Vaccines, regular Pap smears recommended

January is National Cervical Cancer Awareness Month, and in Delaware, cervical cancer rates are down.

“It’s actually preventable,” said Dr. Laura Moylan. “We have a good screening modality for cervical cancer, and that’s Pap smears.”

Moylan, a Fellow of The American Congress of Obstetricians and Gynecologists, is one of four doctors at Dedicated to Women, which has locations in Milford, Dover and Middletown.

She credits Greek doctor Georgios Papanikolaou, the inventor of the Pap smear, as the catalyst of a drastic reduction of cervical cancer cases in developed countries.

It was 1928 when Papanikolaou first realized that by collecting cells from a woman’s cervix and observing them under a microscope, cervical cancer could be detected. However, it wasn’t until the 1950s that his method, the Pap smear, was popularized.

United States cervical cancer incidence and death rates fell by more than 60 percent between 1955 and 1992, according to the National Institutes of Health.

“The number started to really decline as Pap smears became more prevalent and we intervened before the cancer could develop,” Moylan said. “That’s the beauty of Pap smears - cancer develops in a step-by-step fashion and you can intervene before it becomes invasive.”

The cause

Moylan recommends women regularly see their gynecologist for Pap smears to detect cancer early, but thanks to modern medicine, many of today’s youth may never see an abnormal Pap.

Doctors realized in the 1980s that cervical cancer is caused by the human papilloma virus, the most common sexually transmitted infection in the U.S. HPV is a group of over 150 related viruses, some of which are more likely to cause cancer than others. Many people who have contracted HPV will never show symptoms. Those that do may notice warts (genital or otherwise).

According to the U.S. Centers for Disease Control and Prevention, HPV is so common that nearly all sexually active men and women get the virus at some point. Usually, it goes away on its own, but in 2017, an estimated 12,820 cases of cervical cancer were diagnosed, the majority caused by HPV.

“We see it all the time,” Moylan said. “It’s a ubiquitous virus. It’s all over the place.”

However, with a little luck, that likely won’t be the case for long.

In 2006 the U.S. Food and Drug Administration approved Gardasil, the first HPV vaccine. Now, the CDC recommends all preteens get two doses of the vaccine to protect against cancers caused by HPV, including cancer of the cervix, vulva, vagina, penis and anus.

The HPV vaccine isn’t as popular as, say, a Hepatitis B vaccine, but in 2016, 60 percent of teens between 13 and 17 years old received one or more doses of the HPV vaccine, up 4 percent from 2015.

“If you’re young enough, the best thing you can do to prevent cervical cancer is get vaccinated,” Moylan said.

Males can get vaccinated until they are 22 years old, females until they are 27.

Too late

Abstinence and condoms are best defense against HPV for those who aren’t vaccinated or are too old for the vaccine to be effective.

However, many people already have HPV. A woman’s best defense against the cancers it causes is a regular Pap smear. Women whose Pap smears come back as abnormal don’t necessarily need to be biopsied or treated right away.

“HPV is slow growing, and if you are healthy a lot of times your body will fight off the virus,” Moylan said. “So we don’t want to act on something your body is going to take care of itself. Even if you have an abnormality in your 20s, we’ll probably just follow it.”

Doctors may want to take care of persistent precancerous cells, though, and they do that by performing a conization, or a biopsy of a cone-shaped portion of the front of the cervix. Another method of conization is called the loop electrosurgical excision procedure, which uses an electrified wire to remove a portion of the front of the cervix. Both are painless thanks to local anesthesia.

Despite the fact that no incisions are made, aside from the biopsied site, both procedures are still considered invasive. A decade ago, they were performed more frequently than they are now. Doctors have since discovered that the body of a female with a healthy immune system will often rid itself of the virus.

“We were doing invasive procedures on lesions that were going to take care of themselves and potentially causing problems with childbearing,” Moylan said.

Women who have had their cervix biopsied are at a higher risk for complications during birth such as premature cervix dilation.

It’s rare today, but occasionally, cervical cancer isn’t found until it’s developed past the point of a biopsy.

“It’s really unusual in the U.S. to have advanced cervical cancer without some precipitating thing, like not going to a doctor for 20 years and smoking three packs a day,” Moylan said.

She said smoking is a cofactor for the development of cervical cancer. “There are toxins in smoke, so you’re compounding things. Plus carbon monoxide displaces oxygen, so things aren’t working the way they’re supposed to.”

For patients who have developed cervical cancer, treatment by surgery, chemotherapy or radiation is usually performed by a gynecological oncologist.

“The definitive treatment of cervical cancer is a hysterectomy,” Moylan said. “And it’s a disease that often occurs in younger women, so we don’t want to get to that point.”

A hysterectomy is the surgical removal of some or all of a female’s reproductive organs, so she can’t have children.

Stay vigilant

According to the latest data from the Delaware Department of Public Health, cervical cancer rates have been falling steadily since 1988, with a slight uptick around 2005.

Moylan said there are a few things women can do every day to prevent cervical cancer.

“Maintain a healthy lifestyle so that your immune system stays intact. HPV, like shingles, is oftentimes associated with times of a stressed or suppressed immune system,” she said. “Don’t smoke … use condoms … and if you’re young enough, get vaccinated.”