By Matthias Muenzer, M.D.
Medford & Melrose OB/GYN
Advances in detection and treatment are helping us win the fight against cervical cancer.
One of the reasons I decided to become an OB/GYN is because I like making complicated things simple. That’s important when treating complex conditions such as cervical cancer. It’s important for women to understand where we started regarding treatment and prevention, where we are, and how they can protect themselves from cervical cancer.
We’ve learned a great deal about cervical cancer since the ancient Greek physician Hippocrates first wrote about it in the fourth century B.C., when he described it as incurable.
Regular gynecological exams and the Pap test have cut the risk of death from cervical cancer in the United States by nearly 70 percent since the 1950s. And with the recent addition of the vaccine to protect against infection with human papillomavirus (HPV), I believe we can look forward to even fewer cases of — and deaths from — cervical cancer in this country.
How a lab test and nuns affected cervical cancer prevention
For much of human history, doctors didn’t know a lot about cervical cancer. In fact, doctors only used to see cervical cancer in women after it had already spread too far to be treated with surgery or medications. In the 1920s, scientists in Europe started calling for women to have regular examinations, with the idea that doctors could find the disease earlier if they were looking for it regularly. And it worked!
In 1928, Greek doctor George Papanicolaou discovered that smears of vaginal cells could detect cervical cancer. This was the beginning of today’s modern Pap test (or Pap smear). Doctors in the United States first started using Pap tests in the 1940s. Though the process has been refined over the years, the Pap test is still the main test we use to find cervical cancer.
In 1713, an Italian doctor named Bernardino Ramazzini noticed that cervical cancer was nearly nonexistent in nuns. He wondered if this was related to their vows of celibacy. His observations paved the way for future research on cervical cancer. For more than 100 years, doctors suspected there was a link between sex and the development of cervical cancer. The development and use of the Pap test helped doctors gather more data to support that theory before proving it in the 1960s.
That research led to the thought that a virus spread by sexual contact could cause cervical cancer. German scientist Harald zur Hausen isolated specific strains of HPV as the cause of cervical cancer — an achievement for which he won the Nobel Prize in Physiology or Medicine in 2008. This discovery led to the development of today’s vaccines for HPV.
How we prevent cervical cancer today
All of this research, conducted over nearly a century, has led us to where we are today in cervical cancer care. And where we are is pretty good, which is good news I pass on to my patients.
Unfortunately, there is a stigma associated with sexually transmitted diseases (STDs). Patients with HPV often come to me upset, saying things like, “I have an STD, and it’s horrible,” or “I slept with a sleazebag, and I’m marked for life. Maybe I can’t get pregnant. I’ll have to tell all my future partners about this.”
I want to remove this stigma from HPV! It’s an almost universally contracted virus. Nearly all sexually active people get HPV at some point in their lives. Over 90 percent of women will get it, including women who have only one sexual partner in their lifetime.
HPV doesn’t fit the mold of most STDs. It’s more like a common cold. In most cases, your body recognizes it and kills it, which eliminates the problem. Very few people go on to have negative consequences from an HPV infection.
But when someone does have negative consequences from HPV, we have the tools and technology to treat it. HPV is a slow-acting virus. It takes at least five years from the first HPV infection to the earliest stage of cancer, and the average development time is more like 10 to 14 years. That gives us time to find anything that goes wrong during our regular annual gynecological exams.
I have seen just one case of cervical cancer in my office since 2008. The patient was a woman from Africa, a country with very different standards for testing. Women in the United States who follow the guidelines for testing will not get cervical cancer. The Centers for Disease Control and Prevention’s Cervical Cancer Screening Guidelines chart compares guidelines from the American Cancer Society, the U.S. Preventive Services Task Force, and the American College of Obstetricians and Gynecologists.
Here’s what I tell my patients:
- If you’re between the ages of 21 and 70, you should have a gynecological visit every year. This visit should include a breast exam and a pelvic exam.
- The Pap test is not the same thing as your annual gynecological exam.
- You should have a Pap test every three years.
Are women at risk? Yes. But if you follow the guidelines, you will be safe. There is no realistic chance you will get cervical cancer if you follow the guidelines because we will catch any changes before it becomes cancer.
More good news: Vaccines for HPV are getting better. Vaccines used to protect against the four most aggressive strains of HPV, and that prevented about 70 percent of cervical cancers. Now we have vaccines that protect against nine types of the virus, and those prevent about 90 percent of cervical cancers.
Even if we do need to address some precancerous cells in the cervix — which is not the same thing as cervical cancer — the procedure to fix it is very simple. In fact, it’s so simple that we almost can’t even call it surgery. It’s a 10-second procedure in which we shave off the surface that has the precancerous cells and remove them before they can develop into cervical cancer.
The future of cervical cancer care and prevention
Right now, the care we provide to patients with HPV and cervical cancer is the best it’s ever been. We can eliminate most kinds of HPV before they have a chance to infect you in the first place. If you do get HPV, and you follow the guidelines for regular gynecological visits, we can make sure you don’t have to deal with cervical cancer.
And our care is only going to get better. We learn more about cervical cancer and HPV all the time. New developments are happening in research facilities all over the world.
We’ll continue to give HPV vaccines to young women and men to eliminate HPV before it ever starts. Right now, we can eliminate about 90 percent of the different types of HPV with vaccines. We’ll likely add more strains to these vaccines until we can eliminate 100 percent of them. At some point, we may not even need to do exams for cervical cancer anymore, because everyone will be vaccinated against it.
We still have some ways to go in the detection and treatment of cervical cancer. But we are winning.
If you need to schedule your regular OB/GYN visit, make an appointment online or call 855-446-2362.
Tags: cancer, cancer prevention, family health, malden, Medford, OB/GYN, women's health