My Pap Smear has HPV: What does this mean?

HPV stands for human papilloma virus and is the most common sexually transmitted infection; it is also the virus that causes cervical cancer. If you have HPV on your Pap smear it does not mean that you have cervical cancer, but may be more likely to develop pre cancerous and cancerous changes in the genital and oral areas. For some women, your health care provider may suggest that you have more frequent Pap smears or a test called a colposcopy, a more detailed examination of the genital area. Most women who are infected with HPV do not know it, because most of the time there will be no symptoms.

Approximately 20 million Americans are infected with HPV and 6 million will be newly infected each year. Indeed, approximately 50% of sexually active women will be infected. About 1% of sexually active adults in the U.S. have genital warts at any one time.

There are more than 40 HPV types that can infect the genital areas of males and females. These HPV types can also infect the anal region, mouth and throat. HPV is passed on through genital contact, anal sex, oral sex and genital-to-genital contact.

A person can have HPV even if years have passed since he or she had sexual contact with an infected person. Most infected persons do not realize they are infected or that they are passing the virus on to a sex partner. It is also possible to get more than one type of HPV.

Most women do not develop serious problems from an HPV infection, and the vast majority of the time a woman’s immune system will clear the virus. However, HPV infections may lead to warts in the genital or oral areas (throat), precancerous and cancerous changes in the cervix, vulva and vagina, and head and neck (tongue, tonsils and throat).

The over 40 HPV types that can infect a woman are generally categorized as high-risk (linked to cancers and significant, high-grade precancerous changes) and low-risk (linked to warts and low grade precancerous changes). HPV infections can cause the cells of the genital and oral areas to turn abnormal. Genital warts can appear weeks to months after infection, cancer most often takes years to develop. If the immune system if effective at clearing the HPV infection, abnormal cells may also go back to normal. Women who have weakened immune systems due to conditions such as HIV or are on immunosuppressant drugs are at higher risk for some HPV-related problems.

HPV can be prevented though vaccines, condoms, and limiting the number of sexual partners. There are currently two HPV vaccines available, Gardasil and Cervarix. These vaccines do not protect against all types of HPV types and are targeted to the most common types. Gardasil protects against the two most common low risk types 6 and 11, as well as the two most common high-risk types 16 and 18. Cervarix protects against HPV types 16 and 18. To be most effective the vaccines should be given before first sexual contact. They are FDA approved for use up to the age of 26 years.

Condoms may lower the risk of transmission of HPV. To be most effective, they should be used with every sex act, from start to finish. They are, however, not 100% effective as the virus can still be transmitted through skin-to-skin contact.

If you do have the presence of an HPV infection, review management with your health care provider. Make sure that you get your Pap smears on a regular basis and recommended more intense screening for precancerous changes of the genital areas, such as colposcopy. If you are having anal intercourse, review this with your health care provider. Currently, there are no screening recommendations for the anal areas, however an anal Pap smear may be recommended. The HPV tests on the market are only used to help screen for cervical cancer. There is no HPV test approved for the mouth or throat. There are no formal recommendations concering head and neck screening for people with HPV. However, symptoms of a persistent sore throat; persistent hoarse voice, neck lump  or mouth lesions may be present. These should be reported to your health care provider. You should see a dentist on a regular basis and talk to your health care provider concerning seeing a head and neck physician for screening.

There is no proven effective treatment for the virus itself, but there are treatments for the diseases that HPV can cause. Eat a healthy diet rich in antioxidant nutrients with a variety of fruits and vegetables.

In summary, HPV usually goes away on its own, without causing major health problems. However, infection can lead to precancerous and cancerous changes of the genital, anal and head and neck areas. Review prevention and screening strategies with your healthcare provider.

Posted: October 23rd, 2010 | Author: | Filed under: cancer diagnosis & treatment, cancer prevention, general health, gynecology | Tags: | No Comments »


My Pap Smear is Abnormal: What does this mean?

First, take a deep breath and realize that if your Pap smear is abnormal it does not mean that you have cancer and that you are not alone. About 55 million Pap tests are performed each year in the United States. Of these, approximately 3.5 million (6 percent) are abnormal and require medical follow-up.. The Pap smear samples cells which are on the surface of the cervix and these cells are looked at underneath the microscope. The procedure is named after the doctor who first discovered that cervical cells changed before cancer of the cervix develops, Dr. George Papanicolaou. Cells on the surface of the cervix sometimes appear abnormal but are very rarely cancerous. The Pap smear was designed to pick up abnormal cells before they have a chance to become cancerous and having regular Pap smear tests and appropriate treatment and follow-up of abnormal results, significantly reduces the chance that cervical cancer will ever develop. Prior to the introduction of the Pap test, cervical cancer was a leading cause of cancer death in women, and still is in some parts of the world.  Since the introduction of the Pap test, deaths caused by carcinoma of the cervix have been reduced by up to 99% in some populations where women are screened regularly.  A healthcare provider may simply describe Pap test results to a patient as “abnormal.” It is important to remember that abnormal conditions do not always become cancerous, and some conditions are more likely to lead to cancer than others.

The cells of the cervix may be abnormal due to infection, lack of estrogen in older women, or precancerous changes. Although the Pap smear is not designed to reliably pick up abnormal cells from sources other than the cervix, some abnormal Pap smears may be due to vaginal, endometrial, fallopian tube, ovarian, or rectal abnormalities. Breast cancer cells have even been found in Pap smears, although quite rarely. The vast majority of precancerous changes in the cervix are due changes in the cells that cover the outer surface of the cervix, the squamous cells. Some precancerous changes will be due to the cells lining the inner portion of the cervix, called glandular cells. If any unusual cells are detected, further tests are done to determine if treatment is needed. This is the best way to find out if cancerous or precancerous cells are present.

Precancerous changes in the squamous cells of the cervix are referred to as cervical dysplasia or cervical intraepithelial neoplasia (CIN). If these type of changes are detected on your Pap test, they will be graded as mild (CIN 1), moderate (CIN 2), or severe (CIN 3). CIN 1 is also referred to as a low-grade squamous intraepithelial lesion (LGSIL) and CIN 2 and CIN 3 are referred to as a high-grade squamous intraepithelial lesions (HGSIL). Any of these changes require further discussion and evaluation with your health care professional.

We know understand that virtually all precancerous and cancerous changes in the cervix are due to the human papilloma virus (HPV), a very common, sexually transmitted virus. HPV infection is the primary risk factor for cervical cancer, however only a very small percentage of women with untreated HPV infections develop cervical cancer.  Approximately 80% of women will become infected with the HPV virus in their lifetime and many times there are no associated signs or symptoms other than an abnormal Pap smear. About 6 million new genital HPV infections occur each year in the United States. HPV may also cause vulvar, vaginal and rectal cancers. In most cases of HPV infection, the immune system quickly attacks the virus, and it is cleared from a woman’s system. For other women, the immune system does not rid the body of the virus, and a small number of these women will develop CIN. The development of CIN is more likely to occur in older women who have had HPV for a long time. Women who smoke and have HPV face twice the risk of developing CIN than women who do not smoke. The good news is that if you have regular Pap smear tests and appropriate, regular follow-up, it’s unlikely that cervical cancer will develop.

The most common system for describing Pap smear test results is the Bethesda System. The Bethesda System uses a number of terms to relate the results. Squamous intraepithelial lesion (SIL) describes precancerous changes in cervical cells. Using this system, your Pap smear test results may be:

  • Normal
  • Atypical squamous cells of undetermined significance (ASCUS) This is the most common abnormal Pap smear test result indicating the presence of cervical cell changes. This term simply means that the squamous cells of the cervix appear unusual and cannot be further categorized. These changes may be due to infections, thinning of the cervix and vagina in women who have low estrogen levels, or precancerous or cancerous changes.
  • Squamous intraepithelial lesion (SIL) This term describes abnormal cervical cell changes that may be a sign of precancer. SIL is either low grade (LGSIL) or high grade (HGSIL). LGSIL or HGSIL refers to the grade of dysplasia and CIN. LGSIL is indicative of either the presence of HPV or mild precancerous changes; this is a common type of abnormal Pap smear result. HGSIL, on the other hand, indicates more serious cervical cell changes.
  • Atypical squamous cells, cannot exclude HGSIL (ASCH) This Pap smear test result means there is uncertainty about whether HSIL is present.
  • Atypical glandular cells (AGC) This term implies precancerous changes to the upper cervix or uterus.
  • Cancer Hopefully, you will never get this result from your Pap smear. Having regular Pap smear tests can almost guarantee that you will never get a result of cancer
  • Endocervical and endometrial abnormalities can also be detected, as well as a number of infectious processes, including yeast, herpes simplex virus, and trichomonas.

What next?

Make sure that you review results with your health care professional. Many times, this will mean a trip to the office to review the meaning of an abnormal Pap smear and review recommendations for treatment.

Not all abnormal Pap smear test results require other tests and sometimes observation and closer surveillance will be recommended. The important thing is that you follow recommendations after having any type of abnormal Pap smear test result. In some instances, further investigation of the cervix with colposcopy will be recommended.

If the Pap test shows an ambiguous or minor abnormality, the healthcare provider may repeat the test to determine whether further follow-up is needed. Many times, cell changes in the cervix go away without treatment. In some cases, healthcare providers may prescribe estrogen cream for women who have ASC–US and are near or past menopause as these cell changes are often caused by low hormone levels. Applying an estrogen cream to the cervix for a few weeks can usually help to clarify the cause of the cell changes.

If the Pap test shows a finding of ASCUS, ASC–H, LGSIL, or HGSIL, the healthcare provider may perform a colpsocopy. A colposcope is a microscope that provides a closer view of the cervix. The colposcopic exam is similar to a regular pelvic exam and should only take a few minutes to perform. Anesthesia is not required.

Dilute acetic acid (vinegar solution) is placed in the vagina to help determine of there are any abnormal areas, they turn white and may be refereed to as aceto-white lesions. The colposcopy itself is painless, however if abnormal areas are seen, then very small (2-3mm) pieces of tissue may be removed in the form of a colposcopically directed biopsy. This may lead to a small about of pain, cramping and bleeding which usually rapidly resolves. This cervical tissue is then sent for laboratory evaluation. These biopsies cause no long-term damage to your cervix. Endocervical sampling may also be performed, which is a scraping from the inside of the cervix. This may also lead to cramping and spotting.

If the testing shows abnormal cells that have a high chance of becoming cancer, further treatment is needed. Treatment options include the following: LEEP (loop electrosurgical excision procedure) is surgery that uses an electrical current which is passed through a thin wire loop to act as a knife and is a larger cervical biopsy, CO2 laser which uses a narrow beam of intense light to destroy or remove abnormal cells, or conization which removes a cone-shaped piece of tissue using a knife, a laser, or the LEEP technique.

Summary:

Take a deep breath, the vast majority of abnormal Pap smears do not indicate the presence of cancer.

Follow your healthcare providers recommendations for treatment and follow-up.

Treatment of abnormal Pap smear test results depend on the type of cervical changes seen, the age of the women, and other individual circumstances.

With appropriate treatment, cervical cancer can be prevented in the vast majority of the time.

Resources:

http://www.cancer.gov/cancertopics/factsheet/Detection/Pap-tes

http://www.cancer.gov/cancertopics/factsheet/Risk/HPV

http://www.cancer.gov/cancertopics/understandingcervicalchanges

Posted: June 19th, 2010 | Author: | Filed under: cancer diagnosis & treatment, cancer prevention, general health, gynecology | Tags: , , , | 3 Comments »


Preventing Cancer Through Our Diets

Red Wine, Microwaves and Local Produce: Preventing Cancer Through Our Diets

Released: 2/12/2010 2:00 PM EST
Source: Wolters Kluwer Health: Lippincott Williams & Wilkins

Newswise — Eating a balanced diet and preparing your food in the correct way may be your best defense against developing cancer, according to top cancer researchers Professor Attilio Giacosa and Professor Jaak Janssens. In two interviews published on the LWWPartnerships website (www.lwwpartnerships.com) this month, Prof Giacosa explains how a preventative diet boosts the body’s natural defenses, while Prof Janssens discusses the latest developments in breast cancer prevention.
Prof Giacosa, head of the Department of Gastroenterology at Policlinico di Monza in Italy, is one of the most vocal supporters of the “preventative diet,” advocating the consumption of fruit and vegetables as one of the best means of cancer prevention. He explains that the benefit of fruit and vegetables has been proven “through epidemiological data and observations in population groups with cancer that were compared to age and sex matched groups without cancer.”
“If we look at the diet and eating habits of both groups,” Prof Giacosa explains, “case-control studies have irrefutably demonstrated a protective role of fruits and vegetables against many types of cancer in diverse social, environmental, geographic situations, especially for tumours of the lung, oral cavity, oesophagus, stomach, and intestine.”
Oranges, garlic, cabbage, broccoli, cauliflower and brussel sprouts are among some of the most beneficial foods. But it’s not only what we eat, but how we eat it, that optimizes the cancer-preventing qualities of fruit and vegetables.
“The optimal approach [is] to consume vegetables grown within zero kilometers [of where you live], in the right season,” he says, emphasizing that the way in which we prepare our food is also important. “Using proper tools like sharp knives [reduces] the waste of crucial essences,” he explains, adding that “it’s really important to promote microwaved and steamed cooking, two great techniques.”
Prof Giacosa also advocates the consumption of a glass or two of wine every day, as it contains “all the active principals of fruit, especially polyphenols – a component of great significance because even the very colour of wine, the colour red or ruby, the flavours, the fragrances, are tied to specific compounds linked to polyphenols, themselves extremely beneficial to our organism.” Red wine is said to be more beneficial than white, though Prof Giacosa warns that, as with any food, moderating your consumption is key to reaping the benefits.
In his discussion on breast cancer prevention, Prof Janssens, President of the European Cancer Prevention Organization in Belgium, agrees that a balanced diet is beneficial. Recognizing that breast cancer is said to originate almost entirely at puberty, Prof Janssens explains that “changing the lifestyle of children will have an effect on growth characteristics (for example menarche) and secondary on breast cancer risk.”
There is an increasing focus on preventative studies in oncology research, as Prof Janssens explains that “treatment of cancer is often mutilating and toxic, and above all not able to cure all patients. To reduce mortality and mutilation as much as possible, prevention is the next step to go. If we consider for example that almost 90 % of lung cancers are from smoking, cessation of smoking would decrease mortality up to 85%.”
He goes on to discuss how the focus on cancer prevention has seen a marked decrease in breast cancer mortality.
“The decrease in breast cancer mortality has been mainly achieved by earlier detection through innovations in mammography, ultrasound, and tissue acquisition,” he says. “Another important issue is women’s awareness. If they feel or see an abnormality, most women will seek immediate help. In addition, women at risk have been better identified by genetic testing, type of mammogram (dense breasts), and appropriately treated with hormonal medication.”
In the ongoing battle against cancer, methods of prevention are becoming an increasingly vital field of oncology research.

Posted: February 12th, 2010 | Author: | Filed under: breast cancer, cancer diagnosis & treatment, cancer prevention, weight loss | Tags: , , , | 4 Comments »