A recent study conducted by the Centers for Disease Control found that 60% of women with cervical cancer had not received the recommended screening before their diagnosis.
Many were unfamiliar with the risk factors associated with cervical cancer or did not understand the implications of their screening test results. Many lacked health insurance to pay for screenings.
“Screening helps identify early changes in the cervix that predate cancer. Through special examinations, we can identify more precisely what the abnormalities are and treat them as a way of preventing cancer,” said Dr. Iris Wertheim, a gynecologic oncologist at Open Door Family Medical Center, “With this type of early action, cervical cancer, for the most part, is preventable.”
In cases where cervical cancer is found, when it’s found early, it is highly treatable. But each year in the United States, an estimated 13,000 women are diagnosed with cervical cancer, and more than 4,000 women die from it.
Through a grant from the New York State Department of Health, Open Door offers cervical cancer screenings – as well as screenings for breast and colorectal cancer – as part of the New York State Cancer Services Program (CSP). A pap test and pelvic exam are offered to women ages 40 and older who live in New York State and lack health insurance or have health insurance that would make the cost of cancer screenings and diagnostic services prohibitive.
The overwhelming majority of cervical cancer is caused by the human papillomavirus (HPV), an extremely common virus that is spread through sexual contact. This is why the HPV vaccine is strongly encouraged for girls and boys at a young age, long before they are likely to become sexually active, and why regular screening is so important for women.
In its early stages, cervical cancer may present with no symptoms – which makes screening especially important, even for those vaccinated against HPV. Symptoms during the later stages may include irregular bleeding between periods; persistent back, leg and pelvic pain; leg swelling; fatigue; and vaginal discomfort or discharge.
If a Pap smear or HPV test show an abnormal result, additional tests are performed to confirm a diagnosis of early cervical cancer, which is rare and more commonly precancerous abnormalities called, collectively, dysplasia. Testing may include a colposcopy, 10 minute in-office exam of the cervix using a magnifying device where biopsies are taken if necessary; and a Loop Electrosurgical Excision Procedure (LEEP), a minimally invasive procedure done in an outpatient setting under local anesthesia to remove abnormal cells that may develop into cervical cancer.
Treatment of more advanced stages of cervical cancer include surgery, chemotherapy and/or radiation. “The whole goal of our cervical cancer prevention program, like screenings for other preventable cancers like colorectal and breast, is to avoid getting to that point,” said Dr. Wertheim.
Part of the problem, she said, is the stigma around cervical cancer screening. “We try to normalize exposure to HPV,” she said. “It’s not something to be ashamed of.”
HPV has a capacity for dormancy and may not show up for years, explains Dr. Wertheim. “Women will say to me, ‘I’ve only had one sexual partner in 15, 20 years, so how did I get this?’ That’s why education is the key.”
At Open Door, cervical cancer screening is incorporated into the primary care visit. “The fact that you can go for your physical at Open Door and get a pelvic exam during the same visit, so you don’t have to schedule a separate appointment with the gynecologist, is really important,” said Sara Hodgdon, who oversees the CSP program at Open Door. “And, as a medical home, Open Door contacts patients every three to five years to remind them that they are due for their cervical cancer screening.”
The New York State Cancer Services Program grant is administered by Hudson Information Technology for Community Health (HITCH), in partnership with Sun River Health. Screenings are available through CSP of the Hudson Valley for eligible individuals residing in Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster and Westchester Counties.
