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January 2018 The American Cancer Society estimates that more than 13,000 new cervical cancer cases will be diagnosed this year, and more than 4,000 women will die from cervical cancer. This is heartbreaking, because cervical cancer is entirely preventable. Unlike many types of cancer, we know what causes cervical cancer, we know it takes a long time to develop (20 years or so), and we have an affordable test to detect it early. Given these facts, no one should die of cervical cancer. Cervical cancer is caused by the human papillomavirus (HPV), a sexually transmitted infection that almost all women can clear without the need for medical treatment. Women at higher risk for HPV (and therefore cervical cancer) include those with multiple sex partners and those with weak immune systems. Smoking and obesity also increase a woman’s risk of HPV. For those who become infected by the virus, a pap smear is the initial test used to detect abnormalities. Women should get paps every three years starting at age 21. If results indicate mild cervical cell changes, another pap will be scheduled the following year to see if the body was able to clear the virus. To return to routine screening after an abnormal pap, patients need two negative (normal) pap smears. About 90 percent of patients are able to clear the virus and go back to a normal pap smear in 24 months. If results indicate moderate to severe changes (either during the initial pap or the follow up pap), a colposcopy and biopsies are typically recommended. This is when we will catch the 10 percent of women who could progress to more severe dysplasia and ultimately on to cervical cancer after 10 -20 years of infection with HPV. The colposcope is an instrument with magnifying lenses that lets us (medical providers) see the surface of the cervix more clearly. During the colposcopy, we apply a vinegar-like solution to your cervix that causes any abnormal areas to turn white. If an area turns white, we biopsy it (take a tissue sample) and send it to the lab. Biopsy results let us know whether you have cancer, pre-cancer, or neither. We use this information to determine the best course of treatment. Cervical cancer usually requires some combination of surgery, radiation therapy, chemotherapy, and/or targeted therapy. The good news is that there is now an HPV vaccine to prevent the spread of the virus. Ideally, it is administered to adolescents before they become sexually active, but it can be administered to men and women in their early 20s. For optimum health, it is best for women to schedule an annual well-woman exam. Although paps are only give every three years, an annual well-woman exam is an opportunity to check for signs and symptoms of other medical problems, to refill birth control prescriptions, and to address any behavioral health issues. Some types of cancer are much more aggressive, including breast cancer, uterine cancer, and ovarian cancer, so it is important to screen for those more frequently. Also, as women go through each phase of life, their bodies change and they face different emotional challenges. It is important to know what to expect, and to recognize problems so we can treat them before they become too big. There’s no topic too embarrassing or awkward to discuss with your women’s health practitioner. We’ve heard it all and we don’t judge. We’re here to help. No matter what your concerns are, we can help you figure out what to do next. Even the biggest problems seem smaller when you take them one step at a time. Carolyn Wyatt is a women’s health nurse practitioner at Care for Her, a department of MCHC Health Centers, a local, non-profit, federally qualified health center offering medical, dental and behavioral health care to people in Lake and Mendocino Counties.