Talking Cervical Cancer with Dr. Taylor Orellana

Screening, prevention are best defenses against cervical cancer

Routine screening for cervical cancer is a public health success and one of the best defenses against this disease, says Dr. Taylor Orellana, a gynecologic oncologist at MUSC's NCI-designated Hollings Cancer Center. Moreover, screenings are widely available at primary care and obstetrician gynecologist physician offices. We talked with Dr. Orellana, who is also an assistant professor of gynecologic oncology, about the cause of cervical cancer, treatments and how women can minimize their risk.

What causes cervical cancer?

Most cervical cancers are caused by HPV, the human papillomavirus. HPV is sexually transmitted and can lead to a precancerous condition called cervical dysplasia, as well as cervical cancer. Cervical dysplasia is highly treatable if caught early, which can prevent the progression to cancer.

What are the symptoms of HPV and cervical cancer?

HPV infection has no symptoms, but cervical cancer can cause pelvic pain, abnormal bleeding, heavier periods and bleeding with intercourse or sexual activity. Any woman experiencing these symptoms should be evaluated.

When should screening for cervical cancer begin?

Cervical cancer screening should begin at age 21 and continue every 3 years until age 29. Women between the ages of 30 and 65 should be screened every 5 years, and women who have had negative test results for cervical cancer can stop at age 65.

What does screening involve?

Your doctor will do a Pap test, which involves scraping the cervix for cells and analyzing them under a microscope for any abnormalities. HPV testing is also typically performed on the Pap smear to check for the presence of the HPV virus.

If a woman no longer needs a Pap test after 65, does she still need her annual gynecologic exam?

Absolutely, yes. We recommend all women have an annual gynecologic exam to make sure she has no abnormal symptoms and to be screened for signs of other cancers such as vulvar, ovarian and endometrial cancers. The annual visit is also the time to discuss overall health, including diet, exercise and emotional health, and if she is over 40, to schedule her mammogram.

Is cervical cancer survivable?

Cervical cancer is survivable and even curable for some patients. However, the best outcomes are for patients in whom cervical cancer is prevented, for example, by treatment of dysplasia, or diagnosis at an early stage. Prevention and screening are our best tools against this disease.

What are the treatments for cervical cancer?

Treatment for cervical cancer depends on the stage when it is diagnosed. In the early stage, the recommendation is a total hysterectomy — removal of the uterus, cervix and ovaries. In its advanced stage, when it has spread beyond the cervix, we recommend chemotherapy and radiation. At Hollings, our patients have access to the most advanced treatments and the advantage of being cared for by a multidisciplinary team of nationally recognized oncologists, radiation oncologists and staff dedicated to caring for patients.

How can HPV and cervical cancer be prevented?

The relationship between HPV and cervical cancer is the reason why the HPV vaccine was developed. When teens get the HPV vaccine, they are protecting themselves against HPV-related cancers because the vaccine provides long-term immunity against the most common strains of HPV. This is something we try to address from a public health standpoint. In addition to the vaccine, we recommend smoking cessation because tobacco use is associated with HPV infection and cervical cancer, and is one of the most modifiable risk factors for this disease.

At what age should someone get the vaccine?

The CDC recommends boys and girls get vaccinated between the ages of 11 and 12, but the vaccine can be given to adults up to age 26. The vaccine is recommended for women even if they have a history of cervical dysplasia or HPV infection.

What is the most prevalent gynecologic cancer?

The most common gynecologic cancer is endometrial cancer. But cervical cancer and vulvar cancer are prevalent. Even though vulvar cancer is a rare disease, it is also associated with HPV and tobacco use, and we diagnose and treat many cases of vulvar cancer at Hollings.

What do you want women to know about cervical cancer?

I emphasize that, even without a family history of cervical cancer, women must be screened. Unfortunately, a lot of women use their family history as a guide for themselves, and typically cervical cancer does not have a genetic or familial component like breast, colon or endometrial cancers.

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Dr. Orellana sees patients at MUSC’s Hollings Cancer Center and Florence Medical Center. To make an appointment at one of these locations, click on the links above or call 843-792-9300.