By ALLAN BORUSZAK, MD.

For the Daily News

 

Each year in the United States, cervical cancer is diagnosed in more than 12,000 women, and nearly 4,000 die from the disease.  The vast majority of cervical cancers are caused by the HPV (Human Papilloma Virus).  Most of these can be prevented with pap smear and HPV screening.  The newer generation also has the benefit of the HPV vaccine.  With proper use of these modalities, we should be able to minimize the occurrence of cervical cancer.

In years past, Pap Smear screening was done at every well woman annual exam. This is no longer necessary.  Current guidelines are testing every three years for women ages 21-65; routine cervical cancer screening for women under 21 and over 65 is no longer recommended. There is also the option of a lengthened, five-year screening interval for women ages 30-65 when screened with a combination of Pap testing and human papillomavirus (HPV) testing.  Yearly gynecologic exams are still necessary despite the changes in pap smear guidelines, as there is still a risk of cancer of the breast, ovaries and other female organs.  Even if the woman has had a hysterectomy, there are still indications to have a pap smear.  This should be discussed with your physician.

HPV virus is a sexually transmitted disease (STD) that is very common.  There are no symptoms unless the person develops warts or abnormal pap smears. The virus can be present for many years before causing a problem.  Recent development of the bivalent and quadrivalent HPV vaccines will go a long way to minimize cervical cancer.  The Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention recommends that HPV vaccination routinely be targeted to females and males aged 11 years or 12 years as part of the adolescent immunization platform to help reduce the incidence of genital cancers and genital warts associated with HPV infection. The quadrivalent HPV vaccine is approved for use in males and females, whereas the bivalent HPV vaccine is approved for use only in females. For those not vaccinated at the target age, catch-up vaccination is recommended up to age 26 years.  Best results occur if the person has not been sexually active, but those who have had sexual encounters should still be vaccinated.

There are a variety of results that can be given on a pap smear.  The one we hope for is normal, but an abnormal result should not be cause for panic. Most of the abnormal results are due to inflammatory changes and/or are very early abnormalities that could clear up on their own.  It takes many years to develop cervical cancer, and with proper follow up we can catch these long before they become dangerous. The three most abnormal results are low-grade lesions (LGSIL), atypical squamous cells (ASCUS) and high grade lesions (HGSIL).  ASCUS is only of concern if the HPV test is positive. If these occur on your pap smear your physician will perform a procedure known as a colposcopy.  This is an examination of the cervix with a magnifying glass.  You may need to have a biopsy if an abnormality is seen.

There are many treatments for HPV infections and pap smear abnormalities that do not require major surgery.  We offer many in office treatments for early and mid stage lesions. These will be discussed with your physician.

In future years the patients we should see with cervical cancer, are those who do not have proper pap smear screening, and those who have had abnormal pap smears and do not follow up on a regular basis.

Allan Boruszak, MD. FACOG is obstetrician and gynecologist at Vidant Women’s Care located at 1210 Brown Street in Washington and can be reached by calling 975-1188.