Anyone with a cervix should get their first Pap smear at age 21 and another every three years before turning 30. Those ages 30 to 65 should have a Pap test every three to five years.

“If you are younger than 21, the American College of Obstetricians and Gynecologists (ACOG) says you do not need this type of screening,” said Amy E. Farrell, M.D., OB/GYN with Norton Women’s Care.

What is a Pap smear test?

A Pap smear (also referred to as cervical cytology or Pap test and named for its developer George Papanicolaou, M.D.) can detect abnormal, precancerous cervical cells. 

Precancerous changes to cervical tissue, or cervical dysplasia, won’t cause any symptoms, but can be identified through lab testing. A Pap test is a very effective cervical screening test. Early detection allows for early treatment, which can be the most successful. A regular Pap smear can identify abnormal cervical cells before they develop into cancer. Even if cervical cancer has started to develop, a Pap test can detect it and lead to early treatment that can preserve fertility. 

READ MORE: What’s the right age to start getting Pap smear tests?

The test is very brief, and while it may be a bit uncomfortable, it doesn’t hurt. You’ll lie on your back with your feet in stirrups and a drape over your legs. Your gynecologist or other health care provider will insert a speculum in your vagina to hold it open to provide access to your cervix. A small brush collects cervical cells and is placed in a tube for testing.

For two days prior to your Pap smear test, refrain from vaginal sex, stop using tampons, vaginal creams, medicines, lubricants or douches. Schedule your appointment for after your period ends. If you have your period on the day of the exam, contact your provider, as menstruation could alter the results.

A pelvic exam is not the same thing as a Pap smear. Although they commonly occur during the same visit, both tests are not a requirement for every appointment. They serve as important ways to keep you healthy, including prevention of certain medical conditions and screening for cancer.

According to ACOG, a pelvic exam is not necessary — unless certain symptoms are present or there is a risk of specific conditions — but a patient and provider should make this decision together.

Is a Pap smear also an HPV test?

Cervical cells collected during a Pap smear are also tested for HPV, a very common virus that often has no symptoms and clears up in a year or two without causing cancer. An HPV infection that persists for many years can lead to precancerous changes that can develop into cervical cancer. 

HPV testing and vaccination can significantly reduce the risk of cervical cancer.

After an abnormal Pap test result

If you get an abnormal Pap test or HPV result, you and your provider will discuss next steps, which could include:

• A review of your medical history with an emphasis on relatives who may have had cervical or another gynecologic cancer
• A physical exam that includes feeling your lymph nodes for any abnormalities
• Follow-up test called a colposcopy: This test gives your health care provider a magnified view of the surface of your cervix. As with a Pap smear, you’ll lie on your back, and your provider will insert a speculum in your vagina to provide access for the colposcopy. The exam causes no more discomfort than a Pap smear. A weak solution of acetic acid (the same acid in vinegar) will be applied to your cervix to highlight abnormal areas. A small piece of cervical tissue may be removed for a biopsy to determine whether there are signs of cervical precancer, cancer or neither. 
• A cone biopsy retrieves a bit of tissue for testing and can serve as treatment by removing all the abnormal cervical tissue. The small piece of tissue is cut in the shape of a cone and may leave you with some discomfort for about a week.

The post What’s the right age to start getting Pap smear tests? appeared first on Norton Healthcare.

Ways to help prevent cervical cancer

The best steps that can be taken to prevent cervical cancer include the following:

• Vaccinations (the Gardasil vaccination can be given to boys and girls as young as 9 and young adults up to age 45)
• Minimizing exposure (abstaining, wearing barrier protection such as condoms, having fewer partners)
• Following recommended screening guidelines

“This is one of the truly curable gynecological cancers if detected at an early stage,” said Justin W. Gorski, M.D., gynecologic oncologist with Norton Cancer Institute. “The Pap smear really does save lives, and the vaccine is a complete game changer. It gives us the opportunity to eradicate cervical cancer if widely used.”

READ MORE: What’s the right age to start getting Pap smear tests?

Screening for cervical cancer

Cervical Pap screenings should begin at age 21. Based on the results, a patient then can continue with routine screening or begin more intensive surveillance. The screening also can detect whether steps need to be taken to address any concerns.

Early signs of cervical cancer

Often there are no signs, which is why regular screening is so important. Abnormal screening Pap smears, bleeding after intercourse, irregular bleeding, discharge or pain can be signs associated with cervical cancer.

Risk factors for cervical cancer

The biggest risk factor is exposure to HPV, a virus that is widespread. There are hundreds of strains of HPV. Some of these are considered “high risk” strains for developing cervical cancer. Most sexually active women will be exposed to HPV at some time in their life.

In addition to HPV, smoking and immunocompromised states (HIV, transplant patients on anti-rejection medications or other immunosuppressive medications) are additional risk factors for developing cervical cancer.

What’s the latest treatment for cervical cancer?

Standard treatment for cervical cancer typically includes surgery (only if it is caught early enough), radiation with chemotherapy, or chemotherapy alone. If the cancer returns or progresses, additional chemotherapies or clinical trials may be available.

How will the HPV vaccine for boys prevent cervical cancer?

Vaccinating both girls and boys could reduce the incidence and prevalence of the viruses that cause cervical cancer. So far in studies, vaccine efficacy against HPV is very high — 90.4%.

The post How to prevent cervical cancer appeared first on Norton Healthcare.

“Providers and patients alike need to realize that the risk of sexually transmitted infections, including HPV, are still present in nonheterosexual relationships,” said Jordan Hatchett, APRN, gynecologic oncology nurse practitioner with Norton Cancer Institute.

STIs, including HPV, can be transferred orally, anally, skin to skin and even from sharing toys during sex. Being aware of the risks to your health is important in protecting yourself and your sexual partners.

“Many, independent of their sexuality, do not realize the relation between HPV and cervical cancer,” Jordan said.

Routine Pap tests are recommended every three years from ages 21 to 29. For ages 30 to 65 there are three choices for screening: a Pap test every three years, a high-risk HPV test every five years or co-testing with a Pap test and high-risk HPV test every five years.

Pap tests can help detect HPV and other health issues that could lead to cervical cancer.

“Pap smear testing is important because early detection can allow intervention before an abnormal Pap smear turns into cancer,” said Lynn Parker, M.D., gynecologic oncologist at Norton Cancer Institute.

Barriers to care

Understanding health risks is important to your sexual health. However, like many in the LGBTQ+ community, lesbians face other barriers that may keep them from seeking medical care.

Lesbians have tended to seek out cancer screenings less than heterosexual women, according to Jordan.

READ MORE: What’s the right age to start getting Pap smear tests?

“If lesbians have fewer cancer screenings, a diagnosis is more likely to happen at a later stage when it’s more difficult to treat,” Jordan said. “Trust in the provider is a major barrier. Lesbians sometimes do not feel comfortable ‘coming out’ to their provider for fear of poor treatment or judgment.”

Norton Healthcare’s hospitals, along with Norton Cancer Institute. have earned the Leader in Healthcare Equality designation by the Human Rights Campaign. LGBTQ+ patients can find Norton Healthcare providers who have stepped forward as inclusive providers to make LGBTQ+ patients feel comfortable.

“As gynecologic oncologists, it is important that everyone we see feel included and comfortable discussing all aspects of their health,” Dr. Parker said. “We want to be advocates and a source of information for everyone.”

The post Lesbians and bisexuals are at risk of HPV and delayed treatment for cervical cancer appeared first on Norton Healthcare.

Here’s a guide to tests that can detect cancer and who should get checked when.

Breast cancer

Mammogram — an X-ray of the breast — is often the most effective way of spotting breast cancer early when treatment can be more than 90% successful. Mammograms expose you to low-dose radiation, and for most people in the following age ranges, the benefits of regular mammograms outweigh the risks of radiation exposure.

READ MORE: What’s the right age to start getting Pap smear tests?

• Women age 50 to 74 and at average risk: Every two years, according to the U.S. Preventive Services Task Force (USPSTF).
• Women age 45 to 54 and at average risk: Annually, according to the American Cancer Society.
• Those at high risk of breast cancer because of family history or their own medical history may start screening before age 40 in consultation with their health care provider.

Cervical cancer

Pap smears can detect precancerous cells that can develop into cancer without treatment. The HPV test looks for the human papillomavirus that can trigger the cells to develop into cancer

• Age 21 to 29: Pap smears should start at age 21. A normal test may allow you to wait three years for your next test.
• Age 30 to 65: Talk to your health care provider about what’s right for you. A normal Pap smear may allow you to wait three years before another. A normal HPV test may allow you to wait five years for the next one. If both tests conducted at the same time are normal, you may be able to wait five years to do it again.
• Over age 65: Your provider may advise that you don’t need screening anymore if you’ve had normal screenings for several years or if you’ve had your cervix removed as part of hysterectomy, for instance.

Colon cancer

Colon cancer typically starts with precancerous polyps in the colon or rectum. Once detected, the polyps can be removed before they turn into cancer. A colonoscopy is very thorough and allows the physician to remove any polyps or other suspicious tissue for testing. Stool tests collected at home can be almost as accurate as a colonoscopy, but don’t allow for immediate treatment.

• Age 45 to 75 and at average risk for colon cancer: People in this age group should get a colonoscopy every 10 years. Black adults across all age groups, including under age 50, have colon cancer more frequently and are more likely to die of colon cancer than white adults.
• Age 76 to 85: Talk with your health care provider about your overall health and prior screening history. Current evidence shows there is little benefit in screening everyone in this age group.

Lung cancer

Low-dose computed tomography (low-dose CT scan) is used to screen for lung cancer. The test is quick and painless, but carries risk from low-level radiation exposure.

• Age 50 to 80 with a 20 pack-year smoking history and a current smoker or quit within the past 15 years (A pack year is measured by multiplying the number of packs smoked each day by the number of years. One pack per day for 20 years would be 20 pack years and two packs per day for 20 years would be 40 pack years.)

Screening for ovarian, pancreatic, prostate, testicular and thyroid cancers has not been shown be effective at reducing death, according to the USPSTF.

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“What drives me is we can cure people; we can help people. What drives me every day is to see patients do well,” said Dr. Parker, who trained at the world-renowned MD Anderson Cancer Center in Houston, Texas.

Rapid medical advances are improving the odds significantly for ovarian, uterine, cervical, endometrial and other cancers in the reproductive organs. Unfortunately, even some physicians may not know about many of the new treatments, according to Dr. Parker.

“We can be very successful,” she said. “It’s just a matter of making sure people are aware of the options they have and that our specialty exists. It’s a really exciting time in gynecologic oncology. I don’t want people to get misinformation that there’s not something that can be done to help them when there is.”

Getting the news to patients and primary care doctors alike

To that end, Dr. Parker is on the Communications Committee of the Society of Gynecologic Oncology, an international professional organization.

“We try to get the word out, either through social media or websites,” Dr. Parker said. “To me it’s not only about getting the word to the patients but to the primary care doctors.”

Dr. Parker recalled a patient who was told by her doctor to go home and get her affairs in order because nothing could be done. Dr. Parker saw the patient and started treatment.

“She lived another six years. She had six years with her kids that she otherwise would not have had,” Dr. Parker said.

As a gynecologic oncologist, Dr. Parker performs surgery and sees patients in the office.

Combining a love of science and caregiving

Dr. Parker grew up in a small town in southern Illinois, the daughter of a dentist. Her grandparents lived close by, and she helped care for her grandfather, who had rapidly progressing rheumatoid arthritis.

“I loved science. I loved caregiving. That was a way I could make an impact and help people,” she said.

Dr. Parker completed a combined six-year undergraduate and medical degree at the University of Missouri-Kansas City before doing her medical residency at the University of Oklahoma, Oklahoma City. She then completed a fellowship in gynecology/oncology at MD Anderson.

Dr. Parker is passionate about keeping up with research and what the latest treatments can do for patients.

“I have patients, in the old days, we would say you have nine to 12 months to live. Now I give them a new chemotherapy combination and the tumor goes away. To me that’s very exciting,” she said.

Applying rapid advancements in treatment

Other new treatments include immunotherapy, which uses a patient’s own immune system to fight cancer; PARP inhibitors, which kill cancer cells by stopping them from repairing themselves; and so-called VEGF (vascular endothelial growth factor)

drugs like bevacizumab, which starve tumors by preventing them from forming new blood vessels.

Research also has shown that most cancers that were once thought to arise in the ovary have their origin in the fallopian tubes, according to Dr. Parker. That means cancers potentially can be prevented. For example, if a woman is having a hysterectomy for reasons other than cancer, the fallopian tubes also can be removed.

Genetic testing also is improving, which will help pinpoint which women are most at risk.

“Now we can do very significant profile testing and potentially protect women from ever getting cancer,” Dr. Parker said. “I would love to go out of business for that reason.”

Even with an eye on the latest research, Dr. Parker never loses sight of her patients.

“My patients are amazing people,” Dr. Parker said. “I’m very proud my patients feel at home when they come see us. So much of that is lost in modern medicine. To me it’s about making patients feel like they’re part of a team, part of a family.

“Cancer is so overwhelming you want to know they can always reach you to talk to you. They can ask us all the questions they want. If I don’t know the answer, I will find someone who does.”

In medical school, Dr. Parker met her husband, John Parker, M.D., a neuropathologist who teaches medical students and neurosurgery residents at the University of Louisville School of Medicine. Together, they have a teenage daughter. In her free time, Dr. Lynn Parker likes spending time with her family and spending time outdoors.

The post Making sure patients, physicians know about the advances in treating female cancers appeared first on Norton Healthcare.

In February, he’ll be taking his surgical expertise to women in Chinandega, Nicaragua. Access to health care is an issue in the second poorest country in the Western Hemisphere.

“There are many women in Nicaragua who need help for gynecological issues,” said Dr. Doering, who is a gynecologic oncologist with Norton Cancer Institute and is also board certified in obstetrics and gynecology. “This includes fibroids, stress incontinence and pelvic organ prolapse.

“By providing my services as part of a mission trip, I hope to help women who otherwise would have to live with their symptoms.”

At Norton Women’s & Children’s Hospital, Dr. Doering is part of its designation as a Center of Excellence in Robotic Surgery and Center of Excellence in Minimally Invasive Gynecology. In Nicaragua, he’ll have to do things the “old school” way.

“In the United States we have access to the latest advancements for care,” Dr. Doering said. “If we’re lucky, we’ll have access [in Nicaragua] to some laparoscopy equipment for some minimally invasive techniques.

“If not, we’ll need to use other surgical approaches.”

Norton Healthcare is donating surgical instruments to assist his efforts.

The post Surgeon’s mission trip takes expertise in women’s surgery to Nicaragua appeared first on Norton Healthcare.

Completion is planned for February 2020, with two downtown campus locations getting a makeover.

Norton Cancer Institute – Downtown (676 S. Floyd St.)

• New clinics will serve patients with urgent care needs related to cancer, hepatitis C and sickle cell disease.
• Advanced radiation therapy services will continue to anchor the first floor.
• New multidisciplinary care space will be created for the Head, Neck and Skin Cancer Program and Comprehensive Lung Center.
• Current skin cancer resources will be expanded to include innovative new technology.
• A state-of-the-art oncology pharmacy and an expanded chemotherapy and infusion suite are being added to the third floor.

Norton Cancer Institute Women’s Cancer Center (234 E. Gray St.)

• The new women’s center on the first floor will include offices for gynecologic oncologist Lynn Parker, M.D. along with six large gynecologic oncology exam rooms.
• A new expressive art and music therapy suite will be located on the first floor.
• Offices for Norton Cancer Institute’s research program will occupy part of the second floor.
• A new central call and scheduling center, plus space for the financial services team, will be on floors five and six.
• Additional plans include a multidisciplinary breast health clinic led by medical oncologist Laila S. Agrawal, M.D.
• A designated pull-in valet area will facilitate quick service for those visiting for outpatient blood tests.

The post Women’s cancer facilities and specialized urgent care part of renovation appeared first on Norton Healthcare.

• A test for high-risk strains of human papillomavirus  (hrHPV) every five years
• A Pap test (cervical cytology) every three years, or
• Co-testing with both the HPV and Pap test every five years.

Keeping with its past guidelines, the task force continues to recommend that women ages 21 to 29 should be screened every three years using a Pap test (also called a Pap smear).

Related: Can you get a Pap smear or pelvic exam on your period?

David L. Doering, M.D., gynecologic oncologist with Norton Cancer Institute, said it is important to understand screening recommendations and guidelines are about analyzing and evaluating risks and benefits on a large scale across numerous tests. Overscreening can lead to false positives and unnecessary procedures, but underscreening can lead to a missed chance to catch early abnormal changes before they become cancerous.

“We know that stage one cervical cancer is relatively easy to treat with good outcomes. After stage two, cervical cancer is harder to treat, plus the risk of spread goes up as the stage of cancer goes up,” Dr. Doering said. “The ultimate goal of screening is to detect lesions in the pre-invasive phase, when they are easily cured, with very little risk of complications or side effects.”

According to Dr. Doering, the new guidelines (published in the journal JAMA) raise some concerns. For one thing, the false positive rate for HPV testing alone is yet unknown. For another, they conflict with current American College of Obstetricians and Gynecologists guidelines, which advise against HPV testing alone.

Who can forgo screening?

The task force recommends against cervical cancer screening for women under age 21. Also, the group does not recommend HPV testing for women ages 21 to 29. This is because HPV infection is common in this age group, but such infections often are able to clear on their own.

Women over age 65 can skip annual screening if they have had adequate prior screening and have no history of being at high risk for cervical cancer.

Screening is not recommended for women who have had a hysterectomy with removal of the cervix and no history of a high-grade precancerous lesion or cervical cancer.

Regular screening is key

By most measures, cervical cancer screening in the United States qualifies as a real success story.

READ MORE: What’s the right age to start getting Pap smear tests?

The U.S. Preventive Services Task Force reports that the number of deaths from cervical cancer nationwide has decreased substantially since the start of widespread cervical cancer screenings. From 2000 to 2015, deaths from cervical cancer dropped from 2.8 to 2.3 deaths per 100,000 women.

The task force emphasizes that for women ages 30 to 65, getting screened on a regular basis is far more important than which of the three recommended screening approaches is used.

The post Beyond the Pap smear: What you need to know about new cervical cancer screening guidelines appeared first on Norton Healthcare.

A wellness exam includes a pelvic exam, breast check, Pap smear and a mammogram, depending on your age. Getting your yearly screenings can help you stay healthy and possibly find cancer early — when treatment may be easier and more successful.

Can you prevent cervical cancer?

Every year in the United States, 31,000 women and men are diagnosed with a cancer caused by human papillomavirus (HPV) infection. HPV is very common; one in four people currently have the virus in the U.S., according to the Centers for Disease Control and Prevention (CDC).

HPV can cause cancers of the cervix, vagina, vulva, anus, rectum and back of throat in women. In men, it can cause cancer of the penis, anus, rectum and back of throat. Most of these cancers can be prevented with the HPV vaccine.

READ MORE: What’s the right age to start getting Pap smear tests?

The CDC recommends that boys and girls get two shots of the HPV vaccine at least six months apart at ages 11 or 12, finishing the series before turning 13.

Are you under 26 and have never been vaccinated? You still may qualify for the vaccine. Talk with your health provider about getting the HPV vaccine.

My Pap smear was normal last year. Do I need a women’s wellness exam this year?

The U.S. Preventive Services Task Force recommends women ages 21 and 65 get a Pap smear once every three years. Checks for breast cancer and other conditions should be more frequent, so schedule a wellness exam every year. That applies to millennials too.

In those off years, your provider will give you a pelvic exam to check for any changes, even though a Pap smear will not be performed.

The post Women’s wellness exam: An annual check can catch cervical cancer appeared first on Norton Healthcare.