In primary care we eat, sleep and breathe prevention. We examine and test and screen all in an effort to catch a disease before it even becomes symptomatic. We check lab work for anemias and electrolyte problems. We do EKGs to screen for underlying heart conditions. We do colonoscopies and mammograms to find suspicious-looking tumors and get rid of them before they announce their presence as end-stage metastases. And we do this all because there is proof that if we spend the time and the money to screen for these types of conditions, enough people will test positive and enough lives can be prolonged or even saved. We do this all because it’s worth it.
Probably the most rewarding type of disease to catch and cure is one of only two preventable cancers – cervical cancer. (The other preventable cancer is liver cancer which is caused by hepatitis, for which there is also a vaccine).
Last week at work, I admitted a 40-year old female with Stage 4, metastatic cervical cancer for intractable pain and cough. During her first pregnancy at age 25, her pap smear tested positive for human papillomavirus, or HPV, which is responsible for most types of cervical cancers, as well as vaginal, vulvar, penile, anal and some throat cancers. Despite her doctors urging her to undergo curative cryosurgery, she deferred treatment. Three days before her 40th birthday, she experienced relentless vaginal bleeding that caused her blood counts to drop to a critical low. She was hospitalized for blood transfusions and underwent a series of tests that would reveal the cause of her bleeding – massive tumors of the cervix that had spread to her lungs, liver and bone. She has a 15-year old daughter and a 9-year old son.
In developing countries, cervical cancer is the third leading killer of women. In the U.S., it’s not even in the top 10. Why such a huge discrepancy? Because we screen! Pap smears are performed to extract the cells of the cervix and examine them for developing abnormalities that appear to be pre-cancerous. If and when there are cellular abnormalities, the laboratory will then test for the presence of many of the subtypes of HPV. The human papillomavirus lesions on the cervix can be treated with a variety of approaches including cone-shaped biopsies, laser removal or cryotherapy (freezing them off). Regular follow-ups are required following treatment to ensure that the lesions have all been eradicated. Usually, if detected and treated early, cervical cancer can be cured.
The latest guidelines from the American Cancer Society recommend that pap screening begins at age 21, regardless of age of first intercourse. Depending on your age and risk factors, pap testing may be done every 3-5 years. Your doctor can help you determine the right time to stop screening for cervical cancer. But just because you stop getting pap smears, does not mean you should not undergo an annual pelvic and breast exam. Make sure you’re getting screened according to your doctor’s recommendations. You can see the current guidelines here.
So what makes this disease preventable? The vaccine.
Gardasil is the vaccine designed to confer protection against HPV. As carriers of HPV, the vaccine is also recommended for boys and gay men who may be at higher risk of developing anal cancers. The recommendation is to vaccinate boys and girls ages 13-26 with a three-shot series. Ideally the goal is to vaccinate before the onset of sexual activity. As a parent, I can understand the reluctance to give vaccines to our young children. Educating yourself and your family about safe-sex practices is key, but by understanding the logic behind the HPV vaccine Gardasil, you may save your child’s life.
Alexis Hugelmeyer, D.O. is the wife of Michael, mother of Isabella, 5, and Lance, 2, and a family physician whose passion is hands-on manipulation for treatment and healing of any and every type of medical problem. She is administrative director of medical education and internship director at Peconic Bay Medical Center and also a private practitioner in Riverhead. A graduate of Villanova University and New York College of Osteopathic Medicine, she lives in Baiting Hollow.
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