Ask The Expert: Cervical Cancer

Dr. Amanda Nickles Fader is associate professor in the department of gynecology and obstetrics, where she also serves as director of the Kelly Gynecologic Oncology Service and director of the minimally invasive surgery program.

Internationally recognized as a leading expert in high-risk endometrial cancers, Dr. Fader has particular expertise with the surgical and medical management of endometrial, ovarian, cervical and vulvar cancers, as well as treatment of women who are at high risk for a gynecologic malignancy.

With a special interest in caring for patients throughout the entire spectrum of oncologic care: from preventive oncology minimizing key risk factors that can lead to gynecologic cancer survivorship initiatives addressing all aspects of recovery, including emotional well-being and clinical follow-up, her research centers on minimally invasive surgical innovations in gynecologic oncology, clinical trials and innovative targeted biologic therapies, high-risk endometrial cancer, and the role of obesity in carcinogenesis.

She received her medical degree from the Medical College of Virginia and completed a fellowship in gynecologic oncology at the Cleveland Clinic. Dr. Fader will be speaking at the 2013 A Woman's Journey conference here in Baltimore.

Q: Is cervical cancer preventable (hysterectomies, etc.)?
A: In the last decade, cancer has become the second leading cause of death in the U.S.  The good news is that most cancers diagnosed in women are preventable, including cervical cancer.  

There are several things a woman can do to prevent or decrease her risk of cervical cancer. Since infection with the human papillomavirus (HPV) is the most significant risk factor for cervical cancer and cervical dysplasia (pre-cancer), it is important to avoid genital HPV infection. This can include delaying sex, limiting the number of sex partners, and avoiding a sexual partner who has had many other partners. Condoms are important to prevent the spread of sexually transmitted diseases, but they do not provide complete protection against HPV since there may be contact of exposed areas which can transmit the virus. Smoking also increases the risk of cervical cancer by up to five-fold in the setting of an HPV infection, as it decreases the function the immune system.

It is also extremely important that women undergo regular Pap smear screening.  The Pap smear is a test used to screen for cervical cancer, and can help detect the presence of HPV infection or pre-cancerous cells before they become cancerous. There are usually no symptoms or noticeable signs of early cervical cancer but it can be detected early with regular check-ups.  It is the single most effective and successful cancer screening test in history, and many other screening tests used in medicine are modeled after it.  Prior to the introduction of the Pap smear test in the 1940s, cervical cancer was one of the leading causes of cancer death for women in the United States. But after cervical cancer screening was initiated with the Pap, cervical cancer incidence was reduced by 75 percent and deaths from cervical cancer by 90 percent.

Q: I’ve been told that cervical cancer comes from HPV. Does that mean that it is a sexually transmitted infection and can be spread to others?
A: 99.7% of cervical cancer associated with the human papilloma virus, or HPV.  It is a cancer caused by a sexually transmitted infection and can be spread to sexual partners via sexual intercourse or oral sex.  Over 50% of men and women in the U.S. will be exposed to HPV at some point in their lifetimes, making it one of the most prevalent sexually transmitted infections nationwide.  HPV has no symptoms so most people do not know they have it. 

There are approximately 40 types of genital HPV. Some types can cause cervical cancer in women and can also cause other kinds of cancer in both men and women. Other types can cause genital warts in both males and females. Fortunately, most who are exposed to the virus will not develop cervical cancer, but both men and women should still do everything they can to avoid HPV infection. 

Q: Is there a cure?  
A: One of the most exciting developments in cancer medicine in recent years is the development of the HPV vaccine. Two vaccines, Gardasil and Cervarix, have been approved for use in girls and young women to help prevent cervical cancer. Gardasil immunizes against certain strains of HPV which cause 70% of cervical cancers and 90% of genital wart cases and is effective for at least five years. Cervarix is effective against the two main strains of HPV virus that causes cervical cancer and last for over six years. It is believed that cervical cancer and precancer rates will be decreased significantly because of the vaccine.

Q: How often should a woman undergo Pap smear screening? 
A: Historically, the Pap smear was recommended every 1-3 years.  New recommendations from the U.S. Preventive Services Task Force state that women who are under the age of 21 do not need a Pap smear at all, regardless of sexual history; healthy women who are 21 to 29 years old only need a Pap smear once every three years; and healthy women between the ages of 30 and 65 need a Pap smear only once every five years if they combine it with a test for HPV. The guidelines are in line with the recommendations of the American Cancer Society and other medical organizations.  However, these recommendations are only for healthy women who have not been diagnosed with an HPV infection, cervical dysplasia or cervical cancer.

Q: How prevalent is cervical cancer?
A: In 2013, approximately 13,000 women in the United States will be diagnosed with cervical cancer and 4,000 will die of the disease.

Q: What are the treatment options for someone diagnosed with cervical cancer?
A: Treatment options depend on the stage of the stage of the cancer, the tumor size, the patient’s age and her desire to have children. Early stage disease can be treated conservatively with partial removal of the cervix or with a radical hysterectomy. More advanced stage disease is usually not treated surgically, but instead with combination chemotherapy and radiation.

Q: Is it safe for someone who has had cervical cancer to become pregnant?
A: In select women with a precancerous cervical lesion or very early stage cervical cancer (i.e., a small or microscopic tumor confined to the cervix), conservative surgical procedures may be offered that allow a woman to conserve her fertility. This includes a cervical conization procedure, in which a portion of the cervix with the abnormality is removed, and the rest of the cervix and uterus are preserved.  In other cases, women with early stage cervical cancer may be offered a procedure called a radical trachelectomy, which involves removal of the entire cervix and surrounding tissue with reattachment of the remaining uterus to the upper vagina. In both cases, pregnancy is certainly possible.  In cervical cancer cases that are more advanced, pregnancy is contraindicated.

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4 Comments

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Cindy October 24, 2013 at 9:26 am

How often does HPV virus turn into cervical cancer?
thanks

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Beverly Gaither October 23, 2013 at 10:18 am

Is this doctor seeing patients,if the answer is yes where.

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Lorilei Barsh October 23, 2013 at 11:08 am

Beverly,

Dr. Fader is seeing patients at JHOC and Greenspring Station. You can reach patient scheduling to get an appointment at 443-997-0400 or contact Dr. Fader's office at 410-955-8240.

Thank you!

Lorilei

Reply

Phyllis Crockett October 23, 2013 at 8:16 am

This interview is very timely for me, because I have the HPV virus, I've had a conization and 2 LEEP procedures. My gyn doctor is leaving it up to me if I want to have a complete hysterectomy. That's a difficult decision to make, so I am coming to Hopkins for a second opinion, which should help with my decision. Thank you very mcuh for the ASk the Expert interview on cervical cancer.

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