Pap tests, HPV vaccine, Colposcopies and more
Cervical cancer screening is part of regular preventive care for women and people with a cervix. In this DocTalk video, Jennifer Burzawa, MD, a gynecologic oncology provider with Valley’s Oncology and Hematology Clinic, explains the screening, HPV vaccines, and what happens next if there’s an abnormal result.
A transcript of the talk can be found below the video.
(0:15) What is cervical cancer screening?
A Screening is a test to find a disease. A cervical cancer screening, finds cervical cancer before it happens in what is called the “precancerous phase.”
(0:35) What are your recommendations for cervical cancer screening?
The national recommendations are that patients are screened at age 25 and tested for the human papilloma virus (HPV). The HPV testing, if negative, can be done every five years, up until the age of 65, for most patients. Somebody who has abnormal results may be asked to have their screening more frequently to make sure there’s no progression to dysplasia (abnormal changes in the cells of the cervix). A referral to a gynecologic oncologist happens if dysplasia or cancer is found.
(1:37) What role does the HPV vaccine have in preventing cervical cancer and other cancers?
The HPV vaccine can protect against many different types of cancers, including cervical, vaginal/vulvar, anal, and head and neck. Currently it’s recommended that all persons receive the vaccine at age 11 or 12, which includes two doses. It is currently FDA approved to be given up to all patients up to age 45. The current vaccine protects against nine different types of the virus. There are more than 200 different strains of the HPV virus, but we know that HPV 16 and 18 are the most oncogenic (likely to cause cancer), and the vaccine protects against those. Patients who have been vaccinated should still have routine cervical cancer screenings, though they are very unlikely to develop cervical cancer.
(2:48) What happens when a patient gets cervical cancer screening?
Cervical cancer screening is performed by a provider, such as a primary care provider or OB/GYN. This includes discussion with the provider, followed by a pelvic exam. You will be placed in a position where you’re lying on your back, and your feet will be placed up in footrests. The provider will gently place a device called a speculum into the vagina that opens the vaginal canal so they can see the cervix at the end of the vaginal canal. The cervix is the lower portion of the uterus; it’s the part of the anatomy that dilates (opens) when you’re giving birth. It’s also the part of the body that is most commonly affected by HPV. Once the speculum is in place, the provider will look at the cervix and the surrounding vaginal walls and then take a sample (swab) of the cervix to send for more testing in a laboratory.
(3:57) Can you explain the difference between testing positive for HPV and having abnormal Pap lab results?
The sample that the provider takes at the time of cervical cancer screening can be sent for two different tests, and what we test for has changed a lot over the years. There are two different parts of a Pap test: one is the cytology; when cells from the swab sample of the cervix are placed on a slide that a pathologist looks at under a microscope, to look for abnormality of those cells. The other part of a Pap test is the HPV testing. The current recommendations are that women undergo HPV testing, as that seems to be more predictive for assessing cancer risk, than just cytology.
(4:54) What is a colposcopy and when would a patient need to undergo a colposcopy?
A colposcopy is a procedure usually performed after an abnormal Pap test result, and is performed by a provider with special training. The patient is placed in the same position as for the cervical cancer screening and a speculum is placed in the vagina. The provider applies a special solution, acetic acid (a medical-grade vinegar), to the cervix to highlight any abnormal cells. Then, using a colposcope (type of light microscope) the provider examines the cervix and vaginal walls closely to identify any changes. If abnormal areas are seen, the provider may take small samples known as biopsies for further examination. These biopsies have minimal discomfort and are important for diagnosing the severity of the abnormal cells. While the Pap test screens for potential issues, the colposcopy and biopsies confirm a diagnosis.
(6:24) What is cervical dysplasia and how does it differ from cervical cancer?
Almost all cervical cancer is caused by HPV and that virus takes many, many years to create the changes that ultimately lead to a cervical cancer. The precancerous phases include what we call cervical dysplasia. There are several different degrees, including very low or mild cervical dysplasia, which typically requires close follow-up, to more significant degrees of precancerous cells, which require minor treatment. These are all different than cervical cancer, which requires a much a more aggressive approach to treat.
(7:22) What are the standard treatment options for cervical dysplasia?
If you’re diagnosed with cervical dysplasia, your provider will follow standard guidelines for treatment. For mild dysplasia, you may just need more regular Pap tests, like once a year for a few years. If you have high-grade dysplasia, which is closer to becoming cancer, a small procedure might be recommended. In this procedure, part of the cervix is removed and examined to make sure there’s no early cancer and to remove cells that could turn into cancer. This can often be done in the doctor’s office or sometimes in a hospital, but it’s a minor day surgery and patients recover quickly.
(8:30) If a patient is diagnosed with cervical cancer, what treatment pathways are considered?
There are a variety of different treatments that very much depend on the stage of cervical cancer. For early-stage cervical cancer, surgery is often the option. There are a variety of different surgical techniques that have been used in the past, but the most current recommendation is using an open approach, which is usually like a bikini cut incision, or what we call a “Pfannenstiel” incision. For later-stage cervical cancer, the usual treatment is radiation therapy, which is often given in combination with chemotherapy as well. Sometimes, there are options for less-invasive surgery that can help preserve fertility, should that be a desire for patients who have very early-stage cervical cancer.
(9:25) Are there any new advancements or research in the field of gynecologic oncology that patients should be aware of?
Recently, a type of treatment called immunotherapy has become more important in treating cervical cancer, especially when the cancer comes back or is advanced. Since cervical cancer is usually caused by HPV, researchers are looking into more immunotherapy options and vaccines. We’re expecting to learn more about these new treatments soon.