More than just a Pap test:: Preventing HPV & Cervical Cancer

More than just a Pap test:: Preventing HPV & Cervical Cancer

Back in my years as a resident physician in Obstetrics & Gynecology, one of our core medical services was gynecologic oncology, and from those months, it was our patients with cancer of the cervix, the cylindrical “neck” at the bottom of the uterus, that I will never forget. Cervical cancer is typically a disease of young women, caused by infection with the human papillomavirus {HPV} in about 91% of cases. So these were typically women in their 20s, often with totally relatable reasons for lapsing on their routine gynecologic care – they couldn’t afford insurance and had skipped going to the gynecologist, they were in school or had young kids and had gotten busy, and so on – and in the interval, had developed this cancer. Unlike other malignancies, cancer of the cervix is only curable by surgery in its earliest stages, and often not very sensitive to chemotherapy either. The cancerous cells often emit a strong odor, which would hit your nose before you even walked in the room, and cause so much embarrassment at a time of extreme physical suffering. It’s graphic, I know, but we can take steps to drastically reduce the risk for this horrible disease for ourselves and our daughters. So, with January being Cervical Cancer Awareness Month, let’s break it down a bit with some facts:: 

  1. Cervical cancer affects about 8-9 women for every 100,000. In the United States, that’s more than 4,000 women dying every year, typically at young ages, of something that is frequently preventable through routine Pap testing and HPV vaccination.
  2. Let’s talk about that Pap test:: it has become the stand-in for our well-woman exam. We say we “have to go get our Pap” when what we really mean is we need to visit with our gynecologist. Sometimes, we skip our appointments if we think the Pap can wait. Though, yes, the recommendations don’t recommend Pap testing annually anymore, you should still go see your GYN every year because there is a lot more that gets done at your visit, especially if you don’t see a separate primary care doctor!
  3. Taking your daughter to the GYN:: I think many mothers feel hesitant to introduce their daughters to gynecologic care because they envision subjecting their girls to a speculum or Pap. Another myth! That first visit for your daughter typically does NOT need to involve either of those things, unless she’s in her 20s and/or sexually active. Personal aside – even as a future OB/GYN, navigating my first gynecologic visit on my own made the experience way more traumatic than it needed to be.  I strongly recommend a transition, maybe even with overlap, from pediatrician to gynecologist (and there are many here in town that specifically love taking care of young women) in the late teens or early 20s, or earlier in the context of irregular or painful periods. 
  4. HPV vaccination:: As I mentioned, HPV causes the vast majority of cervical cancer, but it can also cause cancers of the penis, anus, vagina and throat, as well as genital warts. You may shudder to think of these outcomes in your preteen, but it’s important to protect them well before they initiate any sexual activity. The CDC recommends all boys and girls get the HPV vaccine at age 11 or 12 as the vaccine produces a stronger immune response when taken during the preteen years. For this reason, up until age 14, only two doses of vaccine are required. For those 15 and older, a  full three-dose series is needed. It is available up to age 45 and makes a lot of sense for any woman starting new sexual relationships, something I often see women consider after a breakup or divorce.
  5. Myths about promiscuity:: Yup, I get it – that HPV transmission primarily occurs via sexual acts gets a lot of parents up in arms about what their little angels will or won’t do in the future. But try to unlink the two mentally. You get your kids auto insurance even though you hope and pray they will drive defensively and avoid any bad luck, right? [I know insurance is required, but just saying…] At the pediatrician’s office, you can offer as much detail as you choose. As a minor, when my mom arranged the recommended meningococcal vaccine before I headed off to college, or travel vaccinations prior to international family trips, I barely considered the specific diseases at hand. Had I gotten HPV vaccination at age 11, I would have thought about it even less. I can guarantee most kids know that shots are often part of going to the pediatrician, and simply explaining that the vaccine helps reduce the risks of cancer seems sufficient to me. Second, risks of sexually-transmitted infections and unplanned pregnancy are what typically scare kids off of early sexual activity, not the risk of HPV. So the often-cited notion that HPV vaccination encourages promiscuity doesn’t hold water in my eyes. 
  6. HPV vaccination and infertility:: My last rant for this post. A few weeks ago, a “health coach” who used to reside here in town posted some vaccine misinformation with a myth I thought had died out over the years – that the HPV vaccination causes ovarian failure or infertility in young women. In the decade-plus that this vaccine has been available, there has been ample time to study and debunk this claim, and that’s been the consistent finding in every study on the topic. She may have blocked me after I shared the studies on her post, but I’ll say it here too: as a fertility specialist, mother to a daughter, and a woman who chose vaccination when the vaccine came out in my medical school years {and called up my dad to insist he pay for the shots I couldn’t afford at that time!}, I vouch for the overwhelming safety in this regard.

Having just read a recent report about babies who inhaled [undiagnosed] cervical cancer cells at their birth and developed lung cancer as children as a result, this awareness month was perfectly-timed in my eyes. As a takeaway, I would simply say this:: maintaining cervical health is simple and smart. Stay safe and up-to-date on your preventive gynecologic healthcare, and help your children keep their risk low as well by encouraging vaccination, routine healthcare, and safe sex when the time comes. 

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Rashmi Kudesia, MD MSc is a board-certified OB/GYN and Reproductive Endocrinology & Infertility specialist who is passionate about improving women's access to evidence-based, honest reproductive health information and care. Aside from her clinical practice seeing patients in Houston and Sugar Land, Rashmi frequently speaks at conferences and community events, and advocates for women's health via media interviews and social media. Originally a Midwesterner, she moved around the East Coast for school and training, including nearly a decade in NYC, where she met her husband, Ashish, a Houston native. After moving to Houston in 2018, she's continued searching for that perfect work-life balance as the family grew quickly, adding their first pup, Bowser {2018}, their first home, and now their first kiddo, Amara {2019}! Right now, she's learning the ropes of being a working mama, but still loves exploring Houston's amazing food scene, checking out the newest museum exhibits, or planning the family's next trip. She's always on the hunt for the city's best iced latte or glass of wine to be savored with a good book. Find her on Facebook and Instagram {@rkudesia}.


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