Q&A: How to Prevent Cervical Cancer
Vaccinate and stay up to date with pap smears: how you can prevent Cervical cancer; Q&A with Dr. Molly Greenwade of CoxHealth
In recognition of Cervical Health/Cervical Cancer Awareness Month, Springfield-Greene County Health spoke with Dr. Molly Greenwade, a gynecologic oncologist and co-medical director of research at CoxHealth about all you need to know about cervical health.
Though we recognize this awareness month just in January, cervical health is important year-round. We hope this Q&A informs our readers so they can make educated decisions about their cervical health.
Health Department: It’s well known that HPV infections play a large role in the development of cervical cancer. Can you explain the connection between the two?
Dr. Greenwade: Nearly all cervical cancers are related to the Human papillomavirus (HPV) virus. HPV makes proteins that turn off the body’s ability to correct errors during cell division. This, in turn, leads to an accumulation of mutations during cell division and subsequent development of cancer. HPV is contracted through sexual contact. It is estimated that 75–80% of sexually active adults will acquire genital tract HPV before the age of 50. While the infection is common, cervical cancer will only occur in a small number of patients. Most HPV infections are transient and will go away with time; however, when HPV persists, there can be progression to preinvasive lesions followed by cancer. This process, on average, takes about 15 years.
Health Department: What are some prevention methods people can take when it comes to cervical cancer?
Dr. Greenwade: Vaccinate! This is most effective if administered before becoming sexually active. Stay up to date with pap smears and HPV testing as indicated. Practice safe sex. Use condoms to protect against HPV and other sexually transmitted diseases. Avoid smoking. There is a direct relationship between cigarette smoking and cervical cancer.
Health Department: Are there people who are more at risk to develop cervical cancer?
Dr. Greenwade: Because there is a strong relationship between HPV infection and cervical cancer, people at risk for HPV infection are also more at risk for cervical cancer. Risk factors include young age at first sexual intercourse, multiple sexual partners, high-risk sexual partners, history of sexually transmitted infections, history of vulvar or vaginal dysplasia or cancer, and immunosuppression (HIV infection, autoimmune diseases, chronic steroid use). In addition, low socioeconomic status, oral contraceptive use, and cigarette smoking are considered risk factors for cervical cancer.
Health Department: Are there any signs or symptoms of cervical cancer people can look out for?
Dr. Greenwade: The most common symptoms of cervical cancer are irregular or heavy vaginal bleeding and bleeding after intercourse. Some patients may also experience watery or malodorous vaginal discharge, pelvic pain, abdominal pain, problems with urination, and pain that travels down the back of the legs.
Health Department: The HPV vaccine is ideally given as young as 11 or 12 through age 26. Is it possible to get an HPV vaccine after that?
Dr. Greenwade: Yes. Ideally, the HPV vaccine should be administered prior to first sexual encounter. The vaccine is recommended for all people from age 9 to 26 but can be given to anyone up to age 45. Both males and females can receive the vaccine. The HPV 9-valent vaccine (Gardasil) is given as a 3-dose series (the first injection is followed by repeat doses at 2 and 6 months). Patients over 27 years of age should discuss vaccination with their medical provider to assess for benefit.
Health Department: January is Cervical Cancer Awareness Month/Cervical Health Awareness Month. Is there anything specific you would like the community to know about cervical health?
Dr. Greenwade: Cervical cancer is the fourth most common cancer in the world and a leading cause of death in medically underserved countries. Cervical cancer is almost always preventable and is treatable when detected in early stages. For these reasons, it is extremely important to stay up to date on pap smears, follow up if you have an abnormal pap smear, and get the HPV vaccine if you are eligible.
Health Department: There are new ways to treat cervical cancer being researched. Are there any treatments, or prevention methods, you are excited about?
Dr. Greenwade: Over the past few years, we have seen improved outcomes when using immunotherapy in combination with chemotherapy for metastatic or recurrent cervical cancer. For cervical cancer that has progressed on chemotherapy, a newer type of targeted therapy called antibody drug conjugates (ADCs) are showing promise and proving to be efficacious. There are many new advances happening right now in gynecologic cancer research, and I am excited to be a part of this field and to see what new treatment options we will have to offer our patients.
Dr. Molly Greenwade is a gynecologic oncologist and co-medical director of research at CoxHealth. Dr. Greenwade attended medical school at the University of Missouri School of Medicine and went on to complete her obstetrics and gynecology residency at the University of Oklahoma. She also completed her gynecology oncology fellowship at Washington University School of Medicine in St. Louis.