How to decrease your risk for cervical cancer

Last year, 10,000 women in the United States were diagnosed with cervical cancer and almost 4,000 died from this largely preventable disease.  "Today" medical contributor Dr. Judith Reichman was invited onto the show to help educate women about cervical-cancer screening.

A bipartisan association called Women in Government just announced that in some states women are not getting appropriate cervical-cancer screenings.  Best grades for screening were given to Delaware, Massachusetts, Illinois, Maryland and North Carolina. The worst grades went to Tennessee and Texas.

Let’s do a quick review: What is the cause for cervical cancer?  Is it really a sexually transmitted disease?
Yes.  We know that 99.7 percent of cervical cancers are due to sexually transmitted viruses called the human patillomavirus (or HPV). 

There are more than 30 types of genital HPV viruses; those classified as high risk HPVs are more likely to result in cervical-cancer abnormalities or high-grade lesions (HSIL) that lead to cervical cancer.  Low risk HPVs are associated with cervical changes that are less likely to be precancerous (low grade lesions or LSIL) although on occasion, they can cause venereal warts.  It probably takes three years for a persistent high-risk HPV infection to enter the cervical cells, take over their genetic direction and cause mutations. Hence cervical cancer in women under the age of 19 is rare.

HPV is very contagious during intercourse, and, unfortunately, condom use is not completely protective because the virus can spread through skin-to-skin contact beyond the genitals. As a result, HPV is found in more than 70 percent of sexually active young adults. In addition, because there are virtually no symptoms, most are unaware that they have it. (Only 1 percent develop visible venereal warts.)   In other words, it’s become part of our normal vaginal “flora and fauna.”

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Fortunately, most HPV infections do not lead to a pre-cancer or cancer of the cervix.  Most infections are temporary, especially in younger women.  In adolescence and young adulthood, 70 percent of high-risk HPV types regress or disappear after three years.  And 90 percent of low-risk HPVs disappear in that time.  If we perform cervical biopsies on young women who have cervical cell changes, we find that the low-grade lesions spontaneously regress in 90 percent of women.  We’re not too sure about regression of high-grade lesions, but studies have found that it takes at least three years for these lesions to progress into early cancer.  This means that if we wait three years from the onset of intercourse (when a woman can become infected) to begin cervical cancer screening, we shouldn’t miss any cervical cancers. 

How does a woman know she has an HPV infection?  Should she routinely be checked for this type of virus?
I have to emphasize, lack of symptoms does not mean that a woman (or her partner) is virus-free.  And in sexually active younger women, there is a good chance that an HPV viral test will indeed be positive. 

Only on TODAY.MSNBc.com! Dr. Judith Reichman addresses your questions about women's health. LAST WEEK: Will removing my ovaries prevent cancer? GO TO ALL HEALTH TUESDAY COLUMNS

I can tell you from clinical experience that receiving the diagnosis “You have high-risk HPV” can cause a reaction of overwhelming consternation for the patient (and, if involved, her mother.) Questions such as: “When did I get this?  Who gave it to me?  Does this mean that I can give it to all my future partners?  Will it affect my babies?” follow.

Unfortunately, they can’t be answered with any certainty (although the possibility of affecting future children is highly unlikely). Nor can I prescribe a cure.  The only response that I and other physicians can give about an HPV diagnosis is that this virus (like most viruses) will most likely subside and disappear. This, of course, is usually an unsatisfactory answer.

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