cervical cancer

[Grog]

I hope BTChance will provide more enlightening details, but as someone who's been treated for weird stuff on my cervix I can give little info I have.

The pap smear does not test for HPV, it looks for abnormal cells on your cervix. If abnormal cells are found, a test for HPV will be made. However I don't think it matters that much whether the source of the abnormal cells is HPV or something else, it has to be treated anyway, and there is no way to take HPV outside of your body once it's there.

There is a new test around supposedly that is much better than the pap smear but I haven't experienced it personally and am not sure whether it's been approved for mass use.

Pap smears are not totally and do not catch everything. Which is why it is very important to get one every year so that you increase your chance of catching any problem early. Abnormal cells on your cervix, if let to their own nasty thing, might lead to cervical cancer and other cancers in that area. Sometimes they just disappear, too.

Where I'm from, "promiscuity" is not so much of an issue and few people freak out when teenagers have sex. I've always been told that early start of sexual activity is a risk factor. It makes sense: the longer you've had sex, the more chance you have of being exposed to the virus. I don't see it as a moral issue. I encourage you to do the same with your partners, friends, daughters. As others have mentioned, most women who are sexually active have been exposed to HPV. Not all will develop cancer as a result. But it's a virus that's basically omnipresent. Like, by the way, HSV (herpes) that is thought to be present in about 1/6 people if not more. Making it a shameful thing just prevents people from seeking treatment.

**

RM: GO GET THAT ULTRASOUND. NOW. You don't want to wait until the funny looking ovaries start behaving funny. If only for that reason: it HURTS terribly. (Think of a man being repeatedly kicked in the balls.......) And the earlier you get them to straighten their act - or are reassured about it - the better.

[chickwhorips]

my pap keeps coming back abnormal. i don't know why. a couple years ago they took a chunk of my cervix and tested it, but nothing was wrong.

why do i keep having abnormal paps? bc it keeps coming up, i don't really want to keep going back every couple of months to be checked. specially when nothing comes from it. i'm so frustrated.

i've considered getting vaccinated, but don't know much more about it. i hear its good to get until your 26, which i just turned. still debating about it. they probably don't have it out here in the bush, but in town they probably do. i just haven't heard much about it or if my insurance will cover it.

[DrBadger]

For those of you curious about the vaccine for HPV (it is called Guardasil and is made my Merk) it is a series of 3 shots given over 6 months. It is currently FDA "approved" for girls 12-26 in the US. However, this is just a guideline, and many doctors will give it to women older depending on circumstances. Generally they are giving it to women who have not become sexually active yet, as this is the only way to know that they haven't been exposed to one of the 4 strains of HPV that it is effective for. However, I believe that some doctors are giving it to people who have already been sexually active because the chances that they have already been exposed to all 4 strains is pretty low. As for insurance covering it, some are, some aren't, and it might depend on your age.

I have had two of my 3 doses, and I didn't start it until I was 27 (am 28 now), but I had talked to my Dr. the minute it was approved by the FDA since my mom had cervical cancer, and I have not yet been sexually active. While cervical cancer is usually caused by one of the HPV strains, it is still unclear why it only forms into cancer in some women, and there is a thought that that part of it might be genetic. My insurance doesn't cover it (yet), but I can get the vaccine at cost at my university. It is $135 for each injection, so ~$400 for all 3. In my mind, that is a small price to pay for decreasing my risk of cervical cancer.

I would encourage anyone who is able to to get the vaccine, and if you (or your daughters) are in the age group, or close to it, and there is a history of cervical cancer in your family I would really push the Dr. to let you get it ASAP, even if you have to pay for it.

RunningMommy - I know what you mean about this being a touchy subject for partners... my mom only had 1 partner, my dad, and the Dr.s do know that HPV caused her cervical cancer, so my dad hates that there are now all these ads about cancer being caused by a sexually transmitted virus, because it implies that he gave it to her. To add to it, she had to have a full hysterectomy, so no more kids.

For those of you older or yunger, I know that Merk is running clinical trials on women over 26 and on men (so they can't transmit it), so keep watching.

Also, word of warning... the injection hurts like a b**ch! Apparently it is the silver solution they use as the carrier. My clinic has found that the slower they inject it the less painful it is, so suggest that when you get it if they don't say anything.

[Kitsune06]

People know entirely too little about entirely too much.

I'm with you, Knot- I'd like to add that I betya anything that said vaccine for men wouldn't cost $600 for a 3-shot round. We had a client come in and b*tch to my manager (just casual b*tching, my mgr used to be a nurse) that she has three daughters, all under 12, which is the age at which some states are actually *requiring* the immunization. $1800 for protection for her daughters? I Sh*t you not.

Regarding testing- I'd reccommend being tested during annual exams...

Oh, to have health insurance. And even then I don't know if it'd be covered.

I think part of why there isn't as much of a clamor for it is that people think of only promiscuous people picking this up. As stated before, 1 in 4 has a strain of some sort. Sh!t happens that's beyond our control. end of story. Protection is incredibly important.

Think of the sheer amount of healthcare costs that will be reduced when we manage to reduce the number of women who develop cervical cancer because of HPV? What a benefit that would be to society. How dare they charge so much? I know Merck has a policy for those under-funded, but it would likely prove very difficult, indeed, to manage that.

PABadger- Ok, I know it might be awhile before I can afford this, but seriously, yer makin' me nervous. Like I need to be *more* afraid of a vaccination!

[DrBadger]

PABadger- Ok, I know it might be awhile before I can afford this, but seriously, yer makin' me nervous. Like I need to be *more* afraid of a vaccination!

At least it only hurts while they give the injection, and not for days afterwards like the tetanus vacccine I got my first HPV, a tetanus AND my flu shot all on the same day talk about sore arms!

[matagi]

As already mentioned the routine Pap smear looks for abnormal cells. It does not look for the presence of HPV. If you are concerned about HPV then you need to ask for additional testing to look for wart virus DNA.

[btchance]

A question for BTChance: Should all of us chickies get tested for HPV?

Grog did a good job of answering alot of the questions that came up, so thanks! I'll just reiterate a few things (and hopefully not confuse everybody).

The annual exam with a Pap smear determines whether or not you need to be tested for HPV or go directly to treatment for abnormal cells, and then does the test if needed, with the results of the Pap and HPV together guiding any treatment needed.

Basically - you can't treat the actual virus, you can only treat the problems the virus causes, like cancer and atypical cells leading up to cancer.

This is a little more info on Pap smears - you may be interested in this, or it may confuse you any more. It basically tells you when HPV testing is done, and when it's not, and the reasons for it.
- If the Pap is normal, no HPV testing is done - even if the virus is there, it doesn't matter b/c you can't get rid of the virus; you only treat if it causes a problem.
- ASCUS - atypical cells and they don't know what they mean - in this situation they do the test for HPV and the result determines the treatment; if positive, you get another exam looking for areas that need to be biopsied; if negative, you get another Pap smear at follow-up
- any other results (low grade, high grade abnormal cells) - almost all of these Pap smears are going to be HPV positive - they just go ahead and treat the cells and don't bother looking for the virus; whether or not it's there doesn't matter; you're treating the cells, not the virus.

[btchance]

Wow, BTChance. I have been misled and I thought I was fairly informed on the topic. My mother was diagnosed with cervical cancer and the post I wrote was based on information I had gathered at that time. So does having HSV increase the probability of having HPV? Are they linked in some way?

And +1 what Knott said.

Thank you so much for your information.

Wahine - herpes virus and HPV are confused pretty often unless you deal with both of them frequently. The difference between the two of them is that:
HSV - causes ulcers, no cancer
HPV - causes warts (growth-looking lesions) and cancer.
Having HSV indirectly increases risk of HPV just because they are transmitted the same way. It doesn't increase the risk in any other way that I know of.

[btchance]

RunningMommy,

I could be wrong, but two types of HPV are responsible for approximately 70% of cervical cancers (the viruses are labeled 14 and 16, I think). So, no, you do not have to have HPV to get cervical cancer, but it's most likely involved. Plus, the types of HPV that are linked to cancer are the ones that present no physical symptoms (like warts), so most women would have no idea that they were infected unless they were tested after a bad pap result.

You're right, you don't have to have HPV to have cervical cancer. It's just that the majority of cervical ca is caused by HPV.

There are different types of HPV that cause different problems (think of them like dogs - different breeds, each with different characteristics but the same basic make-up)

The ones that cause cervical cancer are 16 (50% of all cancers), 18 (10- 12%), 31, 33, 45, 53, and 58 making up the rest. The ones that cause genital warts are 6 and 11 which make up 90% of warts.

The vaccine only contains 16, 18, 6, and 11. So you can see that it does not prevent you from getting cancer or warts; it only decreases your risk. What I'm afraid of is that all of these women will get the vaccine and will assume that they don't need Pap smears, which they absolutely still do need. There is all this talk about risk factors for cervical cancer, but the main one is no Pap smears or infrequent Pap smears - if you have you're yearly Pap smear done, the risk of the abnormal cells progressing to cancer before they are caught is extremely low. So keep getting your Paps even if you get the vaccine. (okay, I'll get off my soap box now. This is just a pet peeve of mine, not watching out for yourself)

I know there are some more questions and I'll get to those in a bit. I've got some studying to do before a certification test tomorrow. I hope this little bit has helped, and I'll keep trying with any questions you ladies have.

[KnottedYet]

My doc knocked my Pap smears down to once every two years. All this is making me think maybe I should go back to once a year.

[Kitsune06]

This is just a pet peeve of mine, not watching out for yourself).

Damm straight, Btchance, that's my thought on it, too. People shouldn't complain that there are getting to be requirements on having said vaccine. If there're preventative measures out there, one should pursue them. When I can, I intend to get the vacc... I'm 22, so well under their '26' limit, and though I don't sleep around, one never knows. I'd rather be safe than sorry, especially with something like cervical ca and its precursors.

[kelownagirl]

It has never occured to me to ask to be tested for any of those. Should I be? I am obviously too old for any vaccines (46). Can you be totally symptom-free?

Knot - my doctor only wants to do a pap every 2nd year now too.

[LBTC]

Knot - my doctor only wants to do a pap every 2nd year now too.

Mine too. Must be the latest trend.


H&B
~T~

[btchance]

My doc knocked my Pap smears down to once every two years. All this is making me think maybe I should go back to once a year.

The guidelines are that if you are in a stable relationship and have had 3 neg Pap smears in a row, and they use a certain type of Pap, then you can go to every 2 years. you still need a pelvic every year to check the ovaries and uterus, but Paps can be every 2 years.

Edited to add: actually, I'm going to have to go back and double check something here. I know you can definately go to every two years in this circumstances, but there may be some other times. I'll get back to you in a bit on this one.

[annisk2000]

for those of us without a cervix, you too can get HPV and cervical cancer. I know it sounds crazy, but the cancer can sit up high in the "pocket" left after your cervix is removed.

HPV is rampant among single adults and unfortunatly there is no test for men so they dont' even know if they are carriers. Cervical cancer caused by HPV is usually of a slow growing type. As long as you have regular PAP's, you are in good shape. Once you have a positive PAP from HPV, and you are showing signs of displasia or growths, they usually recommend being checked every 3 months until you have 3 good PAP's in a row. It's actually rare to die from the type of cancer caused by HPV because most women get regualr check ups and it's caught early.

So, if you are "active" and have had a hysterectomy, it's still important to get a PAP. Especially if you've had more than one partner over the course of time.

The worst part is trying to sit in your saddle in the drops after having a Culpo and biopsy.