually transmitted infection. It is not one that we hear about all that much. We talk a lot about chlamydia and gonorrhea and HIV. Unfortunately, we’re not talking a lot about HPV. It is sexually transmitted so for most men, they are asymptomatic. For HPV, there are several different strains—viruses—and they can mostly be categorized into low-risk strains and those are the strains that cause genital warts. Then, there are high-risk strains. So, we’re talking here about the high-risk strain. Those are the ones that can cause cervical cancer. For men with high risk strains of HPV, they are largely asymptomatic, and the only way that they would know that they would have it would be that a previous partner has tested positive for HPV and then told them.
Melanie: Okay. So, the tests for HPV—are we just automatically giving tests? And, at what age?
Dr. Goldman: Right. So, screening guidelines over the last few years have changed a lot for cervical cancer. We start screening young women when they are 21 year of age. There are very few exceptions for testing sooner but, by and large, we’re talking about 21-year-olds. We stratify our screening by age, so women between the age of 21 and 29 are screened different from women who are 30 and older. So, in the younger women, 21-29, they are screened with a PAP screen which in an examination of the cells or the cytology of the cells, how they appear in a microscope and every 3 years, if their cells do appear abnormal, that specimen is reflex checked for an HPV virus. This is in contrast to women over the age of 30 who are screened every 3-5 years with a PAP and an HPV test. We call that co-testing. Depending on the results of the tests, that will dictate additional screening or testing needed. That screening is assuming that patient has not had abnormal PAP smears to begin with.
Melanie: So, now, the PAP smear was a standard of care. Everybody got one every year just like a mammogram but now, if you test negative for HPV, how often are you giving PAP smears, if at all.
Dr. Goldman: Right. As I said before, in the younger patients, every year. So, they’re not having HPV testing unless there’s a cellular abnormality. In our patients 30 and older, the screening is—if you’re doing it with HPV testing and they’re both negative and they have previously negative PAP smears, then screening is every 5 years and we’re also not screening women over the age of 65. Again, with the rare exception of women over the age of 65 with a previous history of normal PAP and HPV testing over the past 10 years do not need to be screened.
Melanie: Now, children are getting three doses of the HPV vaccine as recommended by the American academy of pediatrics, Dr. Goldman. What do you see Gardasil doing for your practice in the coming years for women in their twenties that got the vaccine or, in another 10 years, women who have gotten this vaccine? What you see changing?
Dr. Goldman: Yes. So, fortunately, the upcoming young women have mostly been vaccinated. I should mention that there are 3 types of HPV vaccines. There is the Cervarix vaccine that covers 2 high-risk strains of HPV; there’s Gardasil 4 which is going to cover with the low-risk or genital warts viruses and the 2 oncogenic or high-risk strains of HPV and, recently, we are now offering Gardasil 9 which is going to cover against those 2 low-strains and 7 of the most high-risk strains. What we are seeing, fortunately, is that there’s been a decrease in cervical cancers that we’re detecting and also a decrease in the number of abnormal PAP smears.
Melanie: How late in someone's life can they get this vaccine? If you've already turned 25, is it too late?
Dr. Goldman: It’s not, actually. You can get it through the age of 26. So, I tell my patients, “If you’re 26.5 and you are not yet 27 years old, you can complete the series.” It takes 6 months to complete a series, so depending on which vaccine you’re doing, Cervarix is slightly different. They’re all complete within 6 months, so the first vaccine is followed up by a second one at 2 months and then a booster at 6 months. So, you can get it up through the age of 26. So, before the age of 27, it should be covered by most insurance carriers.
Melanie: Dr. Goldman, the oral/pharyngeal cancers—throat and tongue. People hear about head and neck cancers these days. Is HPV affecting those cancers as well? Is the vaccine going to prevent some of those as well as cervical cancer?
Dr. Goldman: Yes. That’s actually a really good point to mention. I will also mention that, in addition to the oral/pharyngeal head and neck cancers, we’re also seeing anal cancers. So, men who participate in high risk behavior might want to consider and talk to their physicians about doing anal PAP smears. Yes, head and neck cancers are associated with HPV. A lot of throat cancers have been. This is being transmitted by the oral/genital route. So, my hope—and I haven’t seen the data on this—as of yet, I don’t know that there is any great data at this point. But, we are going to decrease all of our HPV associated cancers as we encourage our young patients, male and female, to be completely vaccinated.
Melanie: Now, just for a second, speak about transmission. Oral HPV or genital, are these the same? And, can they be transmitted to each other if people engage in oral sexual relations? Can you then transmit the virus that way, too?
Dr. Goldman: Yes, absolutely. So, this is a sexually transmitted virus so, it is transmitted through mucous membranes. That’s either through male/female partners; male to male partners; oral sex. That’s how it can be transmitted. The good news about HPV is that for most young, healthy women who eat a well-rounded diet, don’t smoke cigarettes, most HPV viruses are most resolved spontaneously in about 2 years. So, for the majority of people, this is going to be nothing. It’s going to go away and they’re never going to have to worry about it again. But, unfortunately, there are a few cases or a few instances, where the virus is one of the much higher-risk strains. We can think of that as being HP-16 and virus 18. They can be a little more virulent and harder to get rid of.
Melanie: In just the last few minutes—and what great information, Dr. Goldman—give your best advice about cervical cancers. The question about all women have about whether they should get their PAP smears or not and the HPV virus and vaccine and why they should come to Summit Medical Group for their care.
Dr. Goldman: Great. So, I think one of the most common questions I get is, “I’m 24 years old. I’ve already had an abnormal PAP smear. Why should I get Gardasil?” I think the reason is because we, typically, don’t know what virus caused your abnormal pap smear. So, we only test for certain viruses in a few instances. So, because we don’t know what virus you may have been exposed to, getting the vaccine will help prevent a new infection. Screening should begin, like we said, at age 21. It’s a conversation with your doctor about how you want to handle the screening. Some patients are uncomfortable feeling like they don’t need a PAP for 5 years. That’s a conversation you can have with your physician. So, I think here at Summit Medical Group, we, of course, are on top of all of the most up-to-date and recent guidelines but we also individualize our care. So, if there is a concern that you have with your abnormal PAP smear or normal PAP smear, that’s really a conversation to have with your physician. We can, hopefully, individualize some treatment for you.
Melanie: Thank you so much. What great information. You're listening to us SMG Radio. For more information, you can go to SummitMedicalGroup.com. That’s SummitMedicalGroup.com. This is Melanie Cole. Thanks so much for listening.