Question 1

Cervical Cancer Prevention

Accepted Answer

The HPV vaccine has been critical in reducing the rate of cervical cancer. It offers the greatest health benefits to individuals who receive their two or three doses before engaging in sexual activity. It is recommended for preteen girls and boys at age 11 or 12, all teens, and young adults, but people can be vaccinated starting at the age of 9 through the age of 45 (CDC and Memorial Sloan Kettering Cancer Center).

The vaccine is recommended at the ages of 11 or 12 because it offers protection long before the child would have come in contact with the virus; whereas, HPV vaccination of adults provides less of a benefit because more people in this age range may have been exposed to HPV already (CDC). Have a conversation with your healthcare provider to decide whether or not you should get vaccinated. For parents with children under 18, have a conversation with their pediatrician to decide whether or not you should get vaccinated.

Although Black women have the highest rate of Pap screening, they are among the lowest racial group to complete the vaccination series. The vaccination works at its full capacity to protect against most cervical cancer types only when all prescribed doses are taken. Gardasil 9 is the only HPV vaccine used in the United States since 2016. Women who have received the vaccine should continue to have regular Pap smears as there are some strains of HPV that are not prevented by the vaccination.

Question 2

Cervical Cancer Screening

Accepted Answer

The implementation of routine Pap testing and HPV screening have caused a significant decrease in cervical cancer. According to Dr. Mark H. Stoler, countries without preventative care such screenings have a higher incidence and mortality rate compared to countries that do offer protection and detection tools.

Originally, Pap tests were the main way to detect abnormalities in the cervix. However, recent studies found that primary HPV screenings are even more critical to screening for cervical cancer. This is because the majority of cervical cancers are caused by high risk HPV strains. An HPV test looks for cervical infection of high risk HPVs that are more likely to cause cancers of the cervix. Though both pap smears and HPV tests may find precancerous lesions, HPV tests are more sensitive and are more accurate. The effectiveness of the test safely allows for longer periods of time between screenings. A study comparing HPV screening to cervical pap smears, found that HPV screenings taken at extended times from each other missed fewer cervical precancers than Pap smears. Of women who tested negative at any screening stage, 85-90% do not have a risk of developing cervical cancer for the next 3-5 years (Anna Gottschlich et al. (2022), American Cancer Society, and Mark A. Stoler).

According to the American Cancer Society, cervical cancer has the potential to be virtually eliminated. Cervical cancer was once one the most common cancers affecting American women. However, with the introduction of routine access to Pap tests in 1960 followed by administration of the HPV vaccine starting in 2006, there was a significant and accelerated decrease in mortality. Among women between the ages of 20-24, cervical cancer incidence rates from 2005 through 2012 declined by a total of 33% and by another 65% from 2012 through 2019.

The American Society of Colposcopy and Cervical Pathology recommends Pap screening starting from the age of 21. Women should consult with their doctors about how often to get tested.

How should I prepare for my cervical cancer screening test?

Don’t take the test if you are having your menstrual period.
Don’t douche for two days before the test.
Don’t have sexual intercourse for two days before the test.
Don't use tampons, birth control foams, jellies, or other vaginal creams or vaginal medicines for two days before the test.

Question 3

Risk Factors

Accepted Answer

What are the risk factors for cervical cancer?

Risk factors include but are not limited to:

Human papillomavirus (HPV) infections: Certain strains of HPV put women at higher risk for cervical cancer. This virus can be transmitted by sexual contact.
Smoking: A woman who smokes has a higher chance of getting cervical cancer.
Weak immune systems: Women living with risk factors such as HIV have a greater risk of getting cervical cancer. This is because HIV makes the immune system weaker so the body may not effectively clear the HPV infection.
A family history of cervical cancer: If other people in your family have or have had cervical cancer your risk is higher than a woman without a family history.
Chlamydia infections: This is a sexually-transmitted bacterial infection that may increase your risk of developing cervical cancer.
Diet: Obesity and a diet low in fruits and vegetables may increase the risk for cervical cancer.
Diethylstilbestrol (DES): If a woman's mother took the drug DES when she was pregnant, she has a greater chance of getting cervical cancer.
Socioeconomic status: Many low income or uninsured women still lack or have limited access to healthcare which may prevent regular screenings and increase their risk of cervical cancer.

Question 4

Decreasing Your Risk (American Cancer Society)

Accepted Answer

Get screened with Pap and HPV tests.
Quit smoking.
Avoid intercourse at a young age.
Use condoms during intercourse.
Limit the number of sexual partners.
Get vaccinated with the HPV vaccine.

Question 5

Diagnosis

Accepted Answer

How is cervical cancer diagnosed?

If your screening test shows abnormal cells or if your symptoms suggest the possibility of cervical cancer, follow-up tests will be necessary. The process of diagnosing cervical cancer includes colposcopy, biopsy, and staging:

Colposcopy is a procedure used to help detect abnormal cells in the cervix. During the procedure, a special magnifying tool called the colposcope is used to inspect the tissue that lines the vagina and cervix. Following the colposcopy, a biopsy is performed on any abnormal cells.
Biopsy is a procedure where a sample of tissue is removed from the cervix and viewed under a microscope to check for signs of cancer. The types of biopsies used to check for cervical cancer are punch biopsy, endocervical curettage, loop electrosurgical excision procedure (LEEP), and cone biopsy. If the biopsy shows the presence of cancer, you will be referred to a gynecologic oncologist, a doctor who specializes in treating cancers of the female reproductive system.
Staging is the process in which tests are used to determine the extent of the cancer. This process usually includes lab and imaging tests as well as visual examinations.

During the follow-up appointment, you may be asked about your personal and family medical history in addition to having a physical exam. One or more diagnostic tests may also be recommended depending on factors such as your symptoms, age, general health, or earlier medical tests.

Question 6

Follow-Up with Abnormal Results

Accepted Answer

It is critical to get follow-up care on any abnormal test results. Although Black women have an overall higher rate of reported Pap smears, they have a lower rate of follow-ups for abnormal Pap results. Because Black women take longer to clear HPV, it is important to schedule and keep your follow-up appointments as soon as possible. Delaying follow-ups may lead to cancer developing and spreading, possibly resulting in more intrusive treatments and poor health outcomes.

Question 7

Treatment

Accepted Answer

Every patient should have a personalized treatment plan to guide their care for an extended period of time. The patient’s doctors should be able to construct treatment plans based on the medical guidelines for the specific type and stage of cancer while taking a collaborative approach that is inclusive and respectful of a patient’s needs and wishes.

Treatment for cervical cancer depends on several factors, such as the stage and location of cancer, the presence of other health problems, age, whether you want to have children, and if you are currently pregnant. Treatment options include surgery, radiation, chemotherapy, or a combination of these.

Question 8

Surgical Treatment Options

Accepted Answer

Early-stage cervical cancer may be treated with surgery depending on its stage, location, and whether you would like to have children in the future. Options may include cone biopsy, LEEP, trachelectomy, or hysterectomy:

Cone biopsy is the type of surgery used to cut away the cancer only, leaving the cervix intact and allowing the possibility of future pregnancies. Sometimes this procedure can remove all the cancer; other times some cancerous cells may be missed.

LEEP uses a thin electrified wire to cut out abnormal tissue high in the cervix. This procedure is effective at removing any abnormal or precancerous cells from your cervix; however, it is possible for abnormal cells to return.
Trachelectomy is the removal of the cervix and some surrounding tissue, also leaving the possibility of future pregnancies.
Hysterectomy is the removal of the uterus and may be necessary along with the removal of the cervix and possibly part of the vagina and nearby lymph nodes. This procedure does not allow for future pregnancies.

Question 9

Radiation Therapy Options

Accepted Answer

This choice uses high-powered energy beams to kill cancer cells or to prevent them from growing by damaging their DNA. Radiation options include external radiation therapy or internal radiation therapy:

External radiation therapy uses a machine to send radiation beams towards the target areas from the outside of the body.
Internal radiation therapy uses a radioactive substance sealed in a device such as a needle, seed, wire, or catheter that is placed directly into or near the cancer vaginally.

Radiation therapy may not allow for future pregnancies and may cause early menopause. If you are considering becoming pregnant, talk to your doctors about methods to preserve your eggs before the start of your treatment because radiation can affect the ovaries, thereby resulting in early menopause. Moving the ovaries out of the treatment area before radiation therapy begins may help avoid early menopause (Cancer Research UK).

Question 10

Chemotherapy Options

Accepted Answer

Chemotherapy is the use of drugs to stop the growth of cancer cells by killing the cells or stopping cell division. It may be administered through a vein or taken in pill form. You may be treated with one or more chemotherapy medications in combination. Chemotherapy may be given along with other types of treatment depending on the stage and location of the cancer.

There are also other treatment options besides surgery, radiation, and chemotherapy. Consult with your doctors to find out which method would work best for you. Be sure to express any concerns, especially those in regards to pregnancy.

Question 11

Follow-Up after Treatment

Accepted Answer

Care for cancer does not end when the treatment is completed. Follow-ups with your medical team are just as important as the cancer treatment. This is because there is a risk that the cancer will come back or a second cancer–a cancer different from the initial cancer–may occur. Follow-ups are important because early detection of a local recurrence makes it more easily treatable.

Question 12

What check-ups should a woman have after treatment for cervical cancer?

Accepted Answer

In the first year after treatment, most women are advised to see their doctors every three months for Pap tests and may have to schedule computed tomography (CT scans) regularly. Until the fifth year, women may have check-ups regularly, at least every six months. After five years, a woman will most likely go back to yearly checkups. Women who have been treated for cervical cancer should tell their doctors about any vaginal discharge, bleeding, bone pain, weight loss, and bowel or bladder problems. They should also quit smoking and use protection during intercourse to prevent further problems.

Follow-up care includes examining the area to ensure that the cancer has not returned, managing the side effects of treatments, and monitoring overall health. Your provider may include physical examinations including pelvic examinations, Pap smears, or additional tests or scans depending on clinical factors. Given that pap smears are usually taken from the cervix, patients that have undergone a trachelectomy or hysterectomy will have cells taken from the upper part of their vagina.

For patients treated for precancerous lesions, the American Society of Clinical Oncology (ASCO) recommends they receive follow-up testing a year later with an HPV test. For women with no signs of cervical cancer remaining, doctors recommend a follow-up visit every three to five months for the first two to three years following treatment, then biannually for the next few years. Women with a higher-risk of cervical cancer are encouraged to have clinical follow-ups performed every three months for the first two years, biannually for years three through five, then annually. Regardless of the treatment, women should keep up with their regular screenings.

Oftentimes, cancer rehabilitation may be recommended; this includes services such as nutritional planning, emotional counseling, pain management, physical therapy, and occupational therapy among others. The goal of rehabilitation is to help the patients feel more in control of their lives and remain as independent as possible.

Question 13

Where can someone seek a recommendation to get a second opinion?

Accepted Answer

Here are some of the many ways to start seeking a second opinion:

Call the National Cancer Institute's Cancer Information Service. The number is 1-800-4-CANCER (1-800-422-6237). They have information about treatment facilities, including cancer centers and programs supported by the National Cancer Institute.
Consult the ABMS Directory of Board Certified Medical Specialists. This book, from the American Board of Medical Specialists, lists doctors by state and shows their specialty, background, and training. It is available at most public libraries, but you can also view it online at www.abms.org.
Speak to your primary care physician: Patients who receive a strong physician recommendation are four times more likely to follow through with medical advice (CDC).
Other options: Check with a local medical society, nearby hospital, medical school, or support group to get the names of doctors who can give you a second opinion. You can always ask other people for recommendations.

Don’t be afraid to ask for or seek a second opinion for any reason, including if you are uncomfortable with your healthcare practitioners, your diagnosis, or the treatment options you are offered.

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