Talking with U of M

Talking cervical health with the U of M

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According to the National Cervical Cancer Coalition, more than 14,000 people in the United States are diagnosed with invasive cervical cancer each year. For Cervical Health Awareness Month this January, Dr. Deanna Teoh with the University of Minnesota Medical School and Masonic Cancer Center talks about cervical cancer, vaccinations and appropriate screening.

Q: Why is it important to be educated about cervical health?
Dr. Teoh: The cervix is not a part of the body that is commonly discussed, and many individuals may not know that they have a cervix, or what it does. The cervix is the opening to the uterus; it can be visualized or felt at the top of the vagina. The cervix naturally produces a mucus which is often described as a vaginal discharge, and menstrual blood from the uterus drains through the cervix in a regular pattern (approximately monthly). It is important for individuals with a cervix to learn what is normal for them. If there is discharge that is different from what is expected, or bleeding that occurs in an unpredictable fashion, then evaluation by a gynecologist or primary care provider who can perform a cervical exam is important. 

Q: What is cervical cancer, and is it common?
Dr. Teoh: Cervical cancer develops at the opening of the uterus. It is the fourth most common cancer in biological females worldwide, and the 14th most common cancer in biological females in the United States. In 2021, more than 13,000 individuals were diagnosed with cervical cancer, and almost 6,000 individuals died of the disease. It disproportionately affects individuals without consistent access to preventative healthcare. Cervical cancer can present as irregular bleeding or bleeding after sex, abnormal vaginal discharge, pelvic, abdominal or back pain. However, a majority of early-stage cervical cancers have no symptoms at all. That’s why it is important to get cervical cancer screening even if a person is healthy and has no symptoms associated with cervical cancer. 

Q: Is cervical cancer preventable?
Dr. Teoh: The best way to prevent cervical cancer is to vaccinate against human papillomavirus (HPV). HPV causes over 90% of cervical cancers, and studies from both Sweden and the U.K. show decreases in cervical cancer incidence among vaccinated individuals. The HPV vaccine works best if it is given prior to the onset of sexual activity, and is recommended for all adolescents (males and females) at 11-12 years of age. The vaccination process can be initiated as early as age 9 years old. It is recommended to be received up to age 26 years old, and FDA-approved up to age 45 years old, but is most effective if administered early and prior to exposure to HPV. 

Screening with a Pap test, HPV test or both depending on age and clinic practices is recommended for anyone with a cervix whether or not they have been vaccinated. This further helps to prevent cervical cancer by detecting precancerous lesions which can be treated before they progress to cancer. Additionally, screening can identify early-stage cervical cancers which have not yet caused symptoms, and are still potentially curable. 

Q: Is there a stigma around talking about cervical health and prevention?
Dr. Teoh: Most people do not talk about their cervix — or their problems “down there” — so they are not as aware of what is normal or what warrants further evaluation. Furthermore, there is stigma around HPV and an assumption that HPV infection only occurs in individuals who are sexually promiscuous. This is not true. Over 80% of the population will be infected with HPV at some point during their lifetime; most will clear the infection and many will never know they had the infection. This is why it is important for everyone to get vaccinated against HPV, to get cervical cancer screenings if they have a cervix, and to talk with their healthcare provider if they have any abnormal vaginal discharge or bleeding. 

Q: What are you doing to advance public knowledge about cervical health and cancer?
Dr. Teoh: Locally I work with the terrific group At Your Cervix MN, led by activist Lily Taylor, to increase awareness about cervical cancer and to support individuals affected by cervical cancer. 

Nationally, I work with the American Cancer Society HPV Roundtable to increase HPV vaccination across the United States. I am also working with some of my colleagues in pediatric oncology to test a game-based learning avatar-navigated mobile app to encourage HPV vaccination among survivors of childhood cancer. My dream is to eradicate cervical and other HPV-associated (e.g., anal, head & neck, penile, vaginal and vulvar) cancers. 

Deanna Teoh, MD, MS is a gynecologic oncologist at the U of M Medical School and M Health Fairview. She is a member of the Masonic Cancer Center. Her clinical and research interests are prevention of cervical cancer and other HPV-associated cancers. You can follow her on Instagram and Twitter @deannateoh.

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