Improving HPV-vaccine Rates among Youths

Transcript

00:00 --> 00:03Funding for Yale Cancer Answers is
00:03 --> 00:05provided by Smilow Cancer Hospital.
00:05 --> 00:08Welcome to Yale Cancer Answers with
00:08 --> 00:10your host doctor Anees Chagpar.
00:10 --> 00:12Yale Cancer Answers features the
00:12 --> 00:14latest information on cancer care by
00:14 --> 00:15welcoming oncologists and specialists
00:15 --> 00:18who are on the forefront of the
00:18 --> 00:20battle to fight cancer. This week,
00:20 --> 00:22it's a conversation about improving
00:22 --> 00:23HPV vaccine rates among youths
00:23 --> 00:25with doctor Sangini Sheth.
00:25 --> 00:27Doctor Sheth is an associate
00:27 --> 00:28professor of obstetrics,
00:28 --> 00:29gynecology and reproductive
00:29 --> 00:32sciences at the Yale School of
00:32 --> 00:33Medicine where Doctor Chagpar is
00:33 --> 00:35a professor of surgical oncology.
00:36 --> 00:38Maybe we can start off by
00:38 --> 00:40you telling us a little bit more
00:40 --> 00:42about yourself and what you do.
00:42 --> 00:46Absolutely, I'm a general
00:46 --> 00:47obstetrician gynecologist,
00:47 --> 00:50but my clinical work and my
00:50 --> 00:52research work really focuses
00:52 --> 00:54on cervical cancer prevention,
00:54 --> 00:58I take care of women who have
00:58 --> 01:01abnormal cervical cancer screening,
01:01 --> 01:05so abnormal pap smear results
01:05 --> 01:08and do the additional evaluation
01:08 --> 01:11that's needed to make sure that
01:11 --> 01:14they stay healthy and also spend
01:14 --> 01:16a lot of time thinking about how
01:16 --> 01:19we can improve HPV immunization.
01:21 --> 01:23So that's a lot to kind of unpack,
01:23 --> 01:25but let's start with understanding a
01:25 --> 01:27little bit more about cervical cancer.
01:27 --> 01:29So how common is cervical
01:29 --> 01:32cancer in and who gets it? In
01:32 --> 01:36the United States, we see about
01:36 --> 01:3813,000 cases of cervical cancer
01:38 --> 01:40diagnosed every year, and about
01:40 --> 01:434000 women die from cervical cancer.
01:43 --> 01:45Here in the US each year
01:45 --> 01:49in terms of who gets it.
01:49 --> 01:52You know anyone that has a cervix can
01:52 --> 01:56get cervical cancer the most common ages
01:56 --> 02:00of diagnosis are women in their 30s,
02:00 --> 02:02forties, 50s. Fortunately,
02:02 --> 02:07we can diagnose pre cancer of the
02:07 --> 02:10cervix and that is what allows us
02:10 --> 02:13to try to help prevent cancer from
02:13 --> 02:15framling from progressing to cancer.
02:16 --> 02:19So that brings us to the next question and.
02:19 --> 02:22The the other aspect of cervical
02:22 --> 02:24cancer care that you mentioned that
02:24 --> 02:27you spend a lot of time and energy on
02:27 --> 02:29which is cervical cancer prevention.
02:29 --> 02:32Now you had talked about two separate
02:32 --> 02:34issues here and I want to kind
02:34 --> 02:39of dive into each so one is HPV
02:39 --> 02:43vaccination and the other is cervical
02:43 --> 02:46cancer screening with PAP tests.
02:46 --> 02:48So tell us a little bit more about
02:48 --> 02:50how each of those two things.
02:50 --> 02:53Works and what the difference is in
02:53 --> 02:56terms of how they prevent cancer.
02:56 --> 02:57Absolutely.
02:57 --> 03:00Well, we can start with HPV vaccination,
03:00 --> 03:03which we think of as being
03:03 --> 03:06primary prevention. It's the 1st.
03:08 --> 03:11First element we have to use to
03:11 --> 03:12prevent infection from developing
03:12 --> 03:16in the 1st place with a virus called
03:16 --> 03:19human papilloma virus, that's the HPV.
03:19 --> 03:22That's a very common virus,
03:22 --> 03:26and so by being vaccinated and especially
03:26 --> 03:28vaccinated early in adolescence,
03:28 --> 03:33we're talking about ages 910, eleven.
03:33 --> 03:35Ideally, we can prevent the
03:35 --> 03:37infections from happening in the.
03:37 --> 03:391st place and the reason we want
03:39 --> 03:42to prevent the infection is because
03:42 --> 03:44virtually all cervical cancer is
03:44 --> 03:48caused by infection from the HPV virus.
03:48 --> 03:50When that infection stays around
03:50 --> 03:53around for a long time and and
03:53 --> 03:55isn't cleared by the body.
03:55 --> 03:57So the vaccine at a young age really
03:57 --> 04:00is our first go to for prevention.
04:00 --> 04:02So let's just hit that
04:02 --> 04:04point home a little bit.
04:04 --> 04:05So what you're basically
04:05 --> 04:07telling us is that nearly.
04:07 --> 04:09All cervical cancers are
04:09 --> 04:11caused by an infection of
04:11 --> 04:15a virus and we have safe,
04:15 --> 04:17effective vaccines that prevent
04:17 --> 04:19you from getting infected
04:19 --> 04:22and therefore prevent you
04:22 --> 04:23from getting cervical cancer.
04:25 --> 04:28Exactly, and I want to emphasize the safe
04:28 --> 04:32and effective aspects of the HPV vaccine,
04:32 --> 04:36which we have had available in in some
04:36 --> 04:38form or another in the United States
04:38 --> 04:41for over 15 years now, so we have.
04:41 --> 04:43Millions of doses worth of
04:43 --> 04:46experience of giving the vaccine,
04:46 --> 04:49and in doing so safely and in exactly it
04:49 --> 04:53will prevent the infection from the varying
04:53 --> 04:56virus that can cause cervical cancer.
04:57 --> 05:00So a couple more questions on that. First,
05:00 --> 05:03is it covered by insurance or is it free?
05:03 --> 05:06Are there any cost issues that are potential
05:06 --> 05:09barriers to getting the HPV vaccine?
05:10 --> 05:13The vaccine is covered by insurance.
05:13 --> 05:17For anyone that it is recommended for,
05:17 --> 05:19which is any 192.
05:19 --> 05:22Through age 45 it should be covered
05:22 --> 05:25by insurance and many places have
05:25 --> 05:28programs available to give it up
05:28 --> 05:31to make it available for free to
05:31 --> 05:33uninsured individuals as well.
05:35 --> 05:38And so you know the the other question
05:38 --> 05:40that people may have is you know,
05:40 --> 05:43particularly in light of a lot that we're
05:43 --> 05:46learning about vaccines and viruses.
05:46 --> 05:50Given the current pandemic is.
05:50 --> 05:53You know, does this vaccine actually
05:53 --> 05:57prevent you from getting infected?
05:57 --> 05:59Or does it just make the cervical
05:59 --> 06:01cancer not something that is as lethal?
06:01 --> 06:03So when we think about the COVID vaccine,
06:03 --> 06:06many of us, no friends or family who
06:06 --> 06:09have been fully vaccinated but can still
06:09 --> 06:12get infected and still test positive.
06:12 --> 06:14But we know that the disease
06:14 --> 06:17is not as bad in those people,
06:17 --> 06:20whereas with the HPV vaccine,
06:20 --> 06:24is my understanding correct that if
06:24 --> 06:27you're actually vaccinated, you won't?
06:27 --> 06:28Get cervical cancer,
06:28 --> 06:32at least not the HPV induced cervical cancer,
06:33 --> 06:37right? So the current vaccine we have
06:37 --> 06:40available protects against 9 strains of HPV.
06:40 --> 06:44Seven of those strains are known to
06:44 --> 06:46cause cervical and other cancers,
06:46 --> 06:49and two of those strains are
06:49 --> 06:52known to cause genital warts and
06:52 --> 06:55so by the vaccine protects from
06:55 --> 06:58infection of those nine strains.
06:58 --> 07:00It wouldn't protect against
07:00 --> 07:02infection from other types of HPV,
07:02 --> 07:06and if somebody already has one strain of
07:06 --> 07:09HPV at the time that they get the vaccine,
07:09 --> 07:11it wouldn't protect them from
07:11 --> 07:12what they already had,
07:12 --> 07:15but it is different in that it
07:15 --> 07:18protects from infection and because
07:18 --> 07:21of that we see rates of genital
07:21 --> 07:23warts going down and we see rates
07:23 --> 07:26of the pre cancer of the cervix
07:26 --> 07:28that I mentioned going down.
07:28 --> 07:30And we're starting to see rates of
07:30 --> 07:32cervical cancer going down as well.
07:33 --> 07:35And the other point that I think
07:35 --> 07:37you made and that I just want to.
07:37 --> 07:42A kind of amplify is that if you get the
07:42 --> 07:44vaccine and you're already infected,
07:44 --> 07:47it won't help you against what
07:47 --> 07:48you're already infected against.
07:48 --> 07:51And that's why it's so important to get
07:51 --> 07:53vaccinated early when people are thinking
07:53 --> 07:56about vaccination during childhood.
07:56 --> 07:59910 eleven years old,
07:59 --> 08:01one of the good reasons to
08:01 --> 08:02get vaccinated early is that,
08:02 --> 08:05right? Yep, exactly it is.
08:05 --> 08:07Our immune system responds
08:07 --> 08:08better when we're younger.
08:08 --> 08:11We're going to be protected against
08:11 --> 08:13more of the strains when we're younger,
08:13 --> 08:15and then a little added
08:15 --> 08:17benefit is that if we start the
08:17 --> 08:19vaccine prior to the age of 15.
08:19 --> 08:21It is only two doses as
08:21 --> 08:23opposed to three doses.
08:23 --> 08:24If it is started later.
08:25 --> 08:27You know sangini, I have to ask you
08:27 --> 08:28about the elephant in the room,
08:28 --> 08:32which is the concern that some people have.
08:32 --> 08:36That vaccinating children leads to autism.
08:36 --> 08:40Can you put that kind of myth to bed
08:41 --> 08:44absolutely? So the published
08:44 --> 08:47studies that raise those questions
08:47 --> 08:49turned out to be falsified.
08:49 --> 08:52They were never accurate to begin with
08:52 --> 08:55and certainly for HPV there is no data.
08:55 --> 08:58To bear that out for this vaccine,
08:58 --> 09:01or for any other vaccine.
09:01 --> 09:05OK, so so for anybody
09:05 --> 09:08out there who is concerned about
09:08 --> 09:10autism in children getting vaccines.
09:10 --> 09:12Just to reiterate,
09:12 --> 09:14there is no evidence for that.
09:14 --> 09:16And when you think about the benefit
09:16 --> 09:19that these vaccines have in terms of
09:19 --> 09:21preventing your children from getting
09:21 --> 09:23not just cervical cancer but sangini,
09:23 --> 09:27am I right that it also protects
09:27 --> 09:29against oral pharyngeal cancers?
09:29 --> 09:31Anal cancers?
09:31 --> 09:34A whole myriad of different cancers
09:34 --> 09:37that are all related to HPV, exactly
09:37 --> 09:40we we say 6 cancers total that
09:40 --> 09:43can all be caused by HPV.
09:43 --> 09:46That this vaccine can help prevent
09:46 --> 09:48and so for everybody who has
09:48 --> 09:50always been praying for something
09:50 --> 09:51that will prevent cancer,
09:51 --> 09:55here you have it and such a good reason
09:55 --> 09:58to get get your children vaccinated.
09:58 --> 10:01But let me ask you this sangini 'cause
10:01 --> 10:04I know that people are going to ask.
10:04 --> 10:06When you say the vast majority
10:06 --> 10:08of cancers are caused by HPV,
10:08 --> 10:10are there some that aren't?
10:10 --> 10:12So is it possible that even
10:12 --> 10:14if you are vaccinated,
10:14 --> 10:16you could still get cervical
10:16 --> 10:18cancer but not from HPV?
10:18 --> 10:21And if So what are the risk factors
10:21 --> 10:24aside from HPV that cause cervical
10:24 --> 10:28cancer and how frequent is that there
10:28 --> 10:31are very rare types of cervical
10:31 --> 10:34cancers that are not caused by HPV.
10:34 --> 10:36Again, I want to stress the rare one,
10:36 --> 10:38especially when it comes
10:38 --> 10:40to cervical cancer. There.
10:40 --> 10:44And and we're seeing less and less of this,
10:44 --> 10:48but there used to be exposure to a
10:48 --> 10:51chemical called desd that increase
10:51 --> 10:54the risk of cervical cancer and so.
10:57 --> 11:02Children of women who are exposed to that.
11:02 --> 11:04Our would be at increased risk of a
11:04 --> 11:07non HP form of cancer for example,
11:07 --> 11:09but that chemical stopped being
11:09 --> 11:11used along time ago and so we
11:11 --> 11:13see less and less of that.
11:14 --> 11:18And so let me ask you this question.
11:18 --> 11:20If everybody in the entire world
11:20 --> 11:24was to get vaccinated against HPV.
11:24 --> 11:25Would we essentially be
11:25 --> 11:27putting you out of a job?
11:28 --> 11:30Yeah, that's that,
11:30 --> 11:34and that would be perfectly fine with me.
11:34 --> 11:36But but yes, you know,
11:36 --> 11:39we're actually in a very exciting time.
11:39 --> 11:41Right now. I'm globally.
11:41 --> 11:44The world is focused on the
11:44 --> 11:47elimination of cervical cancer and
11:47 --> 11:49the fact that we can even have
11:49 --> 11:50that conversation is exciting.
11:50 --> 11:53And the reason we can have that
11:53 --> 11:55conversation is because of a
11:55 --> 11:57combination of having the this
11:57 --> 12:00vaccine as well as the screening
12:00 --> 12:02that we you've mentioned already,
12:03 --> 12:07yeah. I mean to even talk about
12:07 --> 12:11eradication of cancer, is is just it?
12:11 --> 12:13It really is exciting and and really
12:13 --> 12:16jubilant. Let me ask you this,
12:16 --> 12:19if you've been vaccinated against HPV,
12:19 --> 12:21do you still need to get Pap smears?
12:21 --> 12:24Do you still need to get screened? Yes,
12:24 --> 12:27right now the screening still is
12:27 --> 12:29a really important component.
12:29 --> 12:31Partly it's because the vaccine right
12:31 --> 12:34now protects against nine strains.
12:34 --> 12:36As I said, seven of which cause.
12:36 --> 12:37Cervical cancer that
12:37 --> 12:40doesn't cover every strain.
12:40 --> 12:43Although it covers about 85 to 90%
12:43 --> 12:47of what can cause cervical cancer.
12:47 --> 12:49But overtime, if we you know have
12:49 --> 12:52very very high rates of vaccination,
12:52 --> 12:54then one day we may see exactly
12:54 --> 12:56how we need to screen and who
12:56 --> 12:58needs to get screen changed.
12:58 --> 12:58But for right
12:59 --> 13:00now you're recommending screening
13:00 --> 13:02for everybody. Is that right
13:02 --> 13:05exactly? Regardless of vaccination history.
13:06 --> 13:08So right after we take a quick
13:08 --> 13:10break for a medical minute,
13:10 --> 13:13I want to dive more into the screening part.
13:13 --> 13:16We've talked a lot about primary prevention
13:16 --> 13:19with vaccines and that is by far the
13:19 --> 13:21most exciting breakthrough, I think.
13:21 --> 13:23But we still need to learn a little
13:23 --> 13:25bit more about secondary prevention.
13:25 --> 13:27Who needs a pap smear?
13:27 --> 13:29What's an HPV test? How exactly does
13:29 --> 13:32that happen and does it affect you?
13:32 --> 13:33So please stay tuned.
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13:43 --> 13:45are offered. To learn more,
13:45 --> 13:48visit Yale Cancer Center org gin.
13:51 --> 13:54Breast cancer is one of the most common
13:54 --> 13:56cancers in women in Connecticut alone,
13:56 --> 13:58approximately 3500 women will be
13:58 --> 14:01diagnosed with breast cancer this year,
14:01 --> 14:02but there is hope,
14:02 --> 14:03thanks to earlier detection,
14:03 --> 14:05noninvasive treatments and the development
14:05 --> 14:08of novel therapies to fight breast cancer.
14:08 --> 14:10Women should schedule a baseline
14:10 --> 14:12mammogram beginning at age 40 or
14:12 --> 14:14earlier if they have risk factors
14:14 --> 14:16associated with the disease.
14:16 --> 14:17With screening early detection
14:17 --> 14:19and a healthy lifestyle,
14:19 --> 14:21breast cancer can be defeated.
14:21 --> 14:23Clinical trials are currently
14:23 --> 14:25underway at federally designated
14:25 --> 14:27Comprehensive cancer centers such
14:27 --> 14:29as Yale Cancer Center and Smilow
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14:31 --> 14:33new treatments available to patients.
14:33 --> 14:36Digital breast Tomosynthesis or 3D
14:36 --> 14:39mammography is also transforming breast
14:39 --> 14:41cancer screening by significantly
14:41 --> 14:43reducing unnecessary procedures
14:43 --> 14:45while picking up more cancers.
14:45 --> 14:48More information is available at
14:48 --> 14:49yalecancercenter.org. You're listening
14:49 --> 14:51to Connecticut Public Radio.
14:52 --> 14:54Welcome back to Yale Cancer Answers.
14:54 --> 14:56This is doctor Anees Chagpar and
14:56 --> 14:58I'm joined tonight by
14:58 --> 14:59my guest Doctor Sangini Sheth.
14:59 --> 15:02We're talking about cervical cancer
15:02 --> 15:04and especially prevention now.
15:04 --> 15:06Right before the break we
15:06 --> 15:09talked a lot about what you called
15:09 --> 15:12primary prevention and that was
15:12 --> 15:14talking about HPV vaccination and
15:14 --> 15:17the potential that vaccination could
15:17 --> 15:20actually eradicate cervical cancer and
15:20 --> 15:23maybe a whole bunch of other cancers as well.
15:23 --> 15:24Which is.
15:24 --> 15:25Completely exciting,
15:25 --> 15:29but you did mention something else which
15:29 --> 15:31is screening or secondary prevention.
15:31 --> 15:34Can you tell us a little bit more about that?
15:34 --> 15:35Absolutely,
15:35 --> 15:37and this is probably what most
15:37 --> 15:39people are very familiar with,
15:39 --> 15:42which is screening with a Pap test which
15:42 --> 15:45we have been using since the 1950s.
15:45 --> 15:48As really the mainstay of cervical
15:48 --> 15:51cancer prevention and the need
15:51 --> 15:54for screening hasn't gone away,
15:54 --> 15:57and it remains very important.
15:57 --> 15:59What's changed about screening
15:59 --> 16:03is that now we're relying more
16:03 --> 16:05and more on HPV testing.
16:05 --> 16:09As the only form of screening or
16:09 --> 16:13or a secondary part to the to the
16:13 --> 16:16Pap smear to to really understand
16:16 --> 16:19who's at risk and how much risk.
16:20 --> 16:22So tell us a little bit more about that.
16:22 --> 16:24So many of us are familiar with Pap smears,
16:24 --> 16:26so let's break it down a little bit.
16:27 --> 16:29So we should start cervical cancer
16:29 --> 16:32screening for people at age 21.
16:32 --> 16:34So anyone with a cervix needs
16:34 --> 16:36to start screening at age 21.
16:36 --> 16:37That screening,
16:37 --> 16:41at least until the age of 25,
16:41 --> 16:45should be in the form of a pap smear.
16:45 --> 16:48Starting at age 25, there are some
16:48 --> 16:51options for how to do this screening.
16:51 --> 16:54We can stay with the Pap smear and we
16:54 --> 16:58or we can start adding in HPV testing.
16:58 --> 17:01The reason that HPV testing makes sense
17:01 --> 17:03is because as we talked about earlier,
17:03 --> 17:07that virus is what we know causes almost
17:07 --> 17:09all cervical cancer and by testing for
17:09 --> 17:12the presence or absence of the virus
17:12 --> 17:15we can start to identify who is at.
17:15 --> 17:18Risk there is some.
17:18 --> 17:21Some newer recommendations that
17:21 --> 17:24we're not really starting to see
17:24 --> 17:27broadly in clinical practice,
17:27 --> 17:31but we we will probably start to
17:31 --> 17:33incorporate more and more often
17:33 --> 17:37and and that is a role for doing
17:37 --> 17:39only HPV testing down the road.
17:40 --> 17:43So let me ask you this.
17:43 --> 17:46The purpose of the Pap smear is
17:46 --> 17:49to find pre cervical cancer cells
17:49 --> 17:52that we can potentially eliminate
17:52 --> 17:55before they actually progress
17:55 --> 17:58into invasive cervical cancer.
17:58 --> 18:00Is that right exactly?
18:00 --> 18:03And so if you were just to
18:03 --> 18:04get tested with for HPV,
18:04 --> 18:06you know that you're at risk.
18:06 --> 18:08But how does that help you to find
18:08 --> 18:10those pre cervical cancer cells?
18:11 --> 18:14By knowing who is positive for HPV
18:14 --> 18:17and then having a little bit more
18:17 --> 18:20information about which type of HPV,
18:20 --> 18:22there's hundreds of types out there,
18:22 --> 18:25but we're really focused on a handful
18:25 --> 18:27that cause most cervical cancer.
18:27 --> 18:31It helps guide us to who needs.
18:31 --> 18:34Further evaluation in the same way that
18:34 --> 18:37a abnormal Pap test would tell us,
18:37 --> 18:40and more and more science is telling
18:40 --> 18:44us that the HPV test alone may be as
18:44 --> 18:48good if not better than the Pap test.
18:49 --> 18:50So tell us a little bit
18:50 --> 18:52more about that HPV test.
18:52 --> 18:53Is that a blood test?
18:53 --> 18:58Is that a cervical kind of swab test
18:58 --> 19:01like a PAP except testing for HPV?
19:01 --> 19:03How exactly does that happen?
19:03 --> 19:06Yeah, so from a patient's perspective,
19:06 --> 19:09what they would experience when they
19:09 --> 19:12go to the doctor is not that different
19:12 --> 19:13from what they were experiencing.
19:13 --> 19:16When if they were getting only a path,
19:16 --> 19:19it still involves a gynecology
19:19 --> 19:22exam with a speculum,
19:22 --> 19:26and the specimen is collected at the cervix
19:26 --> 19:30and then HPV testing is done on that,
19:30 --> 19:33which also allows for.
19:33 --> 19:36If in certain conditions, if a pop.
19:36 --> 19:40Task then needs to be performed later on.
19:40 --> 19:43It can be done on that same collection.
19:43 --> 19:44The patient doesn't need to
19:44 --> 19:46go back for for another exam.
19:46 --> 19:49So basically what you're saying is
19:49 --> 19:52that either way you're going to have
19:52 --> 19:54a gynecological exam and kind of a
19:54 --> 19:56specimen that's taken from the cervix,
19:56 --> 19:59which is either stained to see whether
19:59 --> 20:01there's precancerous cells there,
20:01 --> 20:05like a pap smear or more frequently now.
20:05 --> 20:07It sounds like gets tested.
20:07 --> 20:10For HPV and so.
20:10 --> 20:14If that test is positive for HPV,
20:14 --> 20:15what's the next step?
20:16 --> 20:19This is where a conversation with the
20:19 --> 20:22the physician becomes really important.
20:22 --> 20:25In some cases, the recommendation
20:25 --> 20:28may be needing to do a repeat sooner,
20:28 --> 20:29so maybe a year later
20:29 --> 20:31instead of a few years later.
20:31 --> 20:33But in other situations,
20:33 --> 20:36the next step is going to be the
20:36 --> 20:38recommendation for a procedure
20:38 --> 20:40called Kolpa Skippy, which is a.
20:40 --> 20:44Big fancy word to mean looking at the
20:44 --> 20:47cervix in the office with a microscope
20:47 --> 20:50to get a better look at the cervix
20:50 --> 20:52and take some very small biopsies.
20:52 --> 20:54Again in the office.
20:54 --> 20:56And if you had an abnormal pap smear,
20:56 --> 20:58would that be the next step as well?
20:58 --> 21:01Exactly the the next steps.
21:01 --> 21:02The options of next steps
21:02 --> 21:04don't really change either.
21:04 --> 21:06It would have been following
21:06 --> 21:08up with another test sooner,
21:08 --> 21:10meaning about a year or so
21:10 --> 21:11or being recommended to have
21:11 --> 21:13this colposcopy. Procedure
21:13 --> 21:18and so when you have that procedure.
21:18 --> 21:20Is this something that you need
21:20 --> 21:22to kind of stay off work from?
21:22 --> 21:25Is it really painful or is this
21:25 --> 21:27something that's kind of you know,
21:27 --> 21:29more like a blood test and not
21:29 --> 21:30really too bad and you can
21:30 --> 21:32get back to living your life.
21:33 --> 21:37The latter it is done in the office.
21:37 --> 21:41It doesn't require taking the day off
21:41 --> 21:45from work beyond the time of the exam.
21:45 --> 21:49There's not a recovery period.
21:49 --> 21:53It's much more like a blood test.
21:53 --> 21:55Than than some then some
21:55 --> 21:56larger invasive test.
21:57 --> 22:00OK, so you go in for your
22:00 --> 22:02regular gynecological exam.
22:02 --> 22:04Your doctor does either a pap
22:04 --> 22:07smear or more likely an HPV
22:07 --> 22:09test if it comes back positive,
22:09 --> 22:11you have a colposcopy you go in.
22:11 --> 22:13They take a few samples.
22:13 --> 22:15How long does it take to
22:15 --> 22:16get those results back?
22:16 --> 22:20About 10 days OK and what
22:20 --> 22:22are they looking for?
22:22 --> 22:24Are they looking for precancerous cells?
22:25 --> 22:27Exactly? They're looking
22:27 --> 22:28for precancerous cells.
22:28 --> 22:32We tend to grade pre cancer
22:32 --> 22:35in at three different levels,
22:35 --> 22:38a level 1, the level 2 or Level 3.
22:38 --> 22:41Anything beyond a Level 3 is
22:41 --> 22:43means invasive cervical cancer,
22:43 --> 22:45and then depending on the level,
22:45 --> 22:48what what might be recommended?
22:48 --> 22:50Next varies.
22:51 --> 22:52So tell us more about that.
22:54 --> 22:56So for a level one often referred
22:56 --> 22:59to in medical terms as CIN
22:59 --> 23:02one or low grade dysplasia.
23:02 --> 23:04The risk of future cervical
23:04 --> 23:06cancer is still very low,
23:06 --> 23:09and so we're going to observe.
23:09 --> 23:12Follow that. Observe that with.
23:12 --> 23:15Repeat testing and one year.
23:15 --> 23:17When we get to level 2,
23:17 --> 23:19the risk of cervical cancer
23:19 --> 23:22in the future long term,
23:22 --> 23:26if left untreated, starts to increase,
23:26 --> 23:29but the chances of it resolving
23:29 --> 23:32or going away is also there,
23:32 --> 23:35and so that's where there's a
23:35 --> 23:38we factor in a patient's age.
23:38 --> 23:40What they may be thinking in terms of
23:40 --> 23:43future fertility and childbearing,
23:43 --> 23:46and make a recommendation.
23:46 --> 23:46Accordingly,
23:46 --> 23:50as to whether we recommend treatment
23:50 --> 23:53with something called a LEAP procedure,
23:53 --> 23:55which we can talk about in a
23:55 --> 23:58second or following very closely,
23:58 --> 24:01meaning every six months with a repeat
24:01 --> 24:04colonoscopy for up to two years to
24:04 --> 24:06see if it does in fact resolve,
24:06 --> 24:08or if there's signs that
24:08 --> 24:09it's starting to worsen,
24:09 --> 24:09then say,
24:09 --> 24:11you know we should just move forward
24:11 --> 24:14with treatment and then by the time
24:14 --> 24:17it gets to that Level 3 or a CIN 3.
24:17 --> 24:20We say we just need to proceed with
24:20 --> 24:22treatment without leep procedure.
24:23 --> 24:26So tell us more about this leep
24:26 --> 24:28procedure. In some offices,
24:28 --> 24:30the LEEP procedure can
24:30 --> 24:32also be done in the office,
24:32 --> 24:35it can be very well tolerated with just
24:35 --> 24:38some local anesthetic like lidocaine,
24:38 --> 24:40similar to what someone might
24:40 --> 24:42receive for a dental procedure,
24:42 --> 24:44or it can be done in the operating
24:44 --> 24:46room as the same day surgery,
24:46 --> 24:48and it what it involves is
24:48 --> 24:50removing a small portion of the
24:50 --> 24:52cervix where the abnormal cells
24:52 --> 24:54are to get rid of those cells.
24:55 --> 24:57And then that's it. Then you're done.
24:57 --> 24:59And then you've reduced your
24:59 --> 25:01risk back down to baseline.
25:02 --> 25:07So then we we still do surveillance,
25:07 --> 25:10meaning we follow patients every 6 to
25:10 --> 25:1312 months with PAP tests to to make sure
25:13 --> 25:16that they've truly reduced their risk.
25:16 --> 25:20The risk never goes completely to baseline,
25:20 --> 25:24but it it drops a lot,
25:24 --> 25:26and the longer somebody.
25:26 --> 25:30Goes with having normal or negative testing.
25:30 --> 25:31After that treatment,
25:31 --> 25:34they'll last likely they are to
25:34 --> 25:36to have the issue come back.
25:37 --> 25:40So you know the next question
25:40 --> 25:42is really something I think.
25:42 --> 25:43As I mentioned before the break,
25:43 --> 25:46a lot of people have gotten a
25:46 --> 25:49lot of information and and some
25:49 --> 25:51misinformation from the experience
25:51 --> 25:53that we've had during the pandemic
25:53 --> 25:56and one of the things that we've
25:56 --> 25:57recognized during the pandemic is
25:57 --> 25:59not only the importance of vaccines,
25:59 --> 26:04but also the fact that there are
26:04 --> 26:07treatments available that may treat.
26:07 --> 26:11That there's some viral illness called COVID,
26:11 --> 26:13and so I guess one of the questions
26:13 --> 26:16that people might be wondering is if HPV
26:16 --> 26:19causes cervical cancer aside from the
26:19 --> 26:21HPV vaccine that we've talked about,
26:21 --> 26:23that is so effective.
26:23 --> 26:27Are there kind of entry retrovirals
26:27 --> 26:30or monoclonal antibodies or something
26:30 --> 26:32against HPV that are effective in
26:32 --> 26:34the treatment of cervical cancer?
26:35 --> 26:37That's a great question.
26:37 --> 26:38Unfortunately, right now the
26:38 --> 26:41answer is that there's no other
26:41 --> 26:43medical treatments for to to get
26:43 --> 26:46rid of HPV infection there is.
26:46 --> 26:48That's an area that's gets
26:48 --> 26:49being studied a lot,
26:49 --> 26:52but we don't have anything available to us
26:52 --> 26:54right now which only further underscores.
26:54 --> 26:57Why the vaccine and the screening.
26:57 --> 26:59The things we do have available
26:59 --> 27:01are really important.
27:01 --> 27:03The only other thing I would add
27:03 --> 27:05is you know smoking is.
27:05 --> 27:07The risk factor for cervical cancer
27:07 --> 27:09as we know it is for many other
27:09 --> 27:11cancers and health conditions,
27:11 --> 27:15and so that is something that people can.
27:15 --> 27:17Focus on to reduce their risk
27:17 --> 27:19even more is not smoking.
27:20 --> 27:23And it sounds like you know if
27:23 --> 27:27if you were to get vaccinated.
27:27 --> 27:30You reduce your risk of developing this.
27:30 --> 27:32You still need to get these HPV tests
27:32 --> 27:36and so do you still get them every three
27:36 --> 27:39years as you would otherwise. Once
27:39 --> 27:42someone is age 30 or older,
27:42 --> 27:44if they have a negative HPV test,
27:45 --> 27:46those screening can be spaced
27:46 --> 27:48out to every five years.
27:48 --> 27:50That's one of the other beauties
27:50 --> 27:52of HPV testing is 'cause it's
27:52 --> 27:54testing for the risk factor,
27:54 --> 27:57and so a negative test space is you out more.
27:58 --> 28:00So the last question I have for
28:00 --> 28:03you is when do people stop getting
28:03 --> 28:05screened for cervical cancer?
28:05 --> 28:07Is there an upper age limit?
28:07 --> 28:10If someone has had
28:10 --> 28:12adequate negative testing,
28:12 --> 28:15we can stop starting at age 65.
28:15 --> 28:19Sometimes it's hard to have that information,
28:19 --> 28:22and so often we can't stop somebody
28:22 --> 28:25at that age and the other situation
28:25 --> 28:27would be if someone had surgical
28:27 --> 28:30removal of the uterus and cervix.
28:30 --> 28:33Dr Sangini Sheth is an associate
28:33 --> 28:34professor of obstetrics,
28:34 --> 28:36gynecology and reproductive sciences
28:36 --> 28:38at the Yale School of Medicine.
28:38 --> 28:40If you have questions,
28:40 --> 28:42the address is canceranswers@yale.edu
28:42 --> 28:46and past editions of the program are
28:46 --> 28:48available in audio and written format.
28:48 --> 28:48Gailcancercenter.org,
28:48 --> 28:51we hope you'll join us next week to
28:51 --> 28:53learn more about the fight against
28:53 --> 28:55cancer here on Connecticut Public radio
28:55 --> 28:57funding for Yale Cancer Answers is
28:57 --> 29:00provided by Smilow Cancer Hospital.

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January 30, 2022

Yale Cancer Center

visit: http://www.yalecancercenter.org

email: canceranswers@yale.edu

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