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Transcript
Katherine Banwell:
Before we start talking about screenings and detection, I’d like to start by understanding the basics. What does it mean when we talk about gynecological cancers? What types of cancers are involved?
Dr. Heidi Gray:
Yeah, so the cancers of the gynecologic tract encompass GYN oncology. So, cancers of the uterus, ovaries, fallopian tubes, cervix, the vagina, and the vulva.
Katherine Banwell:
Okay, and why is detection such a powerful tool in preventing more advanced disease?
Dr. Heidi Gray:
Yeah, that’s a great question. So, we know that when we detect cancers at an earlier stage or time in their development, that they always are more curable and more treatable. So, there’s a lot of focus on earlier detection of cancers, to be able to find them at an earlier time in their course, which will make them much more treatable and curable.
Katherine Banwell:
Mm-hmm.
Dr. Heidi Gray:
In addition, there’s also the role of screening. And screening is really looking at methods that detect cancer before it’s become cancer, or it’s precancerous, or in a state before it has turned into cancer. And that, of course, is very important because if you detect a patient or a disease before it’s become into cancer, then, of course, it is much more treatable and curable.
Katherine Banwell:
You’ve mentioned screening, and we’ve talked about why catching these cancers early is so important. I’d like to move on to how they’re detected. What are the current recommended screening guidelines for cervical, ovarian, uterine, and other gynecological cancers?
Dr. Heidi Gray:
Yes, so cervix cancer has been the most developed in terms of our understanding of how this cancer develops. And therefore, we’ve established really powerful tools to screen for precancerous states and prevent it from ever becoming cancer. Most notably, that most women know, is the Pap smear or Pap test – it is more commonly known. In addition, we know that the vast majority of cervix cancer is caused by a virus called HPV. And so, our screening detections of precancer for cervix entails screening both with a Pap test and with HPV.
Katherine Banwell:
So, how effective are tests like Pap smears and HPV testing, and even pelvic exams, at detecting cancer in its early stages?
Dr. Heidi Gray:
Yeah, so, incredibly effective. So, for cervix cancer, when you detect it before it’s become cancer – or what we call dysplasia or precancer – it can be treated either with minimal intervention or minimal harm to the patient and still preserve things like fertility and all of those other important issues for many women.
And it basically, if you fully treat something before it’s become precancerous, then the risk of it becoming cancer is essentially zero.
Katherine Banwell:
Are there patient-specific factors that can adjust the screening guidelines?
Dr. Heidi Gray:
There are, again, let’s talk a little bit about specifically cervix cancer prevention. So, the cervix cancer screening right now is age-related or age-focused. So, we recommend initiating screening with Pap tests at age 21 and then continuing that on for three years until age 29, where then we recommend dual testing with Pap tests and HPV testing every five years until age 65. There is a caveat that there was a new addition to adding HPV testing a little bit earlier. So, at age 25, women could also engage in HPV testing as a screen every five years, and then, as stated before.
So, age-related, because we know that it takes a fair amount of time with exposure to HPV before it turns into precancer or true cancer.
Katherine Banwell:
Dr. Gray, would you take a moment and define HPV for us?
Dr. Heidi Gray:
Yeah, yeah. HPV stands for human papillomavirus. So, it’s a virus that’s very common in humans. It’s found in men and in women. It’s ubiquitous, meaning it’s found – people are exposed to this kind of everywhere. And for most folks, when you’re exposed to HPV, your body can clear it or get rid of it, and it doesn’t cause any harm or disease. In a small portion of patients, however, the HPV lingers in the cells in the body, and in that group of patients, they can be at risk of developing precancer or cancer, particularly of the cervix. But also, HPV is related to cancers of the head and neck.
Katherine Banwell:
Okay, thank you for that.
Dr. Heidi Gray:
Mm-hmm.
Katherine Banwell:
Does the yearly well-woman exam cover detection well enough?
Dr. Heidi Gray:
Mmm, yeah, that’s a great question. I personally think that well-woman exams are very important. They cover a variety of topics. Obviously, my area of focus is on assessing and screening for risk of cancer, but there’s a lot of other very, very important topics that get covered during that visit. But particularly for the focus of finding, detecting either precancer or screening for cancer risk, parts of the well-woman exam – a lot of it is informational.
So, conversational, asking questions with the patient, screening for symptoms, talking about family histories, or screening for family histories of cancer, and assessing risk of cancer in families or genetic risk. And then, additionally, the physical exam does usually entail a pelvic exam where the female organs are evaluated and assessed in a very safe manner.