Is TEAL the New PINK?

January is Cervical Cancer Awareness month, and the color is TEAL. Did you know there are still over 12,000 women in the United States who are diagnosed with this cancer every year? And although our treatments have greatly improved, there are still over 4000 deaths from this cancer every year. The good news is that we have PREVENTION, and with this prevention, we hope to eliminate cervical cancer within our lifetime! Take this CDC Cervical Cancer QUIZ to test your knowledge.

The HPV vaccine is approved and strongly recommended for all adolescents- girls and boys- as part of their routine vaccinations at age 11-12 years. The second generation of Gardasil vaccine (Gardasil 9) now covers not the HPV strains that cause 90% of cervical cancers (as well as the two strains that cause 90% of genital warts.) If your child has started the series with the original Gardasil, they may finish out the series with the Gardasil 9 to increase the spectrum of their immunity.

YES, the vaccine is safe. YES, the vaccine is effective- extremely effective! YES, my daughters are immunized, and they are the two people my husband and I love and care about the most on this planet! Enough said.

Pap tests- are they still necessary? Yes, but NOT EVERY YEAR (and the crowd cheers)! Our current guidelines recommend Pap testing starting at age 21 years, and then every 3 years till age 65. There is also an option for 30-65 year olds to test only every 5 years when they do combined Pap and HPV testing.

Does the Pap check for all sexually transmitted infections? NO. The Pap test checks for early cervical cancer. To check for STI's such as HIV, gonorrhea, chlamydia, syphilis, and herpes, you will need additional testing (of blood, urine, and possibly a swab test performed during a pelvic exam.)

Are there support groups for women diagnosed with cervical cancer? Absolutely! For example, I'm honored to be in the picture above with Tamika Felder, the founder of a wonderful support group CERVIVOR- check out her website!

BOTTOM LINE: That magical "cure for cancer" has not yet been discovered for all cancers, but CERVICAL CANCER is preventable- let's end this disease for our children by vaccinating them now!

To Pap or NOT to Pap?

Choosing Wisely is a wonderful campaign aimed at increasing discussions between doctors and patients about tests and procedures, and what is expected versus what has been shown to be effective. I am starting my focus on this campaign with highlighting the recommendations of my academy- the AAFP (American Academy of Family Physicians.) So far, I've discussed back x-rays, sinusitis treatment, bone density tests and EKGs, and today I would like to address Pap tests.

Pap tests do a wonderful job in helping us detect cervical cancer in early, very treatable stages. With our increased understanding of this disease being caused by HPV (the Human Papilloma Virus) as well as improving technology that allows us to detect the specific strains of HPV that are high risk for cancer, we are changing the recommendations for Pap tests on what seems like an annual basis. This recommendation focuses on two parts: Girls under the age of 21 and women who have had hysterectomies for reasons other than cancer (such as fibroids or heavy bleeding) do NOT need Pap tests. Evidence has shown that the vast majority of teens who are infected with HPV will not progress to cancer, but instead effectively "clear" the infection within a few years (meaning the HPV lowers to an undetectable level, though it still may be present.) Likewise, the incidence of cancer in women who have had their uterus removed for non-cancerous reasons is so small that there is little evidence for improved outcomes.

As a major proponent of sexually transmitted disease awareness, however, I want to be crystal clear that women under the age of 21 STILL NEED TESTING for STDs if they are having sex! No Pap does NOT equal no testing or no exam.

BOTTOM LINE: Pap testing recommendations are changing frequently- please talk with your doctor about the most current recommendations and do not be surprised if you do NOT need one this year!

To Pap, or Not to Pap...

When I was in medical school (not THAT long ago), there was no question about when women should get Pap smears. We knew that this valuable test to screen for cervical cancer saved lives, and every woman should be tested at her annual exams. Subsequently, we learned that all cervical cancer comes from HPV- the Human Papilloma Virus, which is transmitted by intimate skin-to-skin contact, primarily through sex. With that knowledge, we modified the Pap requirements to only those women who had become sexually active.
Now we know that the majority of HPV infections occur upon initiation of sexual activity, and that most of these infections are cleared by the immune system within a couple years, and do not result in cancerous changes. We also realize that invasive cervical cancer is very rare in women younger than 21, and so the current guidelines tell us that women should start having Pap smears when they turn 21 (and have had intimate relations.)
Happily, we also have vaccines to help our immune systems fight off the HPV more effectively, so with Gardasil and Cevarix immunizations, we should be seeing even less cervical cancer!
What if you are over 21? Women aged 21-29 without high risk factors (HIV, organ transplant patients, DES exposure or previous abnormal Pap smears that showed early cancerous changes) should get screening Pap tests every other year in their twenties, and every third year beyond their 30's.
Women over 30 will be tested with both the traditional Pap test and a specific test that checks for the strains of HPV that cause cancer. If you test positive for these high risk strains, your screening will be more frequent (annually.)
When can we STOP? By 70, if you have had a decade of normal results, you are done. Yea!
BOTTOM LINE: Pap tests do not need to be an automatic part of your annual pelvic exam- but YOU STILL NEED ANNUAL PELVIC EXAMS to check for sexually transmitted diseases and other gynecologic concerns (ovaries, etc.)