With SMH Gynecological Oncologist Richard Boothby, MD
Welcome to “Ask an Expert,” a Q&A series with Sarasota Memorial’s health and medical experts, where you can get thorough answers to your health queries from a local source you can trust. Have question that you’d like to “Ask an Expert”? Email them to AskAnExpert@smh.com.
All women are at risk for cervical cancer. That’s the bad news. But the good news is that cervical cancer is highly preventable, and when it’s found early, it’s highly treatable.
To learn more about cervical cancer prevention and ways to screen for the disease, Healthe-Matters editors talked with Dr. Richard Boothby, a gynecological oncologist at Sarasota Memorial Hospital.
Ask An Expert Q&A
What is the leading cause of cervical cancer?
Almost all cervical cancers are caused by human papillomavirus (HPV), a common virus that is passed from person to person during sexual intercourse. Eight out of 10 people will get HPV in their lifetime, but few women will get cervical cancer. This is partly due to the success and availability of cervical cancer screening tests.
Preventative cancer screenings help medical teams find disease at an early stage, when it’s most curable and most treatable. Cervical cancer is the only gynecological cancer commonly screened for in women who have no symptoms or are not at increased risk for developing the disease. The test used to screen for cervical cancer and precancer is called a Pap smear.
All women should begin regular Pap smears at age 21. If the results are consistently normal, then it’s recommended to have the screening every three years from age 21 to 30. Women who are age 30 and older should also have regular testing for high-risk HPV; if results are negative, then HPV testing is recommended every three years, and if positive, then there is a algorithm to test for precancerous changes.
Pap smears can be done either at a gynecologist or primary care office, and in our area, they also can be obtained at the Sarasota County Health Department.
Who is most likely to get cervical cancer?
I’d say that about 60% of our patients who have cervical cancer are those who have not had regular screening. Either they've never had a Pap smear, or they have gone more than five years without one. The other 40% are women who have fallen through the cracks somehow, or have just not heeded doctors’ advice for follow-ups.
Moms actually make up most of that 60% without regular Pap smears — women who are so busy in their late 20s or 30s having and raising children that they neglect their own healthcare. These women often go from age 30 to 40, or even 45, without seeing their doctor or getting a Pap smear. And in that 10- to 15-year time period, they develop cervical cancer.
It is important to take care of your family, but it’s also important to take care of yourself. This is a perfectly preventable type of cancer, if women are regularly screened with Pap smears and do any needed follow-up steps.
How can I avoid getting HPV?
HPV is the most common sexually transmitted infection. The best way to avoid getting the virus is to be vaccinated with the HPV vaccine. The other way to avoid HPV is to avoid sexual intercourse, and that's usually not feasible for most folks.
There are no other ways to avoid getting HPV. There are no medicines that we can give patients to prevent it, and there are no other methods of birth control or anything that prevent an infection with HPV.
Cervical Cancer Screening
For cervical cancer screening, see your gynecologist, OB/GYN or primary care physician. For HPV vaccines, see your family physician, pediatrician or OB/GYN. If you need help finding a doctor, reach out to our HealthLine team at 941-917-7777.
Should everyone have the HPV vaccine?
We recommend the HPV vaccine for both males and females, from the ages of 9 to 45. The HPV vaccine has been given to millions and millions of people worldwide. It is very safe, and it’s very, very effective. It prevents 99% of cases of HPV-related illnesses; these include cervical cancer and genital warts, which can be very common in young women and men.
Early-age vaccination around age 11 or 12 is ideal. Children are getting other vaccines usually at that point in time, and this is when the immune system is most active; so a vaccination given at 11 or 12 has much more activity than one given, say, at age 25 or 26.
Also, most children are not sexually active at age 12, and it's much better to give the vaccine before the onset of sexual activity, so we are giving it to people before they can be exposed to HPV.
However, if it’s given after a person has become sexually active, it still reduces the risk of getting HPV. Those already infected with HPV should still get the vaccine as well — if they are younger than 26 — as it helps protect against other types of HPV that can lead to cancer.
The HPV vaccine should be given, again, both to boys and girls. While boys/men infected with HPV cannot develop cervical cancer, they can get other HPV-related cancers and genital warts. They also can spread the virus to their sexual partners.
CDC Recommendations for HPV Vaccination
The U.S. Centers for Disease Prevention and Control (CDC) recommends the HPV vaccine for:
• Girls and boys/women and men, ages 9 to 45.
• For those 9 to 14 years old, two shots of vaccine are recommended; the second shot should be given six to 12 months after the first one.
• For those age 15 and older, three shots of vaccine are recommended, and they should be given within six months.
Are there resources for families that are still on the fence about having their children vaccinated for HPV?
Studies show that the HPV vaccine does not increase sexual activity in boys or girls who are given the vaccine. It's also a very safe vaccine, but further information can be obtained from the child’s pediatrician's office. Mom's gynecologist's office should have all the information about the HPV vaccine also, as should the local Health Department branch.
For more on HPV and cervical cancer, check out this Healthe-Mattters post in our blog library.
Richard Boothby, MD, is an experienced gynecologic (GYN) oncologist known for utilizing state-of-the-art, innovative techniques that offer patients more options for diagnosing and treating gynecologic diseases. His specialties include minimally invasive and robotic surgical procedures for GYN cancers and conditions.