HPV, Pap Smears and Cervical Cancer Screening: Clearing the Confusion

Summary

In this episode of the Integrative GYN podcast, Dr. Whitney West and Dr. Gabrielle Hawkins discuss the critical topic of cervical cancer awareness, prevention, and treatment. They delve into the importance of cervical cancer screening, the role of HPV in cervical cancer development, and the significance of vaccination. The conversation also covers updated screening guidelines, risk factors, symptoms to watch for, and treatment options for cervical cancer. The episode emphasizes the need for women to advocate for their health and maintain regular gynecological visits.

Takeaways

Cervical cancer is one of the most preventable cancers.
The pap smear is essential for early detection of cervical cancer.
HPV is a common virus that can lead to cervical cancer.
Vaccination against HPV is crucial for prevention.
Screening guidelines have changed over the years.
Immunosuppression and smoking are significant risk factors for cervical cancer.
Abnormal bleeding should never be ignored.
The HPV vaccine covers most strains that cause cervical cancer.
Regular visits to a gynecologist are vital for women's health.
Women should advocate for their health and understand their test results.

Chapters

00:00 Introduction to Cervical Cancer Awareness
02:31 Understanding Cervical Cancer and Its Prevention
05:13 The Importance of HPV Vaccination
09:23 Current Guidelines for Cervical Cancer Screening
14:54 Identifying Risk Factors for Cervical Cancer
18:54 Recognizing Symptoms of Cervical Health Issues
20:02 Understanding HPV Vaccination Effectiveness
22:15 Treatment Options for Cervical Precancer and Cancer
27:11 The Importance of Open Conversations About Cervical Health
30:58 Advocating for Your Health and Understanding Screening Guidelines
32:36 Empowering Women to Take Charge of Their Health

Resources: 

CDC (cdc.gov/cervical-cancer/screening/index.html) 

American Cancer Society (cancer.org)

National Cancer Institute (cancer.gov)

https://www.cancer.gov/types/cervical/screening/abnormal-hpv-pap-test-results

Connect with Dr. Whitney West

Instagram: @ehwellnesspc

Facebook: Essential Health & Wellness PC

website: https://www.eh-wellnesspc.com

email: info@eh-wellnesspc.com

“You’ve been listening to The Integrative Gyn with Dr. Whitney West — because your health deserves more than fifteen minutes.”

The information shared in this podcast is for educational and informational purposes only and is not intended to be medical advice. This podcast does not establish a physician–patient relationship and should not be used as a substitute for individualized medical care. Always consult your own physician or qualified healthcare professional regarding medical decisions or concerns specific to your health.

Transcript

Dr. Whitney West (00:01.576)
Well, welcome back to the integrative GYN podcast where women's health gets the time and attention it deserves. I'm Dr. Whitney West. January is cervical cancer awareness month and cervical cancer is one of the most preventable cancers yet women are still being diagnosed every year. We are here today to shed light on confusion and provide clarity regarding cervical cancer screening and HPV and its vaccination.

Gabrielle Hawkins (00:16.334)
Thank

Dr. Whitney West (00:29.748)
Today I'm with my good friend and colleague, Dr. Gabrielle Hawkins, who is a gynecologic oncologist, let's say that three times fast, right? Who is here to help us, help the listeners understand the importance of screening, who's at risk and what we can do about it. So welcome Dr. Hawkins to the Integrative GYN. Well, I'm glad you could take the time to

Gabrielle Hawkins (00:37.966)
I know, it's always a mouthful.

Gabrielle Hawkins (00:53.678)
Thank you so much for having me. This is such an honor.

Dr. Whitney West (00:58.686)
to join us today to help us understand what is going on. So at the time of this recording, we're at the end of January. So I wanted to get this out to the listeners so they can understand what's going on. So before we get started on the cervical cancer screening and awareness and all that kind of stuff, just tell me a little bit about yourself.

Gabrielle Hawkins (01:21.036)
Yeah, so like Dr. West said, I'm Gabrielle Hawkins. I'm a board certified gynecological oncologist. So I currently practice in South Louisiana. I'm in Baton Rouge. I was born and raised in Houston, so not too far from home. I also practiced in North Alabama for a little while, and I trained in North Carolina. So I've been in states where there's very large rural populations, and cervical cancer has been very prevalent in each of those. So I do spend a lot of my time talking and educating about cervical cancer awareness, as well as our other gynecologic cancers.

And so super excited to share those conversations with you guys, normalized discussions around cervical cancer and HPV. And I'm ready to get started.

Dr. Whitney West (02:01.234)
Okay, well let's do that. as we get started, let's tell me first, we'll tell the listeners first, why is cervical cancer, why does it matter?

Gabrielle Hawkins (02:10.85)
Yeah, so cervical cancer as a gynecological oncologist, cervical cancer is the one time where we can talk about prevention, right? And so we know that cervical cancer is very preventable. From a GYN cancer standpoint, it's the only cancer that we actually have a screening test for, right? So everyone knows about mammograms and colonoscopies, so for breast cancer screening and colon cancer screening. But the pap smear is the only thing that we have that screens for cervical cancer. And for GYN cancer, that's a really big deal. And so it is something that can happen with your regular gynecologic provider, your gynecologist. And it is preventable because the pap smear can screen for precancers of the cervix, which we'll talk about likely a little bit later. But screening for those precancers is really what helps prevent the development of cervical cancer.

Dr. Whitney West (03:02.626)
Awesome. So, well, now that you just said that, how does cervical cancer typically develop?

Gabrielle Hawkins (03:09.26)
Yeah, so cervical cancer, like many cancers, start out, have cells that are normal and some change happens in those cells and then they don't die when they're supposed to, which means they kind of outlive their lifespan, which means they can change and they can grow and turn into abnormal cells. And so the most common reason why that happens for cervical cancer is with the HPV virus. And so the HPV virus is a very, very common sexually transmitted infection. So most people who've had any type of sexual contact, so that's anal, vaginal, and oral sex, you can acquire HPV. And so that HPV virus is the cause of the majority of cervical cancers, not all, but the vast majority of cervical cancers. And so that virus itself kind of gets into the cell, causes changes that allows that cell to grow out of control. And so the screening that we do with pap smears helps pick up any of those abnormal cells before they turn into cancer. And that's really where we want to try to intervene prior to the cells changing enough to turn into cancer.

Dr. Whitney West (04:14.324)
 how long does it usually take for the abnormal cells to progress to something concerning?

Gabrielle Hawkins (04:20.8)
Yeah, so it usually takes a while. So we used to quote somewhere around a decade, right? So it's usually someone who hasn't had cervical cancer screening in a long time. But somewhere anywhere from a few years to a decade is what I would say, because I've certainly seen people fall outside of that range. But it usually takes a while, which is why catching those pre-cancers and following up is super, super important, because it does typically take a long time to turn into cancer. And if we can pick things up early on, we can really prevent development of cancer.

Dr. Whitney West (04:53.674)
So I have found myself having to kind of talk people into HPV vaccination. So that's one of the questions I ask when they come into the office. And I say, have you gotten the HPV vaccine? And I have to remember how old I am versus when the vaccine came out and how old they are. So most of my patients are within the age range of being able to have had it. But I realize it is not one of the required and if your pediatrician doesn't, you know, ask you whether you want it and you don't ask for it, then you may miss it. Right. So can you explain HPV and, kind of try to reduce the fear and the stigma surrounding it? Cause you know, there's, you know, advertisements out now, for the vaccination.

Gabrielle Hawkins (05:31.148)
Right, you might not get it. Exactly.

Dr. Whitney West (05:48.795)
Trying to get the word out and stuff like that. But can you explain what it is to them? I guess what the vaccination will do and why we need to get that vaccination

Gabrielle Hawkins (06:00.276)
Right, right. So I'll explain kind of twofold. The way that most patients should come to me is having had the vaccine, and then the reason why I recommend the vaccine. So for vaccine, normal vaccine schedule, we recommend HPV vaccine somewhere between age 9 to 12, which gives parents a lot of concern, right? And so those are conversations that you're often having with the pediatrician. And so if they don't bring it up, it's important for you to bring that up. The reason to give the vaccine earlier in age, again, you have to know your child, have a conversation with your doctor. Nothing is written in stone. But the goal of giving the vaccine earlier is to give it prior to first sexual contact of the child. And this is for boys and girls. I know our audience is mostly women, but they often have children, So boys and girls, because even though we're only, we find out that women have the HPV virus because we're testing for pap smears. know, that transmission is happening both between men and women, whether you're in a heterosexual relationship or a homosexual relationship, it doesn't matter, it's being transmitted. And so the goal is to get that vaccine in place prior to exposure because it's going to have the best effectiveness. And so it's a three vaccine series, it happens over the course of six months.

Like I said, ideal age is 9 to 12. There's a catch-up schedule for older children. And then I would say for that population who's between 18 and 26, you're now an adult. If you didn't get vaccinated, you have the opportunity to make that decision for yourself once you've been educated about it. And so if you do plan on being sexually active at some point in your life, it's quite possible you would contact the HPV virus. And prior to having that sexual contact, I would encourage you to have that the vaccine because it's going to be the most effective. Now, the second reason that I recommend it is I take care of a lot of patients who have cervical precancers or what we call cervical dysplasia is the other word you'll hear. And so for those patients, we do know that vaccination up through age 45, because it is approved through age 45, does decrease the risk of recurrent high grade precancers. And those high grade precancers have the highest risk of turning into cancer.

And so that's the most common reason why I recommend it. But those are the two reasons. And so the goal again is to get the vaccine there prior to contact with the virus so you have the best opportunity to fight it. It's no different than the flu vaccine, right? That's the same reason why we talk about getting vaccinated early in flu season so that your body can mount a response if you come in contact with it. And it's no different than this.

Gabrielle Hawkins (08:39.726)
And so that's the same for RSV, when thinking about children. And so that's a newer vaccine, but it's kind of the same idea, right? To have some protection, your body to build some protection prior to getting exposure to it.

Dr. Whitney West (08:55.732)
So we know that, well, me as a general gynecologist, there are the guidelines for when and how a pap smear should be done and how often HPV should be tested and it's changed over the years. I'll say also, I see a lot of patients who may have seen their primary care doctor and they're still going off old guidelines and that kind of thing. So can you explain what the guidelines are and why and how did they change over the last, I guess, decade.

Gabrielle Hawkins
Mm-hmm. Yeah, yeah. So a couple parts to that question. So you are absolutely right. I was actually sitting in a forum a couple years ago, and someone said, you start pap testing for sexual contact, which is not true and hasn't been true for a long, time. So that's not true. The first thing that I will say is that the standard guidelines that are published, right? This is for a healthy woman, healthy person with the cervix, right, who has no medical conditions that increase their risk for cervical cancer development. And I'll explain what that means in a second. So this is standard recommendations for a healthy person. And so for that, the reason why the guidelines have shifted over time, why we don't test at the time for sexual contact anymore, as we've seen that there isn't a significant improvement in detection of cervical precancers and cancers, but the HPV virus is also much more common at that age. And most of those patients are going to rid their bodies, immune system is going to identify it, or they've been vaccinated, their body will identify it because of the antibodies produced and get rid of that virus, and get rid of the virus altogether. And so we were really over treating a lot of patients without making significant strides in decreasing a person's cancer risk. So that age was increased to 21 based on years of looking at data and outcomes based on cervical precancers and cancers. So PAP testing should start at age 21, again, standard healthy individual. And then the recommendation is that PAP testing, if you've had routine testing, right, that's the caveat. If you have had routine testing, stop at age 65. And so that is the timeframe, 21 to 65 and that is with routine testing. The challenge is people move, right? People don't have their records, et cetera. And so I do have this kind of split, right? Where I see patients who are in their late 60s, 70s, who develop cervical cancer, and it's because they haven't been to the doctor usually in 20 years or after they had their last child, which might be longer than that.

And so it is still really important, even if you are outside of testing guidelines for cervical cancer screening, you never lose your relationship with your gynecologist, right? You should still be having annual visits because a pap smear is a screening test, right? So if there's any abnormalities that can be seen on exam without a pap test, right? And you can have a biopsy done, you can have additional testing done. And so it's really, really important at both extremes that you continue to have a relationship with your gynecologist and have pelvic exams. You don't ever get rid of pelvic exams.

Gabrielle Hawkins (12:04.832)
And then, so that's why those guidelines have changed. And so start at age 21. We do recommend that after age 30 that ideally you get co-testing. I don't think there are lots of people who've picked up on primary HPV testing quite yet, but I think that that's going to come soon. But co-testing means that we do a Pap test, which is cytology, which is looking at the cells from the cervix that are scraped, and then also testing for the virus.

So there are two parts to the test. And it's super important that everybody knows their results for both parts. And if you are over age 30, it's standard if you have access, which most places have access, that you should have HPV testing. I never want somebody to have normal cells for years and years and they never had HPV and then they develop a cervical cancer. That is everyone's fear. So you should be getting what we call co-testing or PAP plus HPV.

The other thing that's super important, like you mentioned, guidelines, those do shift based on normals. You can extend out to every five years if you've had negative pap cytology plus HPV testing over the age 30. Younger than that, you can do every three years if you're only having cytology, meaning the cells are only collected. However, I always tell patients because, you know,

Medicine is an art, right? We have guidelines. There are certain things and factors that that patient has that their provider knows about where they might recommend annual testing instead of following the three to five year guidelines. That is a very personal decision to make. And I think that that is the importance of how we take care of patients individually, right? And so I think it's important for those things to be factored in. And then like globally, I told you there are some patients who don't fall into that criteria, right? So if you're chronically immunosuppressed, if you have HIV, if you are immunocompromised in any way, so those are patients who are on chemotherapy, right? So cervical cancers affect a lot of young patients. We're looking at like mid-30s to 40s. And so I also, see a lot of patients who've had breast cancer, right, in my practice and so they've been on chemotherapy. And so those are patients we do need to pay attention to, right? If you've had immunosuppressive medications like chemotherapy or if you're on oral chemotherapy, you don't fall into that normal criteria. And so those are the things where you have to talk to your doctor and they need to know about your history so that you can make a good decision about how often that testing needs to happen. But you just see your gynecologist every year, regardless of whether you're due for a pap smear or not, right? That is the most important thing. And I'm sure you get blue in the face saying that every single day. But that's the most important thing. We can't continue to educate if you don't come in. And so it's beautiful that we have platforms like this, where you can say, oh, gosh, I hadn't even thought about that. When was the last time I went to my gynecologist? And if it's been more than a year, you need to pick up the phone, call them, go in, update them about your history, and make sure that if you get a pap smear, you also know the results of your pap smear.

Dr. Whitney West (14:40.606)
You

Dr. Whitney West (14:48.938)
Mmm.

Dr. Whitney West (14:56.766)
Ha ha ha.

Dr. Whitney West (15:07.722)
Mm-mm.

Gabrielle Hawkins (15:08.684)
It's not enough just to get it. You need to know the results. And if someone doesn't give you those results, you should have access to your portal. need to call and get a copy of it.

Dr. Whitney West (15:17.958)
Right. So I'm glad you just said that because my next question was going to be if you are in the three to five year window for your, your PAP and HPV testing, do you still not see your doctor? Because the thought is for some docs and then they, they impart that to the patient is that, you're good. You don't need this test for another three years. So I don't need to see you. And so I ended up with a lot of patients who have literally gone,

Gabrielle Hawkins (15:36.204)
Yeah.

Dr. Whitney West (15:47.056)
longer than they thought they were because, she told me I didn't have to come back for five years or whatever. And lifestyle has changed. We got new partners. We haven't been checked for other stuff that can contribute to your being abnormal, which is what we're going to talk about next, which is risk factors. So who are the people who are most at risk for cervical cancer?

Gabrielle Hawkins (15:51.756)
Right, right.

Gabrielle Hawkins (16:03.021)
Yep.

Gabrielle Hawkins (16:06.946)
Mm-hmm. Mm-hmm.

Dr. Whitney West (16:12.936)
you know, what are some of the symptoms that we should never ignore, you know, when it comes to our cervical health.

Gabrielle Hawkins (16:16.834)
Mm-hmm.

Yeah, yeah, no, I, gosh, I know, I have that same conversation every day, multiple times a day. But as far as risk factors, I mentioned some of those already, immunosuppression, HIV, autoimmune disorder, so anything that dampens your immune system and its ability to fight off the virus.

Smoking, smoking, smoking is a big one. You are in Alabama, I'm in Louisiana, I was in North Carolina. Tobacco is too cheap. So there's lots of people who smoke. so smoking is one of the primary risk factors for cervical cancer. The HPV virus. Ugh.

Dr. Whitney West (16:53.674)
What about vaping?

Gabrielle Hawkins (16:58.766)
would love to talk to more pulmonologists. think vaping is probably worse for your lungs than smoking a cigarette, but it's all chemicals, right? So it's all chemicals altering your cells and your ability to be healthy and fight off infection, right? So I don't recommend vaping either, right? If I have a patient who's trying to wean off of cigarettes and the vape is the only thing that gets them through the day and they're gonna cut it out for a short period of time, we can have that conversation, but.

Dr. Whitney West (17:00.2)
Hahaha!

Okay, gotcha. Okay. Yeah.

Gabrielle Hawkins (17:25.216)
vaping, smoking, you know, we have a lot of patients who smoke marijuana here as well. And so a lot of people use tobacco paper for, you know, for their marijuana when they smoke that. And so all of it is the same, right? It's all going to alter your cell's ability to fight off that virus from taking over that cell and causing changes. And so stop smoking. It's the best thing you can do for your life and your overall health. Just stop. Don't smoke. And you'll save a lot of money.

Dr. Whitney West (17:29.321)
Mm-hmm.

Dr. Whitney West (17:32.776)
Mm-hmm.

Dr. Whitney West (17:39.295)
Mm-hmm.

Gabrielle Hawkins (17:54.712)
Think about all that money. So smoking, smoking, smoking, where every single time all of my patients, I will bug them over and over again about their smoking.

Dr. Whitney West (17:55.472)
Absolutely.

Gabrielle Hawkins (18:04.462)
And then as you just mentioned, right, so we talked about this age range, right, 30s, 40s, you have patients who might have new partners, they might be in new relationships, they haven't been seen in several years, and we talked about the timeframe, right, where you can get progression from pre-cancer to cancer, and if you don't see your GYN for four years and you hadn't had normal PAP the last time, but we haven't done anything about it, you know, now we're in that window of high concern.

And so having multiple sexual partners increases the exposure to HPV. So that's another big, big risk factor. And then persistent high risk HPV strains. So there are different types when we're testing on the pap smear, it's high risk HPV strains, not just all HPV strains. There are some low risk that cause like genital warts and things like that. So we're talking about high risk HPV strains because those are the ones that cause cervical cancer. So persistent infection with that increases the risk of cervical cancer as well. So those are the biggest things. You'll see OCP used still listed on those risk factors as well. So birth control listed on that. And it really has to do likely with the location of the cervical tissue. changes that and just makes those cells a little bit more susceptible. But that continues to be on the risk factor, but minor in comparison to some of the other things that we've talked about. I feel like you have one more question that I didn't.

Dr. Whitney West (19:29.628)
symptoms that we should not ignore.

Gabrielle Hawkins (19:29.864)
Answer. Symptoms, yes, yes, yes. So also another conversation I have frequently is about bleeding, right? Paying attention to your bleeding. As gynecologists, always talk about menstrual history as a part of our vital signs as to how healthy and how well a woman is doing, right? And so bleeding between periods, if you're still having periods, is abnormal. Bleeding after intercourse is abnormal.

And then even for our post-menopausal patients, right? Anytime you're bleeding after menopause is absolutely abnormal and you should rush to the doctor immediately. So bleeding after menopause, bleeding with intercourse, bleeding between periods, pelvic pain is possible. Sometimes you can have some urinary symptoms like just difficulty urinating, things like that, sometimes pain with intercourse. But remember that early stage cervical cancers typically don't have symptoms at all.

Dr. Whitney West (19:59.338)
Mm-hmm.

Gabrielle Hawkins (20:23.214)
Even with cervical precancers typically don't have symptoms, but any abnormal bleeding always needs to be evaluated. Don't brush it off as just like, I'm perimenopausal, like this is just what's happening. Or, know, it only happened, you know, a couple of times a few months ago and I forgot about it. That always needs to be evaluated.

Dr. Whitney West (20:44.926)
Good. So we talked about the HPV vaccination. you know, we always talk about how good is it? Like, is it going to work? Is it going to stop? So, you know, so what would you explain? How would you explain the effectiveness of the vaccination to our listeners?

Gabrielle Hawkins (20:50.318)
Mm-hmm.

Gabrielle Hawkins (20:56.131)
Yeah.

Gabrielle Hawkins (21:02.222)
Yeah. Yeah. So based on the data that we have, the nine, so there are nine different strains of high risk HPV covered in the newest available Gardasil vaccine. So those are the most, those are the strains that cause about 90 % of cervical cancer. So you're getting pretty good coverage for all of those high risk strains that cause cervical cancer. And when I mentioned earlier that I recommend it for patients who have high-grade pre-cancer as well. So even if you've been infected with one strain, again, we talked about having new partners, new exposures. The science behind it is that being vaccinated with the different strains of the HPV virus actually allows your body to recognize even the infection that you already have. And so that's the thought process behind vaccination, even though you've already had infection with one strain.

And so it's very effective, right? But if you say, well, what about that 10%, right? If we want to focus on the negative and not the positive, that is where regular contact with your GYM provider is super important, right? Because again, looking, talking to you about symptoms can prompt additional evaluation that maybe the pap smear isn't picking up.

And so it's super, super important to have that regular visit and that contact with your gynecologic provider because if you want to focus on the 10%, that's what's important to get rid of that 10%.

Dr. Whitney West (22:38.442)
So, you know, as a, again, I'm a benign generalist gynecologist, you know, I see patients and do prevention, preventive screening. But then when we get to the point where they have progressed, even after, you know, all of our attempts at prevention, we progress into something and it's either that pre-cancer, which is the next stage, you know, to cancer or we were at cervical cancer. So it was caught early.

Gabrielle Hawkins (22:56.557)
Mm-hmm.

Gabrielle Hawkins (23:04.726)
Mm-hmm.

Dr. Whitney West (23:07.754)
What are the treatment options for patients in that situation?

Gabrielle Hawkins (23:11.265)
Yeah.

Yeah, so I'll briefly kind of talk about precancer because I'll often take care of some of those patients too after you've done a couple of excision procedures. So for precancers, usually what we do is excise the abnormal cells to try to prevent recurrence in that area of the precancer. And so you can do that with what's called a LEEP procedure. If anyone's ever heard of that, it stands for loop electrosurgical excision procedure. And then more commonly, what I will do is like a cervical conization

Dr. Whitney West (23:20.26)
Mm-hmm.

Gabrielle Hawkins (23:43.376)
And so it basically just uses a regular scalpel that we use in the operating room to excise that abnormal tissue as well. Gives you the same amount of information. And so we do that to treat cervical precancers. And that typically will require close follow-up afterwards to make sure that it doesn't return because you could need additional treatments. And again, if you've had a procedure on your cervix for cervical precancer, you have to follow up in a different timeframe, right? So that's something that your doctor will discuss with you. So you don't fall into that three, five year criteria anymore. You still need to be at your doctor as frequently as they tell you to based on your results. And then for cervical cancer, so early stage cervical cancer, and by early stage, I mean usually stage one cervical cancers that are small, only in the cervix, haven't spread anywhere else. We usually can do surgery and that surgery usually is called a radical hysterectomy.

It's called radical because we take a little bit more tissue than we normally do with a regular hysterectomy. And so it's a little bit more of an involved surgery, which is why those, usually those patients will come to me as an oncologist to do that surgery. And the goal of that is to get around the cancer itself with negative margins. And so we don't talk about margins often with a lot of our cancers, but margins are basically the tissue on the edges of what we remove. We want that to not have any cancer in it because that's going to decrease the risk of it coming back. And so that is what we do for early cervical cancers. For more advanced cancers, so stage two, three, and four cancers, we typically can't surgically remove those. And we know that even if we did, and we tried to do that with a radical surgery, we already know that the patient's going to require chemotherapy and radiation. And so we would put them through unnecessary surgery when we know that we have fairly high cure rates with radiation and chemotherapy for especially our stage two, stage three cancers.

Gabrielle Hawkins (25:45.608)
And I'll just throw this in here because it's everywhere. Immunotherapy, Keytruda has commercials everywhere, right? So Keytruda has also changed how we take care of our cervical cancer patients who have advanced cervical cancer, stage three and stage four cancers, and have significantly improved survival. Stage four cancers, stage four cervical cancers are the worst cancers because they just should never get to that point, right? And so this is why we have these conversations because I do not want to see another patient with stage four cervical cancer. And so those cancers usually are treated with chemotherapy primarily, and then we use radiation to kind of locally control symptoms that we need to. So there are treatment options available, but ideally we want to jump in at that intersection where there's pre-cancer and prevent this from ever becoming cancer. Because again, I mentioned these are primarily diagnosed in 30, 40 year old range. So these are women who were in the prime of their lives working, often providing for families, caring for children if they have children, parents. And so it is a huge, huge thing to be socially impacted by a cervical cancer diagnosis and have to undergo treatment. So hopefully that was general enough for you.

Dr. Whitney West (27:04.81)
Yes. No, I think it was. It's actually really good information. I think the listeners will find it very, very helpful because the, obviously we, I'm in agreement with what you just said about, you know, stage four cervical cancer. This should not be happening because we have a way to prevent it. I remember long time ago, I was seeing a patient, I was in a clinic I worked at maybe 20 years ago. She was 36 years old. She had an abnormal pap smear and she was essentially lost to follow-up. So she didn't come back. And when we finally saw her a year later, she had advanced cancer and she ended up passing away and left three kids to her mom to take care of. So, and...

Gabrielle Hawkins (27:51.917)
Yeah.

Gabrielle Hawkins (27:55.639)
Yeah.

Dr. Whitney West (27:58.238)
I think she was, I think I remember she was a smoker, but it was just the avoidance and the fear and you know, whatever, whatever other reasons she had, cause she was scared, something was wrong. But you know, the year prior would probably have been the timeframe where we could have caught it and cured it as opposed to, you know, not having, you know, anything we could do by the time she came back in. It was pretty devastating. So, but thank you for all of that information. So,

Gabrielle Hawkins (28:03.714)
Mm-hmm.

Mm-hmm. Yeah.

Gabrielle Hawkins (28:14.008)
Yep. Right.

Gabrielle Hawkins (28:20.696)
Right, Yeah.

Dr. Whitney West (28:27.376)
What do you wish more women understood about cervical health?

Gabrielle Hawkins (28:33.602)
I, you the biggest thing is that people do not talk about GYN health. And because people don't talk about it, everyone feels like they're on an island, that they're experiencing everything in isolation and no one else has ever gone through it. And so every single time I have someone who comes in with a cervical precancer, I say to them, you, the next time you're at lunch with your friends or you're at a play date with somebody that you feel comfortable with, you should just ask them if they know anyone to share your business, right? you can just say, like, I, this is the line I often will give, give patients is like, you know what, I was at my gynecologist the other day and.

You know, she told me that, so for my post-menopausal ladies, I always tell them, she told me that I shouldn't be bleeding after I went through menopause. Did you know that? Has anybody ever told you that before, right? And you can normalize it. You don't have to share your story. If you're ready to do that, you can do it. And so the same thing for cervical precancer is I tell them, the next time you're sitting with a bunch of your girlfriends, ask them if they've ever had an abnormal pap smear.

Ask them if they've ever had a colposcopy, which is a procedure if you've had an abnormal pap smear where we look at the cervix and see if there's any areas that we need to biopsy that look concerning. That's the next step after having an abnormal pap smear. Ask them that. ask them if they've ever had to have a procedure on their cervix because you write your doctor and you guys were talking about it and you hadn't even heard of this before. Just to normalize it and I think people just don't talk about it. think especially with cervical cancer, there's a lot of shame involved and for patients who've been diagnosed with cervical cancer feel like it's something that they did that caused it. And so I think just making sure that they understand the biological process by which cervical cancer develops, but also for patients who have pre-cancer, the process by which it develops so they don't develop cervical cancer, right? And so just like having those conversations, I think the more we feel comfortable talking about GYN health is super important. And I think we're like, you know, I'm in this like in between kind of generation where like our parents are older and didn't really like talk about these things, Grandma died from some womb cancer and you're like, I don't know what that means, right? What does that even mean? I don't know. Some lady, some female cancer, right? And so I think we're in this great place where we can have those conversations with our mothers, our aunts, our cousins even, and talk about these things and making sure that someone's not walking around feeling shame, which...

Dr. Whitney West (30:47.85)
Did not.

Gabrielle Hawkins (31:12.686)
prevents them shame and fear, which prevents them from going to seek care. And the other thing that I will say too is, is because I also hear this very regularly, is that I have patients who come in and say, I have been trying to tell someone something is wrong and I couldn't get to the right person, right? So if you have a provider, who's not a primary gynecologist, not an OB-GYN, not a board-certified OB-GYN, who's doing your cervical cancer screening or taking care of your GYN health and you don't feel like you're being heard, you don't feel like you understand the results from your testing, go find somebody else who will explain it to you, right? There's too much information that's not great out there, but there's information that is good that you can find and find someone else who can explain to you what's going on. Same thing about results, right?

There was this big campaign, right? Know your status with HIV. You need to know when your last mammogram was. You need to know when your last colon cancer screening test was. You need to know when your last pap smear was. You should know those, have them on your phone, know the results. You should have them. And if you don't have them, you need to get them because that information is very powerful for you making decisions for your...

Dr. Whitney West (32:25.514)
Awesome. Because my next question was going to be, do we advocate? How do women advocate for themselves in their screening and their follow-up? It's kind of interesting. There are several doctors who have older doctors who have retired here in town. And over the years, I've been here 25 years. I've seen a lot of, I haven't gotten a lot of referrals from different doctors from, you know, primary care, other GYNs, that kind of thing. So it's very interesting how some doctors are not up to date on the current screening guidelines and then management, because repeat PAP in six months is not a thing, you know. So if you're, you know, just, yeah. Right, so, so, you know.

Gabrielle Hawkins (32:54.786)
Mm-hmm.

Gabrielle Hawkins (33:03.5)
Mm-hmm. Mm-hmm. Mm-hmm.

Gabrielle Hawkins (33:12.534)
I wish I could snap. You're like preaching to the choir.

Gabrielle Hawkins (33:19.402)
Ahem.

Dr. Whitney West (33:19.496)
Listeners, if you are in a situation where you have been getting pap smears every six months, because that's what your doctor has told you need, please seek other assistance, because that's not how we manage things anymore. And then the colposcopy, which is essentially the biopsy, taking a piece of tissue so we can treat if we need to, requires an actual taking tissue. So I've seen a lot of patients who've had colposcopies but never had a biopsy taken. So we can't see with our naked eyes the abnormalities. That's why we actually have to take a sample. So, and then just for those who are listening who've never had this, it's about the size of a breadcrumb. I mean, it's really tiny. It's a really tiny piece of sampling from your cervix to make sure you don't have cancer. That's essentially what we're doing. So.

Gabrielle Hawkins (33:52.238)
Right, right. Yeah, exactly. Yeah. Correct. Yeah. Yeah.

Gabrielle Hawkins (34:07.075)
Mm-hmm.

Gabrielle Hawkins (34:13.144)
Mm-hmm. Yeah.

Dr. Whitney West (34:14.984)
So thank you so much. This has been, I think, some great information. And is there anything that you would like to just leave with the listeners? there one or two things that you want them to take away from this conversation?

Gabrielle Hawkins (34:16.59)
Yeah.

Gabrielle Hawkins (34:31.018)
Yeah, so I think the like I said, there's information out there, so you have to know where to go. And so I one of the best sites I've found, hopefully it's still up. I haven't looked in six months, but the American Cancer Society has like a link to NCI and it actually is the National Cancer Institute. It actually it actually will go through and I'll send the link to you so you can put it there. But it actually goes through like what happens when you get a pap smear? What happens when you have an abnormal? What's

And it's the best summary that I've seen so that you can actually see like, where do I fall in here? What should I be doing next, right? Even if I don't get that call, even if I don't get the reminder about going in.

Like, what should I do next? So I think that site is really helpful. And then for providers who might be listening who want to look at the up-to-date, the ASCCP, so the American Society for Colposcopy and Cervical Pathology, I think I always mess that up, but I think that's what it is. They have an app that you can use and put in.

Dr. Whitney West (35:28.202)
it.

Gabrielle Hawkins (35:33.288)
know, PAPS and it shoots out the guidelines exactly what needs to happen. And if it comes to colposcopy and you're not someone who does that, your next step should be sending that to somebody who does. And so, you know, patients have access to that as well, as far as like the online criteria. So you can look at that. So those are the two things I would say is like, again, I really do believe that a big part, and I know that you do too, a big part of what we do is providing education to our patients and explaining why things are the way they are.

how we are trying to keep their bodies healthy and what they need to do on their part to make that happen.

And so I think the last thing I'll say is, is, you know, we're specifically talking about cervical cancer today. I always take a moment as a GYN oncologist to make sure that I capture kind of all of our other cancers really quickly. And I mentioned it a little bit earlier, but abnormal bleeding, postmenopausal bleeding is one of the biggest things that I wish that people were educated about and talked about in the community. And so just making sure that we can get women in as soon as they start having postmenopausal bleeding and not sending them to the urologist.

not going to the GI doctor to get their colonoscopy updated. If you think you have bleeding from below, you need to see your gynecologist. Have your primary get you to somebody who can see you to evaluate that bleeding.

Dr. Whitney West (36:38.314)
Ha

Gabrielle Hawkins (36:53.526)
And then the last thing that I think I would say is just, you know, just make sure that you advocate for yourselves. And so have people have someone there listening for you to take notes for you, because it's hard to recall everything from visits. And so have someone there with you, whether they're on the phone or they're there in person so that they can listen in, because that extra set of ears will remember a lot more than you can from that from that experience, especially if you've had care related trauma in the past is super, super important. And then with that note.

These exams are very personal and I'm sure you've talked about this all the time too. So it's just really important to let your providers know if you had any history of personal trauma, sexual trauma that impacts your ability to have those exams. Because that's a lot of times why people stay away is they feel like they're painful or uncomfortable or had a bad experience and then they don't go back for many years. So explain that to your provider upfront. That is how we take care of you best. So just make sure that we know the person walking into the room, but it just
it's important to make sure that your provider knows that so they can cater to your needs clinically.

Dr. Whitney West (38:07.444)
That's so, so big. So thank you so much for saying all of that. And I try to, you know, I tell my patients all the time and we're not into torture here, right? Cause we want you to come back, right? We want you to come back. yeah, I'm very, very comfortable. Right. And yep, exactly. And if you're in a situation where that,

Gabrielle Hawkins (38:19.414)
Yes, I say the same thing all the time. Right, right, right. And you always have the ability to say, I'm uncomfortable. I need to stop the exam. Always have the ability to say that. Yeah.

Dr. Whitney West (38:36.83)
does not happen, then you're in the wrong place. So thank you so much, Dr. Hawkins, for joining me today and giving us some really, really good information. And I hope that this has been super helpful for our listeners. And I just want to say to them, if this episode was informative and has offered some clarity, please share it.

Gabrielle Hawkins (38:39.436)
Right, exactly.

Gabrielle Hawkins (38:44.758)
Yes.

Dr. Whitney West (39:01.226)
with someone you know who's probably not been to the past, I mean, not been to the gynecologist in a while, not gotten a pap smear in some time. And then follow us on the next episode of the podcast where we'll have more insightful information that we can give to you. Thank you for joining us on this episode of the Integrative GYN. I'm Dr. Whitney West because your health deserves more than 15 minutes.