More than 13,000 US women are diagnosed with cervical cancer each year. In most cases, cervical cancer can be prevented through vaccination and proper cervical screening.

Despite screening programs, 4,000 US women die from HPV-related cervical cancer each year.

What is the point of a pap smear?

A pap (Papanicolaou) smear is a screening test for cervical cancer. The cervix is the opening of the uterus located at the back of the vagina. During a pap smear, doctors place a device called a speculum into the vagina.

The speculum opens the walls of the vagina allowing visualization of the cervix. Cervical cells are then collected using a small brush. These cells are sent to a lab for analysis.

The cells are processed under a microscope to evaluate for precancerous changes called cervical dysplasia. The goal of pap screening is to detect abnormal cervical changes so we can intervene long before cervical cancer develops.

Do I need an HPV test with my pap?

In addition to analyzing the cervical cells, doctors often perform an HPV test. HPV testing recommendations vary depending on your age. HPV testing is recommended for standard screening in women over 30.

HPV testing is also triggered when an abnormal pap smear is found in women under 30. Cervical dysplasia (precancerous cells of the cervix) are linked to the Human papillomavirus (HPV).

Statistically, 80% of Americans will contract HPV, making it the most common sexually transmitted infection. This means more of us will contract this STI than those who do not. HPV “co-testing” during pap smear helps guide the management steps when an abnormality occurs.

Around 40 of the known 130 known strains of HPV affect the genital tract. In men and women, HPV causes genital warts, and persistent strains can lead to cervical, penile, vaginal, anal, mouth, throat, and neck cancer. Approximately 20,000 women and 12,000 men develop cancer caused by HPV every year in the United States.

Who is at risk for HPV?

Anyone sexually active is at risk. The virus may stay dormant for years. Symptoms may not appear until long after you have sex with someone previously infected. It is rarely possible to know when you first became infected. You can not play the blame game with HPV.

Sexually transmitted HPV types fall into two groups, low risk and high risk.

• Low-risk HPVs mostly cause no disease. However, a few low-risk HPV types can cause warts on or around the genitals, anus, mouth, or throat.
• High-risk HPVs can cause several types of cancer. There are about 14 high-risk HPV types. Two of these, HPV16 and HPV18, are responsible for most HPV-related cancers.

Long-lasting infections with high-risk HPVs can cause cancer in parts of the body where HPV infects cells, such as in the cervix, mouth, throat, anus, rectum, penis, vagina, and vulva. 

The HPV vaccine and keeping your pap smears up to date are our best tools to impact cervical disease and HPV.

There is no cure or medication for HPV. The most effective way to protect yourself from HPV infection is to get vaccinated. The HPV vaccine is FDA approved for men and women age 9–45. The Center for Disease Control recommends that the vaccine be given as early as 11 or 12.

HPV vaccination is recommended by the Centers for Disease Control and Prevention (CDC)’s Advisory Committee on Immunizations Practices (ACIP) to prevent new HPV infections and HPV-associated diseases, including some cancers.

The vaccine is most effective when given before initiating sexual activity. It is still useful for those already sexually active as very few have already been exposed to the nine strains of HPV covered in the vaccine.

The most recent recommendations extended the age from 26 to 45, but insurance coverage for those in this age group is lagging.

Pap smears allow for early detection of disease

When a pap smear comes back abnormal, there is no reason to hit the panic button. The next step is a microscope exam called a colposcopy procedure. A colposcopy is an office procedure that allows your doctor to visualize the cervix more closely using a microscope. The colposcope identifies abnormal cervical tissue that cannot be seen with the naked eye.

This office procedure helps determine where on the cervix the abnormal cells are coming from and how severe the abnormality is.

If an area of the cervix appears concerning or precancerous, the doctor can sample the area with a biopsy during the exam.

If the biopsy shows a precancerous lesion, your healthcare provider may recommend a LEEP (loop electrosurgical excision procedure.)

A few minutes of discomfort can save your life

Pap smears save lives. Period. No one likes to get this test, but the benefits of early detection and prevention outweigh the risks of avoiding it.

If it is time for you to update you pap smear, it is well worth your time to do it. A pap smear could save your life.

The post Pap smears Aren’t Fun But Can Save Your Life by Preventing Cervical Cancer appeared first on Medika Life.

Cervical cancer is a disease in which malignant (cancer) cells form in the cervix. The cervix is the lower, narrow end of the uterus (the hollow, pear-shaped organ where a fetus grows). The cervix connects the uterus to the vagina (birth canal). Cervical cancer usually develops slowly over time. Before cancer appears in the cervix, the cells of the cervix go through a series of changes in which cells that are not normal begin to appear in the cervical tissue.

When cells change from being normal cells to abnormal cells, it is called dysplasia. The abnormal cervical cells may go away without treatment, stay the same, or turn into cancer cells over many years.

The Importance of Cervical Cancer Screening

What is cervical cancer screening?

Cervical cancer screening is an essential part of a woman’s routine health care. Nearly all cases of cervical cancer are caused by infection with sexually transmitted oncogenic, or high-risk, types of human papillomavirus, or HPV. The primary goal of screening is to identify precancerous lesions caused by HPV so they can be removed to prevent invasive cancers from developing.

A secondary goal is to find cervical cancers at an early stage when they can usually be treated successfully. Routine cervical screening has been shown to greatly reduce both the number of cervical cancer cases and deaths from the disease.

For many years, cytology-based screening, known as the Pap test or Pap smear, was the only method of screening. Its use reduced cervical cancer incidence and deaths in countries where screening is common.

However, with the advent of the ability to test for HPV, cervical cancer screening now includes three approaches: HPV testing, which looks for the presence of high-risk HPV types in cervical cells; Pap testing; and HPV/Pap cotesting, which checks the same cell sample for both high-risk HPV types and cervical cell changes.

How is cervical cancer screening done?

Cervical cancer screening can be done in a medical office, a clinic, or a community health center. It is often done during a pelvic examination.

While a woman lies on an exam table, a health care professional inserts an instrument called a speculum into her vagina to widen it so that the upper portion of the vagina and the cervix can be seen. This procedure also allows the health care professional to take a sample of cervical cells. The cells are taken with a wooden or plastic scraper and/or a cervical brush and placed in a vial of liquid preservative.

The slide or vial is then sent to a laboratory where the cells are tested for the presence of high-risk types of HPV and/or examined under a microscope with an automated liquid-based Pap cytology test. When both tests are done using the same sample, this is referred to as “cotesting.” 

Researchers have found that screening may be less effective for obese women, possibly because of challenges in visualizing the cervix and obtaining a cell sample. Approaches to improve cervical visualization in obese women, including the use of larger speculum, may be helpful.

When should a woman begin cervical cancer screening, and how often should she be screened?

Women should talk with their doctor about when to start screening and how often to be screened. In August 2018, updated screening guidelines were released by the United States Preventive Services Task Force. The updated guidelines are as follows:

• Women ages 21 through 29 should be screened with a Pap test every 3 years
• Women ages 30 through 65 should be screened with any of three tests:
  • every 5 years with high-risk HPV testing alone
  • every 5 years with Pap and high-risk HPV cotesting
  • every 3 years with a Pap test alone
• Women with certain risk factors may need to have more frequent screening or to continue screening beyond age 65. These risk factors include:
  • being infected with the human immunodeficiency virus (HIV)
  • being immunosuppressed
  • having been exposed to diethylstilbestrol before birth
  • having been treated for a precancerous cervical lesion or cervical cancer
• Screening for cervical cancer is not recommended for:
  • women younger than 21 years
  • women older than 65 years who have had adequate prior screening, with normal results, and who are not otherwise at high risk for cervical cancer
  • women who have had a total hysterectomy (surgery to remove the uterus and cervix) and have no history of high-grade cervical lesions or cervical cancer

A joint statement released by the American College of Obstetricians and Gynecologists, American Society for Colposcopy and Cervical Pathology, and the Society of Gynecologic Oncology noted that the updated guidelines are largely in line with their clinical guidance, with some differences in the details.

The screening intervals in the 2018 guidelines reflect scientists’ evolving understanding of the natural history of HPV infection and cervical cancer. Although HPV infection of the cervix is very common, most infections will be controlled by the immune system over the course of 1 to 2 years. Because most HPV infections are transient and produce only temporary changes in cervical cells, overly frequent screening could detect HPV infections or cell changes that would never cause cancer.

Treating abnormalities that would have gone away on their own can cause needless psychological stress. Follow-up tests and treatments can also be uncomfortable, and the removal of cervical tissue has the potential to weaken the cervix and may affect fertility or slightly increase the rate of premature delivery, depending on how much tissue is removed.

These screening intervals also limit false-negative results that would delay the diagnosis and treatment of a precancerous condition or cancer. With these intervals, if an HPV infection or cell changes are missed at one screening exam, chances are good that those changes will be detected at the next one, when they can still be treated successfully.

The success of cervical cancer screening is due, in part, to the repeat testing that women typically undergo over many years. A study of a large population of women receiving routine screening showed that women with a history of negative HPV/Pap cotest results have a very low risk of developing precancer or cancer even if a subsequent screening test reveals a new HPV infection or abnormal cervical cells.

How do the three testing options compare?

For women age 30 or older, both HPV/Pap cotesting and HPV testing alone are more sensitive than Pap testing alone. Therefore, a woman with a negative HPV test and normal Pap test—or just a negative HPV test—has a very low risk of developing precancerous cervical lesions over the next several years.

It is for that reason that, when Pap and HPV cotesting or HPV testing alone are used, the  recommended screening interval is 5 years: this longer interval (compared with 3 years for women receiving Pap testing alone) still allows abnormalities to be detected in time to treat them while  reducing the detection of HPV infections that would be successfully controlled by the immune system.

Both Pap and HPV cotesting and HPV testing alone may also improve the detection of glandular cell abnormalities, including adenocarcinoma of the cervix (cancer of the glandular cells of the cervix). Glandular cells are mucus-producing cells found in the endocervical canal (the opening in the center of the cervix) or in the lining of the uterus. Glandular cell abnormalities and adenocarcinoma of the cervix are less common than squamous cell abnormalities and squamous cell carcinoma. Pap testing is not as good at detecting adenocarcinoma and glandular cell abnormalities as it is at detecting squamous cell abnormalities and cancers.

What do the results of cervical cancer screening tests mean?

A health care provider may simply describe Pap test results to a patient as “normal” or “abnormal.”

Likewise, HPV test results can either be “positive,” meaning that a patient’s cervical cells are infected with one or more of a group of high-risk HPV types (which is what most commercially available HPV tests detect), or “negative,” indicating that none of the high-risk HPV types were found. Several HPV tests are specific for HPV16 and HPV18—the types that cause most cervical cancers.

A woman may want to ask her provider for specific information about her Pap and HPV test results and what these results mean.

Most laboratories in the United States use a standard set of terms, called the Bethesda System, to report Pap test results. Under the Bethesda System, samples that have no cell abnormalities are reported as “negative for intraepithelial lesion or malignancy.” A negative Pap test report may also note certain benign findings, such as common infections or inflammation. Pap test results also indicate whether the specimen was satisfactory or unsatisfactory for examination. Guidelines committees are re-evaluating how results of cervical screening tests are reported, based on the most up-to-date research on the natural history of HPV infections.

The Bethesda System considers abnormalities of squamous cells and glandular cells separately. Squamous cell abnormalities are divided into the following categories, ranging from the mildest to the most severe.

• Atypical squamous cells (ASC) are the most common abnormal finding in Pap tests. The Bethesda System divides this category into two groups, ASC-US and ASC-H:
  • ASC-US: atypical squamous cells of undetermined significance. The cells do not appear completely normal, but the cause is unclear. The changes may be related to an HPV infection, but they can also be caused by other factors.
  • ASC-H: atypical squamous cells, cannot exclude a high-grade squamous intraepithelial lesion. ASC-H lesions may be at higher risk of being precancerous than ASC-US lesions.
• Low-grade squamous intraepithelial lesions (LSILs) are considered mild abnormalities caused by HPV infection. LSILs often return to normal as the immune system controls the infection, especially in younger women.
• High-grade squamous intraepithelial lesions (HSILs) are more severe abnormalities that have a higher likelihood of progressing to cancer if left untreated. 
• Carcinoma in situ (CIS) refers to severely abnormal cells that resemble cancer cells but remain on the surface of the cervix and have not invaded more deeply or spread beyond the cervix. 
• Squamous cell carcinoma is cervical cancer. The abnormal squamous cells have invaded more deeply into the cervix or into other tissues or organs. In a well-screened population, such as that in the United States, a finding of cancer during cervical screening is extremely rare.

Glandular cell abnormalities describe abnormal changes that occur in the glandular tissues of the cervix. The Bethesda system divides these abnormalities into the following categories:

• Atypical glandular cells (AGC), meaning the glandular cells do not appear normal, but doctors are uncertain about what the cell changes mean.
• Endocervical adenocarcinoma in situ (AIS), meaning that severely abnormal cells are found but have not spread beyond the glandular tissue of the cervix.
• Adenocarcinoma includes not only cancer of the endocervical canal itself but also, in some cases, endometrial, extrauterine, and other cancers.

What follow-up tests are done if cervical cancer screening results are abnormal?

Depending on the test results, a woman may be recommended to have repeat screening in a year because some abnormalities, especially more minor ones (ASC-US), will go away on their own as the immune system controls the HPV infection. If a woman has more severe cell changes (ASC-H or HSIL) and/or evidence of HPV16 or HPV18, she may be recommended to have a colposcopy, a procedure that involves the use of an instrument  (called a colposcope) to examine the cervix.

During a colposcopy, the provider inserts a speculum into the vagina to widen it and may apply a dilute vinegar solution to the cervix, which causes areas of HPV infection, inflammation, precancer, or other cell changes to turn white. The provider then uses the colposcope (which remains outside the body) to examine the cervix. When a provider performs colposcopy, he or she will usually remove cells or tissues from one or more concerning areas for examination under a microscope, a procedure called a biopsy.

Can an HPV infection come back after a negative test? 

Yes. Sometimes, after many years of negative HPV tests, an infection that the immune system had previously controlled can become active again, resulting in an HPV-positive test result. Such reactivation of an old, previously undetectable HPV infection can happen due to age-related changes in the immune system.

There is no way to tell whether a newly positive HPV result is a sign of a new infection or represents a reactivation of an old infection. It is also not yet known whether reactivated HPV infections can cause cell changes that lead to precancer and cancer.

Do women who have been vaccinated against HPV still need to be screened for cervical cancer?

Yes. Current HPV vaccines do not protect against all HPV types that cause cervical cancer, so it is important for vaccinated women to continue to undergo routine cervical cancer screening. 

Cervical Cancer Prevention

Key Points

• Avoiding risk factors and increasing protective factors may help prevent cancer.
• The following are risk factors for cervical cancer:
  • HPV infection
  • DES
• In women who are infected with HPV, other risk factors add to the increased risk of cervical cancer:
  • Giving birth to many children
  • Using oral contraceptives for a long time
  • Smoking cigarettes
• The following increase the risk of HPV infection:
  • Having a weakened immune system
  • Being sexually active at a young age or having many sexual partners
• The following protective factors decrease the risk of cervical cancer:
  • Avoiding sexual activity
  • Getting an HPV vaccine
  • Using barrier protection during sexual activity
• Cancer prevention clinical trials are used to study ways to prevent cancer.
• New ways to prevent cervical cancer are being studied in clinical trials.

Avoiding risk factors and increasing protective factors may help prevent cancer.

Avoiding cancer risk factors may help prevent certain cancers. Risk factors include smoking, being overweight, and not getting enough exercise. Increasing protective factors such as quitting smoking and exercising may also help prevent some cancers. Talk to your doctor or other health care professional about how you might lower your risk of cancer.

The following are risk factors for cervical cancer:

HPV infection

Cervical cancer is almost always caused by human papillomavirus (HPV) infection that is spread through sexual contact. There are more than 80 types of human papillomavirus and about 30 of these can infect the cervix. HPV types 16 and 18 are most often linked to cervical cancer.

Most of the time, the body’s immune system can fight the HPV infection before cancer forms. Only a very small number of women infected with HPV develop cervical cancer.

DES

Being exposed to a drug called diethylstilbestrol (DES) while in the mother’s womb increases the risk of cervical dysplasia and clear cell adenocarcinoma of the vagina and cervix. Between 1940 and 1971, DES was given to some pregnant women in the United States to prevent miscarriage (premature birth of a fetus that cannot survive) and premature labor.

In women who are infected with HPV, other risk factors add to the increased risk of cervical cancer:

Giving birth to many children

Among women who are infected with HPV, those who have had 7 or more full-term pregnancies have an increased risk of cervical cancer.

Using oral contraceptives for a long time

Among women who are infected with HPV, those who have used oral contraceptives (“the Pill”) for 5 to 9 years have a risk of cervical cancer that is 3 times greater than that of women who have never used oral contraceptives. The risk is 4 times greater after 10 or more years of use. In women who stop taking oral contraceptives, over a 10 year period, the risk of cervical cancer returns to that of women who never used oral contraceptives.

Smoking cigarettes

Among women who are infected with HPV, those who either smoke cigarettes or breathe in secondhand smoke have an increased risk of cervical cancer. The risk increases with the number of cigarettes smoked per day and how long the woman has smoked. Current and former smokers have 2 to 3 times the risk of cervical dysplasia and invasive cervical cancer.

The following increase the risk of HPV infection:

Having a weakened immune system

Having a weakened immune system caused by immunosuppression increases the risk of HPV infection and cervical cancer. Immunosuppression weakens the body’s ability to fight infection and other diseases.

Immunosuppression can be caused by these and other conditions:

• Human immunodeficiency virus (HIV). This virus causes AIDS and weakens the body’s immune system.
• Medicine given to prevent organ rejection after transplant. Women who have an organ transplant are given medicine to weaken the body’s immune system and help prevent organ rejection.

Women who are infected with the HIV virus or who take medicine to prevent organ rejection after transplant are less able to fight HPV infection and are at increased risk of cervical cancer.

Being sexually active at a young age or having many sexual partners

The risk of HPV infection is higher in women who become sexually active before age 18 and in women who have had 6 or more sexual partners.

The following protective factors decrease the risk of cervical cancer:

Note: Screening with the Pap test and the HPV DNA test reduces the number of new cases of cervical cancer.

Avoiding sexual activity

Nearly all cases of cervical cancer are caused by HPV infection, which is spread through sexual activity. Women who are not sexually active have almost no risk of cervical cancer.

Getting an HPV vaccine

Vaccines that protect against HPV infection greatly reduce the risk of cervical cancer. These vaccines do not protect women who are already infected with HPV.

Several HPV vaccines have been approved by the U.S. Food and Drug Administration (FDA). These vaccines have been shown to prevent infection with the types of HPV that cause most cervical cancers. Protection against HPV infection lasts for 6 to 8 years. It is not known if the protection lasts longer.

Harms of HPV vaccines include dizziness, feeling faint, headache, fever, and redness, tenderness, or warmth at the place of injection. Allergic reactions are rare. Getting the HPV vaccine while pregnant does not have a harmful effect on the pregnancy.

Using barrier protection during sexual activity

Some methods used to prevent sexually transmitted diseases (STDs) decrease the risk of HPV infection. The use of a barrier method of birth control, such as a condom or diaphragm, helps protect against HPV infection.

Drugs approved for Cervical Cancer

Drugs Approved to Prevent Cervical Cancer

• Cervarix (Recombinant HPV Bivalent Vaccine)
• Gardasil (Recombinant HPV Quadrivalent Vaccine)
• Gardasil 9 (Recombinant HPV Nonavalent Vaccine)
• Recombinant Human Papillomavirus (HPV) Bivalent Vaccine
• Recombinant Human Papillomavirus (HPV) Nonavalent Vaccine
• Recombinant Human Papillomavirus (HPV) Quadrivalent Vaccine

Drugs Approved to Treat Cervical Cancer

• Avastin (Bevacizumab)
• Bevacizumab
• Bleomycin Sulfate
• Hycamtin (Topotecan Hydrochloride)
• Keytruda (Pembrolizumab)
• Mvasi (Bevacizumab)
• Pembrolizumab
• Topotecan Hydrochloride

Drug Combinations Used in Cervical Cancer

• Gemcitabine-Cisplatin

The post Cervical Cancer appeared first on Medika Life.

HPV is a group of more than 200 related viruses, some of which are spread through vaginal, anal, or oral sex.

Sexually transmitted HPV types fall into two groups, low risk and high risk.

• Low-risk HPVs mostly cause no disease. However, a few low-risk HPV types can cause warts on or around the genitals, anus, mouth, or throat.
• High-risk HPVs can cause several types of cancer. There are about 14 high-risk HPV types. Two of these, HPV16 and HPV18, are responsible for most HPV-related cancers.

HPV infection is common: Nearly all sexually active people are infected with HPV almost immediately once they become sexually active. Around half of these infections are with a high-risk HPV type.

Most HPV infections don’t cause cancer: Your immune system usually controls HPV infections so they don’t cause cancer.

High-risk HPV infections that persist can cause cancer: Sometimes HPV infections are not successfully controlled by your immune system. When a high-risk HPV infection persists for many years, it can lead to cell changes that, if untreated, may get worse over time and become cancer.

HPV vaccination can prevent cancer: HPV vaccines can prevent infection with disease-causing HPV types, preventing many HPV-related cancers and cases of genital warts.

Cancers Caused by HPV Infection

Long-lasting infections with high-risk HPVs can cause cancer in parts of the body where HPV infects cells, such as in the cervix, oropharynx (the part of the throat at the back of the mouth, including the soft palate, the base of the tongue, and the tonsils), anus, rectum, penis, vagina, and vulva. 

HPV infects the squamous cells that line the inner surfaces of these organs. For this reason, most HPV-related cancers are a type of cancer called squamous cell carcinoma. Some cervical cancers come from HPV infection of gland cells in the cervix and are called adenocarcinomas.

HPV-related cancers include:

• Cervical cancer: Virtually all cervical cancers are caused by HPV. Routine screening can prevent most cervical cancers by allowing health care providers to find and remove precancerous cells before they develop into cancer. As a result, cervical cancer incidence rates in the United States are decreasing.
• Oropharyngeal cancers: Most oropharyngeal cancers (70%) in the United States are caused by HPV. The number of new cases is increasing each year, and oropharyngeal cancers are now the most common HPV-related cancer in the United States.
• Anal cancer: Over 90% of anal cancers are caused by HPV. The number of new cases and deaths from anal cancer are increasing each year.
• Penile cancer: Most penile cancers (over 60%) are caused by HPV.
• Vaginal cancer: Most vaginal cancers (75%) are caused by HPV.
• Vulvar cancer: Most vulvar cancers (70%) are caused by HPV.

In the United States, high-risk HPVs cause 3% of all cancers in women and 2% of all cancers in men. There are about 44,000 new cases of cancer in parts of the body where HPV is often found, and HPV is estimated to cause about 34,000 cancers each year, according to the latest statistics from the Centers for Disease Control.

Worldwide, the burden of HPV-related cancers is much greater. High-risk HPVs cause about 5% of all cancers worldwide, with an estimated 570,000 women and an estimated 60,000 men getting an HPV-related cancer each year. Cervical cancer is among the most common cancers and a leading cause of cancer-related deaths in low- and middle-income countries, where screening tests and treatment of early cervical cell changes are not readily available.

How is HPV Transmitted?

HPV is transmitted through vaginal intercourse, anal and oral sex, and other intimate, skin-to-skin contact. The infection passes easily between sexual partners. Condoms and dental dams can reduce the likelihood of HPV transmission but do not completely prevent it.

Does HPV Infection Cause Symptoms?

No, infection with high-risk HPV does not cause symptoms. The precancerous cell changes caused by a persistent HPV infection at the cervix also do not cause symptoms. However, precancerous lesions at other sites in the body may cause symptoms. And if an HPV infection develops into cancer, the cancer may cause symptoms.

HPV Vaccination: Preventing HPV Infection

The HPV vaccine Gardasil 9® protects against infection with nine HPV types: the two low-risk HPV types that cause most genital warts, plus the seven high-risk HPV types that cause most HPV-related cancers.

HPV vaccination is recommended by the Centers for Disease Control and Prevention (CDC)’s Advisory Committee on Immunizations Practices (ACIP) to prevent new HPV infections and HPV-associated diseases, including some cancers.

HPV vaccination provides strong protection against new HPV infections, but the vaccine does not cure, and is not used to treat, HPV infections or diseases caused by HPV. HPV vaccination offers the most protection when given before someone is exposed to the virus. 

Who should get the HPV vaccine?

The HPV vaccine series is recommended for girls and boys at the age of 11 or 12; the series can be started at age 9. Children who start the series before age 15 need two doses to be protected. For young people who didn’t get vaccinated on time, HPV vaccination is recommended up to age 45; those who receive their first dose at age 15 or older need three doses to be protected. A fair warning, many insurance companies only cover it up to age 26 reflecting the older guidelines.

Can the HPV vaccine be given at older ages?

Yes, the vaccine can be given to adults between the ages of 27 and 45 who didn’t receive all vaccine doses earlier. In fact, it is now recommended. Adults in this age group benefit less from the vaccine because they are more likely to have been exposed to HPV already. But if you are concerned that you are at risk for new HPV infections, you should talk with your health care provider about whether the vaccine may be right for you. 

Screening for HPV and Cell Changes Caused by HPV

Screening tests are tests used to check for disease when there are no symptoms. The goal of screening for cervical cancer is to find precancerous cell changes at an early stage, even before they become cancer and when treatment can work to prevent cancer from ever happening. Currently, cervical cancer is the only HPV-caused cancer for which FDA-approved screening tests are available.

Screening for Cervical Cancer

Cervical cancer screening tests:

• the HPV test checks cervical cells for high-risk HPV
• the Pap test checks for cervical cell changes that can be caused by high-risk HPV
• the HPV/Pap cotest checks for both high-risk HPV and cervical cell changes

These screening ages and intervals apply to most women:

• Age 21-29 years: Pap testing every 3 years.
• Age 30-65 years: Screening using one of these tests:
  • HPV testing every 5 years
  • HPV/Pap cotesting every 5 years
  • Pap testing every 3 years 
• Older than 65 years: If you have been screened at regular intervals and your test results for the last decade have been normal, you may be advised that you no longer need to be screened for cervical cancer. Screening should continue past age 65 for women with recent abnormal Pap or HPV tests.

Depending on the test results and her age, a woman may have another test after 12 months, or she may have an exam called a colposcopy to allow her provider to examine the cervix and, if needed, remove a sample of tissue for analysis (a procedure called a biopsy).

What Does It Mean If a Woman Has a Positive HPV Test after Many Years of Negative Tests?

Sometimes, after a several negative HPV tests, a woman may have a positive HPV test result. This is not necessarily a sign of a new HPV infection, and it doesn’t mean that she or her partner has a new sexual partner. Sometimes an HPV infection can become active again after many years. Other viruses behave this way as well, for example the chickenpox virus can reactivate later in life to cause shingles.

There is no way to tell whether a newly positive HPV test result is a sign of a new infection or a reactivation of an old infection. Researchers don’t know whether a reactivated HPV infection has the same risk of causing precancer or cancer as a new HPV infection.

Screening for Other HPV-Related Cancers

There are no FDA-approved tests to detect HPV infections or HPV-caused cell changes in anal, rectal, vulvar, vaginal, penile, or oropharyngeal tissues. However, there is some evidence that, among populations that are at higher risk for HPV infection, such as men who have sex with men or men who are HIV-positive, anal Pap tests may help to detect early cell changes or precancerous cells. In anal Pap tests, a sample of anal cells is checked for abnormal cells.

Treatment for Cell Changes Caused by HPV Infection

Although HPV infection itself cannot be treated, there are treatments for the precancerous cell changes caused by infection with high-risk HPV.

• Precancerous cervical cell changes: Most women who have precancerous cervical cell changes are treated with the loop electrosurgical excision procedure (LEEP), which is a method to remove the abnormal tissue.
• Precancerous vaginal, vulvar, penile, and anal lesions; genital warts; and benign respiratory tract tumors: Treatment methods include topical medicines, surgical excision, cryosurgery, and LEEP.
• HPV-related cancers: Individuals who develop an HPV-related cancer generally receive the same treatment as patients with tumors at the same site that are not related to HPV infection. However, patients with HPV-positive oropharyngeal cancer may receive different treatments than patients whose oropharyngeal cancers are not caused by HPV. 

How Does HPV Cause Cancer?

Once high-risk HPV infects cells, it interferes with the ways in which these cells communicate with one another, causing infected cells to multiply in an uncontrolled manner. These infected cells are usually recognized and controlled by the immune system. However, sometimes the infected cells remain and continue to grow, eventually forming an area of precancerous cells that, if not treated, can become cancer. Research has found that it can take 10 to 20 years, or even longer, for HPV-infected cervical cells to develop into a cancerous tumor.

Among women whose cervical cells are infected with high-risk HPV, several factors increase the chance that the infection will be long lasting and lead to precancerous cervical cells:

• giving birth to many children
• using oral contraceptives for a long time
• smoking cigarettes

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What is a Loop Electrosurgical Excision Procedure?

LEEP stands for Loop Electrosurgical Excision Procedure. It’s a treatment to prevent cancer after precancerous cells are identified during cervical cancer screening. Precancerous cells are caused by HPV, the human papillomavirus.

80% of Americans will contract HPV, making it the most common sexually transmitted infection. HPV causes genital warts, and persistent strains lead to cervical, vaginal, anal, throat, and neck cancer. Despite screening programs, 4,000 US women die from HPV related cervical cancer annually. A LEEP procedure saves lives. 

80% of Americans will contract HPV, making it the most common sexually transmitted infection. Persistent HPV strains lead to cervical, vaginal, anal, throat, and neck cancer. Despite screening programs, 4,000 US women die from HPV related cervical cancer annually. A LEEP procedure saves lives.

A small wire loop is used to remove abnormal cells from your cervix. The thin wire loop is attached to an electrical current to cut away the top layer of cervical cells and remove the effects of HPV. 

HPV effects are detected during a routine paps smears, the first step in cervical cancer prevention. When someone has an abnormal pap smear, the next step is a diagnostic procedure called a colposcopy.

A colposcopy is an office procedure that allows your doctor to visualize the cervix more closely using a microscope. The colposcope identifies abnormal cervical tissue that cannot be seen with the naked eye. Areas of the cervix concerning for pre-cancer or cancer can then be biopsied (sampled) during the exam.

If the biopsy shows a precancerous lesion then, your healthcare provider may recommend a LEEP (loop electrosurgical excision procedure.)

Where is a LEEP Procedure performed?

A Loop electro excision procedure can be performed in a variety of settings. Most commonly, Obgyns perform this procedure in the office setting. 

The office, surgery center, or hospital are all reasonable and appropriate surgical settings.

Can my family visit me?

Most LEEP procedures are performed in a medical office setting. A trusted family member should drive you to and from the appointment. If the procedure is done in an hospital or Ambulatory Surgery Center, your family is welcome to stay with you before and after the procedure.

Does my procedure require an anesthetic?

Anesthesia is required for a LEEP procedure. The type of anesthesia will vary depending on the surgical setting, the surgeon’s experience, and the availability of office equipment. 

Oral sedation, paracervical block, IV sedation, and general anesthesia are all potential anesthetic options. 

In the office setting, anesthesia is provided via a paracervical anesthetic. A paracervical block is an anesthetic technique done by a gynecologist to numb the uterus. Medication is injected into the cervical tissue to reduce pain during surgery. For a LEEP procedure, a medication called epinephrine is mixed with the anesthetic to reduce the risk of intraoperative bleeding.

Some gynecologists also recommend oral medication to reduce anxiety.

What’s the procedure when I check in?

Most surgeries will involve a preoperative visit with your surgeon. The risks and benefits of the procedure will be discussed in detail and questions regarding your procedure are discussed. The surgical consent form is reviewed, signed, or updated with any changes.

In most settings, patients will receive a preoperative phone call by a nurse or medical assistant one to two days before surgery. If any blood work or preoperative testing is required, it will be scheduled and confirmed.

When a LEEP procedure is performed in an office setting, the experience will feel like a normal office visit. After checking in, you will be taken to a procedure room. The medical assistant will prepare the room and provide a gown or leg coverings. When all is prepared, your surgeon will come and review any last-minute questions.

If a LEEP is scheduled in a hospital or Ambulatory Surgery Center, the staff will guide you to the preoperative holding area to change into a surgical gown and store your valuables. If an IV is required, it will be placed at this time. You will meet the nursing team who will provide care during your stay. The anesthesia team will come to interview you and answer questions. Typically your surgeon will also come and review any last-minute questions.

What happens in the operating room??

For an office-based procedure, your surgeon will help position your legs into the stirrups. A speculum is placed into the vagina to allow visualization of the cervix, the opening of your uterus located at the back of the vagina. The cervix is cleaned to make the area sterile. 

A paracervical block anesthetic is then gently injected into the cervical tissue. The medication absorbs into the surrounding area to numb the nerves and make the procedure more comfortable. 

The surgeon selects the appropriate sized LEEP wire to match the size and appearance of your cervix. Because a low dose electrical current is used to do the cutting, a grounding pad is placed on the outside of your leg. The doctor will take extra precautions to ensure an adequate and safe view of the cervix. A grounding pad is placed on the outside of your leg.

Once all preoperative safety checks are confirmed, the surgeon will activate the electrical current to pass the wire across the top layer of the cervix. This action removes a small, pancake layer of cervical cells. This specimen is sent to a pathologist for analysis. 

The electrical current is then used to stop any bleeding through a process called cauterization. Often, a drying chemical called Monsel’s solution is painted onto the cervix to prevent bleeding later on. This chemical is messy and will cause a brown, coffee-ground vaginal discharge over the next few days. 

In the hospital setting, things function a little differently. 

After the preoperative evaluation, the team will guide you to the operating or procedure room. You will move from the mobile bed to the operating table. Once you are positioned comfortably and safely, the anesthesiologist will give you medication through your IV if the procedure is being done outside of the office setting. 

The OR nursing team will cover your body with sterile drapes and prep the vagina for surgical sterility. The team then performs a “surgical time-out.” A surgical safety checklist is read out loud requiring all surgical team members to be present and attentive.

The surgeon then performs the surgical procedure as described above.

Once the procedure is complete. A post-procedure review is done together as a surgical team. All instruments and equipment are counted and verified. Once complete, the anesthesiologist will begin to assist the patient in waking up for transfer to the recovery room.

How long will I be in the operating room?

Once the patient enters the operating room a series of safety steps must occur. This process takes about 20 minutes. 

A LEEP procedure takes approximately 10–15 minutes of surgical time. This includes the surgical time as well as accounting for positioning, the speculum insertion, a paracervical block anesthetic, and removal of the instruments.

When can I go home?

After an office-based LEEP procedure, patients may go home after getting dressed as long as you are feeling normal. 

Hospital-based procedures under general anesthesia will follow a different process. 

Postoperative recovery time will vary from person to person. Each patient must meet certain discharge criteria. The patient’s vital signs must be stable. The patient must be alert, oriented, and able to walk with assistance. Postoperative nausea, vomiting, and pain must be controlled as well as confirmation of no postoperative bleeding.

The nursing team will go over discharge instructions, and the plan for postoperative pain management options will be confirmed.

LEEP procedures require a minimal amount of postoperative recovery. Patients are often discharged as early as 30–60 minutes after the procedure.

What is the usual recovery time

You should be able to resume all work and household activities the day after your procedure. You should expect to feel a little vaginal soreness for 2–3 days. Mild uterine cramping is also common. 

Some patients will require mild pain medication like NSAIDs or even low dose narcotics for a brief period of time. 

It is wise to wear a sanitary pad for a few days as you may experience vaginal spotting or dark vaginal discharge. 

You will be instructed to abide by pelvic rest for approximately one week. This includes no douching, no sex, and no tampons. 

You should call your doctor if you experience heavy vaginal bleeding, fevers, or worsening abdominal pain.

What aftercare is required?

Most women should be able to return to normal daily activities the next day. You should speak with your physician regarding the resumption of sexual activity. Typically, the recommendation is no intercourse for 1–2 weeks. 

You should not use tampons for up to seven days after the procedure to reduce the potential risk of infection.

Light bleeding, spotting, and brown or black discharge is common and expected. Sanitary napkins are advised. 

Your doctor will schedule a postoperative examination to evaluate your cervix 1–2 weeks after the procedure. The cervical specimen pathology report will be reviewed during this visit. 

A follow-up pap smear will be scheduled to confirm all of the abnormal cells have been successfully removed and do not come back. 

Danger Signals to look out for after the procedure

After a LEEP procedure, we expect light spotting and vaginal discharge.

If you experience heavy bleeding, abdominal or pelvic pain, a fever, or pain that increases over time beyond 24 hours, call your physician. After any surgery contact your physician if you meet any of the following criteria:

What should I pack at home to take with?

Nothing special is required after a LEEP procedure. A supply of sanitary napkins will help keep your clothing clean.

What information should I provide to my doctors and nurses?

It is very important to provide your doctor with an updated list of all medications, vitamins, and dietary supplements prior to surgery. All medication and food allergies should be reviewed. Share any lab work, radiologic procedures, or other medical tests done by other healthcare providers with your surgeon prior to your procedure.

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