What You Need to Know About Cervical Cancer Dr. Ronald Alvarez, Professor & Chairman of the Department of Obstetrics and Gynecology at VUMC, discusses the basics of cervical cancer, including risk factors, symptoms, screening, prevention, and resources available at Vanderbilt and within the community. Begin Transcript Marissa Wertheimer: Welcome to this edition of the Vanderbilt University Health and Wellness Wellcast. I am Marissa Wertheimer with Health Plus. I am here today with Dr. Ronald Alvarez, Professor and Chairman from the Department of OB-GYN. Thank you so much, Dr. Alvarez for taking the time today to talk to us about cervical cancer. So, to start, what is cervical cancer? Dr. Ronald Alvarez: Cervical cancer is when you get a cancer of the mouth of the womb. People aren’t so familiar with female anatomy, you know you have the uterus and the cervix which is the bottom part of the uterus that is really the part through which the babies will be delivered through, and then, there is the vagina and the vulva area and also with the ovaries and the fallopian tube, but the cervix is really the part around the mouth of the womb that we are so concerned about women having risk for developing cervical cancer. Marissa Wertheimer: Okay and who is at risk and what are some of the risk factors for cervical cancer? Dr. Ronald Alvarez: Well, cervical cancer used to be one of the major causes of death due to cancer in women in the early 1900s and late 1800s, and some of the risk factors we thought about that contributed to the development of cervical cancer really have come to be found out as risk of being infected by the HPV virus, the human papillomavirus. A lot of women are exposed to human papillomavirus particularly when they become sexually active. We know that there are certain types of HPV virus that actually put women at higher risk for developing cervical cancer. Like type 16 and 18 are probably the highest risk HPV types. Other risk factors that women have are early age of intercourse, multiple sexual partners, other sexually transmitted diseases, and smoking. All of these lifestyle and environmental factors contribute to the development of cervical cancer, putting women at risk for developing cervical cancer. Marissa Wertheimer: What can we do to lower our risk of cervical cancer? Dr. Ronald Alvarez: Well, I have kind of bundled it in three areas. First is a lifestyle modification. So, probably delayed onset of sexual activity is healthy, limiting the number of sexual partners is really important, not smoking I think is really important, and those are some of the things you can do from a lifestyle modification, and then, the next big thing is HPV vaccination. We have very effective vaccines for cervical cancer. Unfortunately, in this country we have less than probably 40-60% of eligible people that are getting their vaccines. We know that the HPV vaccine is actually approved for women ages 9 through 26. It is actually also approved for boys age 9 through 26, and in the younger age group, there are two dosages of vaccine that you can get in. The older group that is 15 through 26 needs the three dosages of the vaccine. So, that is very effective in terms of not only reducing cancer but reducing genital warts, reducing pre-cancers that happen on the cervix, and so, it is something that we need to make sure as a country we are seeing an improvement in the uptake of the vaccine. Now, the last thing that is really important and what really was the major impetus to seeing the incidence of cervical cancer decrease in this country was the development of cervical cancer screening, and that was initially done by the development of the Papanicolaou smear or the Pap smear. That was actually developed in 1940s and has really contributed significantly through the reduction of cervical cancer, and the reason it does so is because it not only detects cervical cancer but detects pre-cancerous lesions that are much easier to treat and will reduce the risk of women developing cervical cancer if detected early enough. Now, cervical cancer screening has evolved to where we are using not only the Pap smear, but we are also using tests that will check for the presence of high-risk HPV types and so at various different age groups like between the ages of 25 and 30 we just used the Pap smear on an every 3 year basis. From the ages of 30 to 65, we actually will use combination of both the Pap smear and HPV test. Beyond 65, particularly if women have been healthy, we do not advocate for any further screening, but the most important thing is that women do get screened for cervical cancer because even if you have had the vaccination we want to make sure that women don’t develop the other types of cervical cancer or cervical cancer related to other HPV types. Those three things – lifestyle modification, HPV vaccination, and cervical cancer screening – can really go a long way in terms of reducing a woman’s risk of cervical cancer. Marissa Wertheimer: So, just by making some modifications to lifestyles, getting the HPV vaccination, and then making sure that women are getting screened on a regular basis can significantly reduce our risk for developing cervical cancer. Dr. Ronald Alvarez: Absolutely and let me tell you something the saddest thing I have ever seen in my life is women that die of cervical cancer because usually they are younger, usually they have younger children, and to me it is one of the most tragic things that I have experienced in my professional career. Marissa Wertheimer: Are there any symptoms of cervical cancer, and if so, what are they? Dr. Ronald Alvarez: Most people who have pre-cancerous lesions do not have symptoms, but patients who have early symptoms generally they will have some sort of abnormal bleeding and often times may be bleeding after intercourse because there is usually a lesion on the cervix and with intercourse it traumatizes that lesion and women will get some bleeding after intercourse. Sometimes, they will have a discharge that is really like the worst discharge you have ever had in your whole life, and it is not really like the type you have had when you had a vaginal infection but is more copious or more odorous type of discharge. So, if you have any symptoms like that make sure you see your doctor and have them evaluate you for the possibility of cervical cancer. Marissa Wertheimer: What are some resources available here at the Vanderbilt and also within the community that people can get more information on screening and on treatment for cervical cancer? Dr. Ronald Alvarez: Here on campus, we have a big Department of OB-GYN services to be able to offer to both our employees, our students, and other members of the community. Just getting to see your OB-GYN doctor or your nurse practitioner, and talking about this important topic I think is really critical. So, taking advantage of the primary care services that we offer through the Department of OB-GYN is certainly one thing that all women should take advantage of. And make sure that you talk to your doctor about what are my risks for cervical cancer, how can I reduce those risks, and let’s see if we can help you out there. Marissa Wertheimer: Thanks for listening. Please feel free to leave us any comments on this Wellcast on the form at the bottom of this page. If you have a story suggestion, please email it to us at health.wellness@vanderbilt.edu or you can use the “Contact Us” page on our website at healthandwellness.vanderbilt.edu. -- end of recording --
