11 Things You Never Knew to Ask Your Gyno About Cervical Cancer
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Do you know someone who has had breast cancer? Chances are you can name one — or more — friend, relative or co-worker without giving the question too much thought. However, if I were asking about cervical cancer instead, you might need a little more time to think, and even then you may find yourself unable to call anyone to mind. But just because this gynecologic cancer occurs less frequently doesn’t mean it’s less deadly.
In fact, cervical cancer was once the No. 1 leading cause of cancer death for women in the US. What’s worse? The disease is almost 100 percent preventable. This fact is especially chilling for Latinas, who have the highest incidence of cervical cancer and the second-highest death rate from the disease. But how can we even know what to ask our gynos about cervical cancer if we have such a little understanding of it? In honor of National Cervical Cancer Awareness Month, here are some questions (and answers!) you never really knew to ask your gyno about this gynecologic disease.
Why is it that Latinas have a higher incidence rate of cervical cancer?
Despite the “spicy” stereotypes, Latinas’ high occurrence of cervical cancer is neither attributed to their sexual behavior nor their bodies. In fact, according to Dr. Cheryl Saenz, a professor in reproductive medicine and a member of the Gynecologic Oncology Group (GOG), the reason for the high rate is multifactorial. For starters, Saenz notes that Latinas face real monetary, cultural and linguistic barriers to health insurance and, thus, health care services. However, she also finds that many Latina patients seek help too late. This, Saenz believes, explains why the incidence rate of cervical cancer from 1999 to 2011 mostly decreased for women across race and ethnic lines, except for Latinas, who saw an increase. In other words: Latinas don’t see the same benefits from Pap smears as other women because they are already in advanced stages when they seek care.
I’m no longer planning on having babies. Do I still need a Pap smear?
Yes. While the median age for cervical cancer diagnosis is 49, Saenz has treated women as old as 70, long past their reproductive years. According to Saenz, the misconception that Pap smears are only necessary during reproductive ages also contributes to Latinas’ high cervical cancer rate. “Many Hispanic women in their 50s tell me ‘the last time I saw my gyno was when I was in my 30s.’ They don’t think to consider their own health care after their children. But the fact that you stop having children doesn’t mean you are no longer at risk,” says Saenz.
I was given the HPV vaccine. Doesn’t that mean I don’t have to worry about HPV or cervical cancer?
No. The HPV vaccine protects against 70 percent of cervical cancers occurring in North America. So while it’s very unlikely for someone who has been vaccinated to suffer from cervical cancer, it still remains a small possibility.
How early should I give my child the vaccine?
While the HPV vaccination is available for women as old as 26 and men through age 21, it is recommended that girls and boys start and finish the HPV vaccine series when they are 11 or 12 years old. “If we can vaccinate children before they can become exposed, then the chances of them getting HPV decreases to about a 30 percent risk,” said Saenz.
Will my children become sexually active once they’ve been vaccinated?
Not exactly. There are currently two studies published that look at the potential association between the HPV vaccine and risky sexual behavior, and both of which have found no evidence of an increase in sexual activity. However, many Latino parents, like families across the US, still believe that in giving their teenagers the vaccine, they will become sexually active. In fact, a 2012 study found that only 41 percent of low-income and minority adolescent girls who receive public health insurance initiated HPV vaccination, while just 20 percent completed the series. Saenz quells parents’ worries by sharing comparative scenarios. “I tell them, ‘I want you to think of the Hepatitis B vaccine. … It’s not that easily contracted; you’d need to get a blood transfusion. But we are not giving our children permission to be drug addicts. We are saying there is a virus, and it can cause you harm, and I’m going to do whatever I can to keep you from harm.’”
I’m lesbian. Do I need to worry about HPV or cervical cancer?
Yes. HPV is not exclusive to the act of intercourse; it can be passed along from skin-to-skin contact. Despite this fact, research from the University of Maryland School of Medicine shows that lesbians are less likely to undergo screening for cervical cancer than heterosexual women, putting them more at risk of developing the highly preventable cancer.
I’m asexual. There’s no reason for me to get a Pap test, right?
Wrong. While it’s not common, some cervical cancers arise without patients ever being exposed to HPV. Thus asexual people who don’t get Pap smears are still at risk for developing non-HPV-related cervical cancers. However, it must be noted that Pap tests can be extremely uncomfortable for someone who is sex-adverse. That’s why Saenz says clinicians must listen to individual patient concerns. “It’s important for women to be their own advocate and try to get regular checkups, but for some it is more traumatic for them. But there has to be something else. In my experience, it is pretty rare to not be able to work with someone to figure out how to care for a cancer that is almost preventable at this point.”
I’m transgender, genderqueer or gender noncomforming. Do I still need cervical cancer screenings?
Yes. Anyone with a cervix can contract cervical cancer, so this means that trans men, genderqueer and gender nonconforming people are at risk, too. However, because trans people often endure discrimination from health care providers and insurance plans, many are unable to obtain preventative care or simply avoid seeking it. In fact, according to a 2010 National Transgender Discrimination Survey, 50 percent of study participants postponed preventative care due to discrimination and disrespect from providers, while 19 percent reported being refused health care because of their gender identity.
According to Saenz, this is an emerging issue in healthcare, and medicine is just beginning to be more astute about the way they treat transgender cervical cancer patients.
Did I inherit this from my parents?
At the moment, Saenz says scientists see no gene that predisposes people to cervical cancer. However, because Latinas and Native Americans tend to have a higher risk of cervical cancer, she wonders if molecular markers of the disease may be found in the future.
Could my cervical cancer come back?
Yes. According to Saenz, about 10 percent of patients seem to have problems keeping the virus in remission. So cervical cancer survivors may have additional episodes of cervical dysplasia or the disease may affect other organs like the vagina, the vulva or the anus.
Can I expose my family to the disease?
Yes and no. Because condoms are not effective against HPV, it is very likely that one’s spouse or partner has already been exposed to the virus. However, it’s less probable for other family members to contract HPV.