Michelle Rupp: Hello and welcome to this week’s edition of AFMC TV. We’re glad you’re joining us. January is Cervical Cancer Awareness month and so to discuss that topic as well as the HPV vaccine Is Dr. Heather Williams. And Dr. Williams, you are the, I want to get this right, gynecological oncologist at UAMS. Did I get it right? Ok, well thank you for joining us today.

Dr. Heather Williams: I am glad to be here.

MR: So, let’s first kind of level set and talk about just what is cervical cancer.

HW: So cervical cancer is cancer that starts in the cervix, and it can either start on the kind of the cells on the outside the cervix or inside the kind of opening of the cervix.

MR: Now is cervical cancer something completely different than HPV?

HW: It is. HPV causes cervical cancer. HPV is a viral infection, and it stands for human papilloma virus.

MR: Now, if you were diagnosed with HPV, does that mean you will develop cervical cancer or does that mean you have a higher risk of developing it?

HW: That’s correct. You have a higher risk for getting cancer. If you have an infection with HPV and there are different types of strains of the virus which we all learned from the pandemic different strains. And so, there’s really two strains of the HPV virus that cause 99% of cervical cancers and that is HPV 16 and 18 and so pap smears are the screening tool that helps screen for the HPV infection and then also screen for any abnormal cells. The goal of the pap smear is to catch the infection when it just begins or when it’s early and it can be treated. So that it doesn’t have the opportunity to develop into cancer,

MR: I want to talk to you about risk factors but before we do if the pap Is what is used for screening and a female has consistently had normal results on their on her path. Is she out of the woods or not necessarily. Could this rear its ugly head many, many years down the road or do we know?

HW: So, it’s a great question. Sometimes we do get patients many years after the fact that kind of end up with an infection. And so, we do think that maybe the virus can lay what’s called dormant similar to how people get shingles later in life. So there is some thought to that. Certainly, if you are someone that was in a relationship early on and then have a new partner a new spouse, there’s the potential there to come in contact with a new infection that you didn’t have before. and then that is a way that you could also come up with it. Ok, well, let’s step a let’s go back and let’s go back to some other risk factors because there are there are, I’m sure a whole slew of them. Sure. So Smoking is a big risk factor for this it just alters your body’s ability to fight the infection off and then anyone who has like chronic immunosuppression. so maybe you take drugs for say rheumatoid arthritis or some other autoimmune condition, you’re at increased risk for not being able to kind of clear this infection, and then sexual activity. it is a sexually transmitted virus, but it is very common and up to 80 to 90% of people will have been exposed by the time they’re in their forties or fifties, so if you say are someone who had kind of earlier onset of sexual activity or you are with a partner who has a history of having multiple partners? That increases your chance just to be exposed to the virus and then trying to think of those are really the big ones.

MR: Are there any signs that we as women should be aware of if we start to recognize that something may seem abnormal?

HW: Yes, so some of the symptoms can be very subtle and you can women are constantly taking care of other people so they tend to just brush things off um sort of the big ones if you start having any discharge that can be watery or maybe seems like there might be an infection that doesn’t clear. I encourage you to see your doctor, not just get antibiotics, you know, kind of prescribed over the phone, we’re busy, so sometimes that’s done but if it doesn’t clear up I do encourage you to be seen, if you have any bleeding after sexual activity, that can be a sign if you’re having bleeding in between your periods, that can be something that can be a sign of this and then just other kind of pelvic pain, feeling of like pressure or heaviness in the pelvis, changes in how you’re emptying your bladder. So maybe you’re going to the bathroom more often and not feeling like you’re emptying your bladder, those are all kind of non-specific things. that could be a sign.

MR: Ok, how early can cervical cancer show up? Is there an age?

HW: Yeah, so it can show up, you know, as early as someone kind of gets exposed and gets the infection the vast majority of cases though it does follow kind of a progression. So, there’s a period of infection and that infection has to kind of change the cell cells in that environment and then those cells kind of become abnormal and then over time, you know they develop the ability to, you know, they become so abnormal that they become cancer. So, it’s not like someone, it happens overnight. On average we say, you know, from exposure to cancer is approximately like a 10-year timeline. But it can happen much earlier, but we do recommend that women start having pap smears by the age of 21. And so, the assumption there is that, you know, if they became sexually active in their teen years and they were exposed at that that point, their body should have cleared the virus. But if it hasn’t, then it would be picked up on the pap smear and then they can get the appropriate treatment or follow up that they would need.

MR: Gotcha. Ok, is there treatment or even a cure once a positive diagnosis for cervical cancer is made?

HW: Definitely. If the cancer is caught early, it is curable Oftentimes it can be cured with surgery if it’s caught early enough if it is too advanced for surgery and the patient needs chemotherapy with radiation that too, can be curative. in a lot of patients. Really the key is just you know, being aware and early diagnosis once it is advanced and so stage three or four it does become more difficult to cure in those settings and oftentimes the treatment the intent is to kind of make sure the patient is not symptomatic from it and then also to help slow the progression of the disease.

MR: Ok Could can this be fatal? Cervical cancer definitely can be fatal. And we still lose about 5-6,000 women in the United States each year to cervical cancer.

MR: OK, but we don’t have to get to that point.

HW: No, we don’t.

MR: Yes, that’s the good news here. What else. what else would you like to add?

HW: So, I think a big component when we talk about cervical cancer like you said we don’t have to get to that point. So actually, this like I said 99% of cases are caused by a virus and we actually have a vaccination that is protective against the virus. the HPV vaccine and it can be given to boys and girls starting at age 11 and it is recommended up to even age 45 for certain patients. and this will prevent the two strains that cause the majority of cervical cancer. It also helps prevent genital warts which is another discussion, but that can be very disfiguring and life altering for patients that suffer with that. So really, we have an opportunity to really eradicate cervical cancer. and other countries that have kind of implemented widespread vaccination are on target to eliminate cervical cancer from detectable levels essentially. which would be wonderful. cervical cancer It is an orphan disease. It takes our mothers and our sisters. it can also take our grandmothers but it definitely leaves Children without their mothers And so we really need to make sure that I can get the word out about the vaccine. It is safe. So, I do encourage you to speak with your doctor or your child’s pediatrician about it because it is safe and again, it’s a cancer fighting vaccine and if we can prevent it then that’s the best cure for sure for sure.

MR: In our remaining moments just touch on the importance of having conversations with your doctor, your OBGYN. And just how important having those open conversations really are.

HW: Well extremely important, you know, oftentimes the patients are the best advocates for themselves and if the patient feels like something is wrong or you’re having a symptom you know and you don’t feel like you’re being heard, I encourage you to kind of speak up. And really Be an advocate for yourself to get the care you need. but also ask questions Again though screening with your pap smear is very important and typically on average that’s going to be every three years. I do recommend women follow up with their whoever is doing their well woman exam so that they can at least have a pelvic exam every 1 to 2 years to make sure that nothing has kind of developed since their last pap smear. a lot of women we see with cervical cancer, they give the same history that they haven’t been back to their O. B. G. Y N. Since they had their baby. because they are women are generally more healthy and they don’t feel the need and they don’t probably don’t have the time, but it is very important for them to take care of themselves and to continue to get their pap smear screening.

MR: Ok. If someone wanted to reach out to you, how would they do that? Do we direct them to the UAMS website?

HW: Yes. Ok. Yes, that would be perfect.

MR: Fantastic. All right, Doctor Williams. Anything else you’d like to add for cervical cancer awareness month?

HW: I think we’ve covered everything today.

MR: Fantastic. Ok, well thank you so much for coming in and joining us today.

HW: Thank you.

MR: And thank you so much for joining us, we’ll see you back here next week for more AFMC TV.