During a recent PW Podcast episode, we spoke with gynecologic oncologist Valena Wright, MD, author of the book “It’s Time You Knew: The Power of Your Choices to Prevent Women’s Cancer.” Following is a summary of that interview below:
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What can clinicians tell their patients about the current status of gynecologic cancers?
There are many myths that ovarian or fallopian tube cancer can be screened for with cancer antigen 125 testing or ultrasound. Patients should be informed that cervix cancer is the only gynecologic cancer with an approved screening test— cervical cytology (aka, Pap smear)—and that models generally show about a 10-year period between acquiring HPV and developing a dysplasia to progressing to cancer, which is why cervical cytology is so successful.
While Pap smears were historically done annually, guidelines have changed, and it’s become confusing to keep up to date. For example, the American Cancer Society this past summer advocated for primary screening for HPV, which makes sense because cervix cancer is directly linked to the presence of HPV and screening can help eliminate false positives from performing cytology alone. Guidelines also now suggest to not screen until age 21, because invasive cervical cancer is exceedingly rare before that.
Women should also be informed that positive screens are followed by colposcopy with biopsies and then a treatment plan. Clinicians should consider that this process involves uncomfortable procedures that can cause anxiety and adverse outcomes that affect reproductive health. We want to be conservative in young, lowrisk women.
While screening is important, women should know that we’re able to decrease rates of cervix cancer through treatment of dysplasia and HPV vaccination. Since multiple sex partners is a risk factor for cervical cancer, women should know that they acquire the risk of their partners, that it’s important to practice safe sex, and that while condom use is always recommended, condoms don’t necessarily protect from HPV transfer.
Also, although the HPV vaccine is most effective in pediatric patients, the FDA in 2020 approved the vaccine to be extended up to age 45, because men have the highest incidence of HPV-related cancer. Women should know that HPV also causes lower genital tract dysplasia —affecting not just the cervix, but the vagina and the vulva—as well as anal and oropharyngeal cancers.
The COVID-19 pandemic has shown a light on the social determinants of health and vaccine hesitancy that come into play with vaccination. In 2019, the WHO listed vaccine hesitancy as the number one global threat. Vaccination programs and addressing vaccine hesitancy can hopefully help resolve these issues as they relate to HPV vaccination.
