Cervical Health Awareness: A Q&A with Christina Bandera, MD
Christina Bandera, MD, a gynecologic oncologist, director of the Center for Gynecologic Cancers at the Women’s Medicine Collaborative, and chief of obstetrics and gynecology at The Miriam and Rhode Island hospitals, addresses some of the most important things women should know about the risks, screening and symptoms of human papilloma virus (HPV) and cervical cancer.
What is HPV and how is it detected?
Any woman who has had sexual intercourse with even just one partner may have been exposed to HPV. Human papilloma virus is the most common sexually transmitted virus in the U.S. – causing up to 99 percent of all cervical cancers. It is passed to a partner during vaginal, oral or anal sexual activity. A person can get HPV even if their partner does not have signs or symptoms of infection.
Someone can be colonized with HPV even if several years have passed since having sexual contact with an infected person. Since most people do not know they are infected, they do not realize they may be passing HPV to their partner(s). While the Pap test has helped to detect and decrease the number of cervical cancer cases in the U.S., precancerous cells can be missed. It is recommended that women age 30 and older have the HPV test in addition to the Pap test, and that women under 30 have the HPV test done if their Pap test results are concerning.
What is the connection between HPV and cancer?
While about 80 percent of women will have had HPV by age 50, having HPV does not mean a woman has or will ever have cervical cancer. For the majority of women who develop an HPV infection, it resolves on its own without causing any problems. But for some, the infection persists, and over a long period of time can cause abnormal cells to form that could develop into cervical cancer. We know that certain behaviors increase a woman’s risk of cervical cancer. These include smoking, engaging in sexual intercourse at an early age, having multiple sexual partners, a history of Chlamydia infection, and women with weakened immune systems or HIV infection.
What screening and vaccination options are available?
It is possible to get more than one type of HPV. With the addition of HPV screening, women found to have a high-risk HPV infection can be monitored for precancerous cell changes and treated before cervical cancer develops. This screening is very important because while some low-risk types of HPV can cause genital warts – a visible sign of infection – the high-risk HPV types associated with cervical cancer more often go undetected until abnormal cells have developed. That is why all women are encouraged to get routine screening with Pap and HPV tests.
Women who experience vaginal bleeding or discharge after intercourse and/or between menstrual periods or who complain of pelvic pain or pain during intercourse should speak with their provider, as these could be signs of cervical cancer, a concerning infection, or other treatable conditions. The good news is that in addition to the Pap test and HPV test, the HPV vaccination is available for men and women aged pre-teen to early 20s. However, women who receive the HPV vaccine must continue to be tested with the Pap and HPV tests. The HPV vaccine protects against only two of the more than one dozen types of cancer-causing HPV types and is only fully effective when given to individuals not yet exposed to HPV.
All women should discuss their risk factors for HPV and cervical cancer with their provider and consider the HPV vaccination in addition to regular Pap and HPV test screening. Awareness is critical and early HPV detection can prevent cancer from ever developing. In third world countries where this type of screening and prevention is not available, cervical cancer remains one of the most common causes of cancer death for women. For more information about cancers of the reproductive system, contact the Women’s Medicine Collaborative at 401-793-7917 or visit the Center for Gynecologic Cancers.