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September 26, 2016

Paying attention to cervical cancer: An Interview with Tucker Kueny, MD, Chief of Obstetrics and Gynecology

September 26, 2016

January is Cervical Health Awareness Month, an opportunity to review the facts about cervical cancer and remind women to take charge of their health by getting screened regularly and, for younger people, getting vaccinated.

A generation or two ago in the United States, cervical cancer was the leading cause of cancer death among women. But those numbers have declined by more than 50 percent –now, about 13,000 women are diagnosed with cervical cancer each year and 4,000 die from the disease.

There are two main reasons for these positive changes: screening, which can detect pre-cancerous cells and also identify the presence of Human Papilloma Virus (HPV), and vaccination against HPV.

Pap test

Tucker Kueny, MD, OB/GYN,
Cooley Dickinson Medical Group
Women’s Health; Chief of
Obstetrics & Gynecology,
Cooley Dickinson Hospital

The main screening for cervical cancer is the Pap test or Pap smear. More than 30 million Pap tests are provided in physician offices, clinics, and hospital outpatient departments in the U.S. each year. “The Pap test checks the cervix to determine if there are any abnormal cell changes,” said Tucker Kueny, MD, obstetrician/gynecologist and chief of obstetrics and gynecology at Cooley Dickinson Hospital.

“It’s a simple test in which some cells are taken from the surface of the cervix. The cells are sent to a lab for testing.” Health care providers often perform a pelvic exam at the same time as the Pap smear, “to make sure there are no problems in the uterus, ovaries, or other nearby organs,” he added.

Pap tests are recommended for women beginning at age 21 and through age 65. Whether the test is done annually or less regularly depends on test results – if the results are consistently normal, women may be able to go 3-5 years between Pap tests.  Your individual testing recommendations should be discussed with your provider.

Women over age 30 may choose to have an HPV test along with the Pap test. “The HPV test looks for the human papilloma virus that causes the vast majority of cervical cancers,” said Kueny. The same sample of cells collected during the Pap test is used to test for HPV.

HPV

Most cervical cancers in the U.S. are caused by HPV. HPV is a cluster of more than 100 related viruses, some of which cause the growth of papillomas, or warts, in various parts of the body – from hands and feet to male and female genital organs.

Other types of the virus are responsible for the abnormal cell changes on the cervix.   “HPV is a very common virus,” said Kueny. “Nearly one-quarter of the people in the U.S. carries HPV right now.”

HPV is easily transmitted from one person to another from skin-on-skin contact. It also is transmitted through sexual contact. Both males and females carry the virus, which can cause not only cervical cancer in women but also penile cancer in men and head and neck cancers in both men and women. “In fact, experts believe that by 2020, head and neck cancer will overtake cervical cancer as the most common HPV-related cancer,” he added.

“The key is preventing HPV in the first place,” said Kueny. Vaccines are available to prevent infection by many types of HPV and some of the cancers linked to them.

The HPV vaccine is recommended for preteen boys and girls at age 11 or 12. “This protects them before ever being exposed to the virus,” said Kueny. The vaccine is given in three shots; the second is given one or two months after the first one and the final shot is given six months after the first one. The CDC recommends that children get the full series of shots.

Treatment for HPV and cervical cancer

Although there is no cure for HPV, treatments are available for warts and abnormal cell growths caused by HPV.

If a Pap test shows the presence of abnormal cells, further testing is done, including colposcopy (which uses a magnifying device to allow the physician to look closely at the cervix) and several types of biopsy. If cancer is found, further testing can show the extent of the cancer. The cancer is then staged – assigned a particular number based on size, whether it has spread, and other factors – to determine the right treatment plan. Treatment can include surgery, radiation, chemotherapy, and other therapies.

The good news for patients is that their cancer care team has grown exponentially since the opening of the Mass General Cancer Center at Cooley Dickinson Hospital last fall.

“Our partnership with MGH allows us to coordinate care locally and in Boston as needed so patients can be assured of customized, cutting-edge, and compassionate cancer care,” said Kueny

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