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What more women should know about cervical cancer

What more women should know about cervical cancer

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Jerlinda Ross, M.D., had her heart set on entering women’s health care to become a maternal fetal medicine physician. She loved helping women through their birthing journeys, from conception through watching the baby grow until delivery.

But it wasn’t until a rotation during her second year of residency training that she discovered her true, unexpected passion: helping women navigate the ups and downs of cancer.

Now the oncologist at MUSC Hollings Cancer Center and assistant professor of obstetrics and gynecology enjoys connecting with her patients on a personal level while helping them achieve the best possible quality of life and the longest amount of time with their friends and families.

“The thing I try to remember in my practice is that it’s easy to become focused just on treating a patient’s cancer,” Ross said. “But, when you have the time to get to know these patients, you realize there’s a lot more to them than their cancer.

“You get to learn what they like, what they do and more about their families. I like getting to be with a woman through diagnosis, treatment and, hopefully, through a cure.”

January is Cervical Cancer Awareness Month, spotlighting what used to be the leading cause of cancer deaths for women in the United States. Over the past few decades, however, a drastic uptake in regular screenings and the human papillomavirus (HPV) vaccine have significantly decreased the number of cervical cancer cases and deaths, as changes in the cervix can either be prevented or detected before a cancer develops.

Here, Ross shares why she’s passionate about gynecologic cancer care, what she wishes more women knew about cervical cancer and how research can help to reduce disparities that exist in women’s cancer care.

Q: What are some things most women don’t know about cervical cancer that might surprise them?

A: Oftentimes, cervical cancer affects women who are quite young. It’s most frequently diagnosed in women who are in their 30s and 40s, with the average age at diagnosis being 50. However, 20% of cervical cancers are also diagnosed in women over age 65. After women go through menopause, they may not be getting their annual pelvic exam and the routine screenings that they need, including a Pap smear and HPV testing. Women need to know that just because their periods have stopped does not mean that their risk of developing cervical cancer has disappeared.

Women may also not be aware that getting an annual Pap smear can detect changes on the cervix before a cancer develops and can identify early-stage cancers while they are still small and can be more easily treated. Most cervical cancers develop in women who haven’t undergone a Pap smear in the last five years, and of the women who do develop cervical cancer, most don’t experience any symptoms until the cancer has grown and spread. At that point, treatment options may be limited.

Q: What are some of the risk factors for developing cervical cancer?

A: HPV infections cause more than 90% of cervical cancers. Most women who are sexually active will encounter or acquire an HPV infection at some point in their lives, which is why it’s so important for both men and women to get the HPV vaccination.

Some lifestyle choices can also contribute to cancer risk, such as being overweight, not getting enough physical activity and smoking. Most women don’t know that cigarettes and tobacco products produce chemicals that can damage cervical cells, which over time can lead to cervical cancer. There is also a link between cancer and obesity. Maintaining a healthy weight can help to protect patients who already have cancer from developing a second cancer type and can prevent secondary illnesses – such as diabetes and hypertension – which can affect which types of chemotherapy and surgery a woman may receive during cancer treatment.

Q: What health disparities exist in gynecologic cancer care and specifically within South Carolina?

A: The biggest disparity in South Carolina is access to specialty care for gynecologic cancer. The state has a high percentage of residents living in rural and medically underserved areas, and people who live outside of a city may have to drive for hours just to have an initial consultation or to get an initial workup to determine if they have a cancer. This can cause delays in diagnosis and care, which will ultimately affect a patient’s long-term survival.

Some of the biggest social and cultural disparities in gynecologic cancer care also relate to clinical trials. Because of historical events that led to the mistreatment of minority groups and immigrants, these groups are often less likely to enroll in a trial, even though these trials can be quite helpful to them. Studies show that these women often do worse on the standard of care, and it may be something specific about how these groups respond to certain medications, but we can’t get them in enough clinical trials to find out what’s happening. This limits us from being able to find out whether these drugs work for them.

Q: What research is being done to address gynecologic cancer care disparities?

A: One of my research interests is using geospatial technology to “geo-code” a community’s health profile regarding resources and access to health care. The big push right now is to figure out how we can treat women in the community in which they live. We want to get doctors there to treat them, but we also need to focus on other things in their community that could be missing, such as access to recreational facilities for exercise or to healthy foods, which can be expensive.

Oftentimes, we tell women they should eat healthy, work out, lose weight and get a mammogram, but they may not be able to do some of those things without driving really far. The goal of using geographic information systems is to learn more about these communities so that we can try to improve them.

At Hollings, we’re also using geospatial technology to understand areas in the state where there are high rates of cancer and obesity to uncover this link and to identify areas where cervical cancer rates are high and HPV vaccination rates are low, helping us to identify where we should be pushing vaccine education.

Q: What immediate steps can women take to reduce their risk of developing cervical cancer?

A: Two of the best things women can do to lower their cervical cancer risk are to get vaccinated against HPV and to get their regular Pap smear screenings and HPV testing. It’s important to know that the recommended age range for the HPV vaccine has been expanded, so anyone between the ages of 9 and 45 can get vaccinated. Studies have shown that even if you’ve had some form of HPV infection in the past, you could still benefit from being vaccinated. It’s also important for parents to vaccinate their children to prevent them from developing one of six types of cancer in the future, including cancers of the anus, mouth, throat, cervix, vagina and vulva.

Quitting smoking is also an important first step, as tobacco has certain chemicals that can cause damage to cells in the cervix, leading to pre-cancer changes.

Additionally, living a healthy lifestyle with physical activity and a well-balanced diet of fresh fruits and vegetables is always important to decrease the risk of developing certain cancers and to promote a healthy life.

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