“Cervical Cancer can be prevented. Welcome to SBH Bronx Health Talk produced by SBH health system and broadcast from the beautiful studios at St. Barnabas Hospital in the Bronx. I’mSteven Clark, more than 12,000 American women get Cervical Cancer every year and about one-third will die from it. Yet as many as 93 percent of Cervical Cancers. That’s more than 9 out of 10 could be prevented. With us to discuss Cervical Cancer screening and Prevention is Dr. Ana Tergas a gynecologic oncologist at SBH Health System. Dr. Tergas cares for women with all gynecologic cancers as well as those with precancerous conditions. She has a particular interest in improving the quality of gynecologic cancer care for underserved and disadvantaged women. Welcome Dr. Tergas.”

“Thank you for having me.”

“So what makes Cervical Cancer largely preventable?”

“So Cervical Cancer almost all cases of Cervical Cancer are preventable and this is because not only do we have a good screening method but we also have a vaccine against HPV which is the cause of cervical cancer.”

“So how come that from what I’ve read 8 million US women between the ages of 21 and 65 have not been screened for cervical cancer in the last five years, why do you think that is?”

“I think there’s a lot of a reason for this and many reasons have to do with difficulty accessing the medical system. So that may be either patients don’t know where to go or how to make an appointment or they may not have health insurance or also women often have competing aspects of their lives that makes it difficult for them to take the time out to get their annual checkups.”

“Okay, what exactly is the relationship between HPV or human papillomavirus and Cervical Cancer?”

“HPV is a sexually transmitted infection that causes abnormal changes in the cells of the cervix and if we’re not able to treat these abnormal changes then eventually it will lead to cervical cancer.”

“Is HPV the only cause of cervical Cancer, is there a genetic component?”

“So Cervical cancer is not a genetic cancer. HPV causes the vast majority of cervical Cancer cases.”

“How common is HPV? “

“HPV is actually extremely common. There are several different types of HPV. There’s two broad categories first there’s low risk HPV and then there’s high risk HPV. Low risk HPV does not cause cervical cancer we know that high risk HPV causes cervical cancer and within this category there’s actually several different types as well.”

“Okay, a lot has been written about the importance of getting your preteen vaccinated against HPV, to prevent cervical cancer. Is that also a consideration for women who are older who may not have been vaccinated when they were younger?”

“Yeah, very recently the FDA approved the HPV vaccine for women up to age 45 and this is a very exciting development because now we can vaccinate additional women because it used to be that you can receive the vaccine up to age 26. However having said all of this the best time to receive the HPV vaccine is whenever someone is young before they’ve actually been exposed so the actual age for the recommended age for vaccination is at 11 years.”

“Okay, now what about pap smears, how important are those?”

“Pap smears are important as well and even for women that have been vaccinated against HPV. And the reason why that is, is because the vaccines even though they work extremely well we still have to make sure that women are screened for any of these abnormal changes and with pap smear we can actually catch cervical cancer before develops so we can catch what’s called pre-cancer and this is when we can treat women and prevent them from getting cancer.”

“How often should you get a pap smear?”

“So it actually depends on your age and your prior history. It’s important to ask your individual doctor for how often you should get the pap smear but women should know that guidelines have changed a little bit and for the most part you actually don’t need a pap smear every year but like I said because it depends a lot on your prior history and your age it’s important to see your gynecologist and ask them directly because they know that case better than anyone.”

“If you’re infected by HPV and that causes dysplasia or pre-cancer what do you do then? What’s the treatment?”

“The treatment for this is a very simple office procedure where we simply remove this small area of abnormalities before it can progress to actual cervical cancer. So this is a very simple office procedure that takes about five minutes and you can go home the same day or even go to work because there’s not that much pain associated with it. The good news is that not only do we have the vaccine to prevent HPV infection but we also have the pap smear to find these abnormal changes and we also have a very simple treatment for this.”

“So I guess in a perfect world cervical cancer is sort of like colon cancer, if you do the screening it’s largely preventable right?”

“Yes absolutely but it’s actually even the situation is even better than colon cancer in that we actually have a vaccine to prevent the majority of the cases based on HPV infection.”

“Can you do anything to say bolster your immune system to prevent the likelihood of getting HP infection.”

“No this is a common misconception among women you know earlier I discussed how HPV is extremely common. So you know it’s important to know that almost everyone and 80% of people will have an HPV infection at some point in their life and so you know there shouldn’t be any stigma behind actually having HPV and unfortunately there’s not much that you can do in terms of helping your immune system other than not smoke. We know that smoking is a significant risk factor for cervical cancer. So once you actually have already been infected with HPV the cigarette smoke can cause changes in your cells that can make it easier for the HPV infection to stick around and cause those abnormal changes because for the vast majority of people they actually clear the vaccine on their own. It’s important to not smoke and that’s really the number one thing that you can do in terms of helping your body clear the HPV infection.”

“If you’re a preteen and you get the HPV virus at 11 years old this is

Dr. Tergas: “You mean a vaccine.”

”I’m sorry yes does that mean you know anything to worry about that you are immune from getting HPV? “

“No, the HPV vaccine it’s 99% effective and so if there is that chance that you will still receive the that you should you still may get an HPV infection and so that’s why it’s still important even if you have received the vaccine to to get screened for cervical cancer because having the vaccine doesn’t eliminate the risk completely.”

“Right, other certain signs or symptoms of cervical cancer? “

“Yeah absolutely, so abnormal bleeding is a common sign of cervical cancer back pain, leg pain, and also bleeding specifically after intercourse is a very worrisome sign, However I should really emphasize that these are symptoms that develop once cervical cancer has actually grown to be a fairly decent size. So pre cancer actually does not really have symptoms.”

“Right…”

“That’s why it’s important to go see the gynecologist regularly and so she can perform an exam, perform the pap, and try to find these changes before they grow big enough to actually cause symptoms. You know another another big issue is that you know women think to themselves well you know I don’t have any abnormal discharge, I don’t have any abnormal bleeding, I don’t have any pain, so I must be okay. You know sometimes things can be going on down there without someone being aware of it. That’s why it’s important to be of examined by a physician.”

“What’s the treatment for cervical cancer?”

“Once somebody actually has cervical cancer and the treatment depends on the person’s stage. Options include anything from surgery to chemotherapy to radiation but again I it’s important to get your screening early enough to where we can control the changes before they develop into cervical cancer.”

“I guess the bottom line in this this whole podcast is really don’t be afraid to see your your gynecologist on a regular basis.”

“Absolutely, you know it’s it’s so important to touch base with your gynecologist you know it it does require that you prioritize this and you know take the time out of your busy schedule to do this but it really can be life-saving and you know science is improving every year and we have more and more treatment options and and so it’s really important to go see the gynecologist and talk to him or her about you know how you’re doing and what treatments if any you may need.”

“And I guess also as a corollary to that make sure you’re your preteen is vaccinated as well.”

Dr. Tergas: “Absolutely you know from a personal experience I have a very young son he’s not old enough to receive the vaccine yet but as soon as he turned 11 I will certainly be vaccinating him against HPV and it’s important to know that it’s both boys and girls that can receive the HPV infection because HPV causes not only cervical cancer but could also cause head and neck cancer and penile cancer in men.”

“Okay well thank you Dr. Tergas for joining us today on SBH Bronx health talk. If a listener wants to make an appointment for a screening let me give you that phone number it’s 718-960-3730 that’s 718-960-3730.”

“Thank you very much for having me.”

“Sure and for information on services available at SBH health system visit www.SBHNY.org Thank you for joining us until next time.”