CERVICAL CANCER, continued from 15
The high level of HPV infection, particularly in those under 30, combined with the fact that the vast majority of cases clear up on their own, has led to changes in screening recommendations. The American College of Obstetricians and Gynecologists suggests women begin getting Pap smears at 21 and get one every other year until 30. A woman in her 30s may move to a three-year Pap regimen if she has had three normal test results in a row, no history of dysplasia and a healthy immune system. Women on the three-year Pap schedule may discontinue the test after 65 if they are no longer sexually active. These recommendations don’t “mean that women don’t need a yearly gynecologic visit for other reasons, but that the actual Pap may not need to be done at every visit,” says Mandel. WHILE THE PAP SMEAR DETECTS ABNORMAL CELLS ON THE CERVIX, A
1848081
IMPORTANT NEWS
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Gazette Health | Spring 2012
A GAZETTE PUBLICATION
relatively new test identifies the presence of HPV. Many gynecologists now use the HPV DNA test in conjunction with a Pap in women over 30, according to Chandra Graham-Parker, M.D., an obstetrician with Scartascini & Rogers in Greenbelt and Bowie and privileges at Doctors Community Hospital in Lanham. The test also is used as a follow-up to abnormal Pap results. Depending on the results of the HPV DNA test and the woman’s age and history, a physician may decide to monitor her or conduct further testing. “While the life span of HPV is 12 to 18 months, we can’t be sure where a woman is within that time period,” says Graham-Parker. “So, we bring her back every four to six months to repeat the test and make sure the abnormal cells are not progressing to a higher stage but are, in fact, going back to normal.” Sometimes a colposcopy is performed. “That’s where we look at the cervix under a microscope and use a vinegar solution that makes the abnormal cells turn white,” says Young. If a problem is detected, the gynecologist will remove a small sample of tissue for more detailed study. The results of a colposcopy tell the physician whether the abnormal cells are precancerous or cancerous. “If we have mild dysplasia…we usually monitor, repeating Pap smears and, depending on the person, HPV tests at about six-month intervals,” says Nardone. Moderate to advanced dysplasia usually requires the ablation or excision of abnormal cells. A LEEP (loop electrosurgical excision procedure) is commonly used to remove the abnormal tissue. “We numb the cervix and use electricity to get rid of the bad cells,” says Young. “There’s a 95 percent chance that we’ll get them all.” If cancer is detected, further tests will determine whether it is confined to the cervix or has spread to other parts of the body. At a minimum, a portion of the cervix will need to be removed, says Graham-Parker. A hysterectomy may be required. In cases where the cancer has spread, radiation and/or chemotherapy may be prescribed. “The survival rate for women whose cancer has not spread outside the cervix is 92 percent after five years,” says Tran. “The five-year survival rate for all stages of the cancer is about 75 percent.” Many cases of cervical cancer are not diagnosed until the later stages. “It’s estimated that over 50 percent of the women who develop cervical cancer have never had a Pap smear,” says Mandel. “Another 10 percent have not been screened within the five years prior to their diagnosis being made.” While it may not be possible to eradicate cervical cancer in the near term, it is possible to both reduce the rate of incidence and catch it earlier “by doing the right things,” says Mandel. The right things include, for those young enough, an HPV vaccine and, for all females, “getting screened on a regular basis, using condoms, not smoking and not engaging in risky sexual behavior.”