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Regular screenings key to cervical wellness

Hollie Deese, Tennessean Newspaper

“I sat in the office and talked to her for a few minutes, and she seemed to think it was menopause, too, or maybe endometriosis,” Carney says. “After the exam, she called me back into her office and she did not think it was endometriosis. She started naming a few things it could possibly be, and one of the things she named was cervical cancer.”

At one point, Carney asked her doctor whether she should be concerned but was told not to worry until they knew for sure what was going on. But Carney couldn’t help but worry. She went online that weekend to research cervical cancer and knew without a doubt that was what she had.

A visit the next week with Dr. B. Stephens Dudley of Tennessee Oncology confirmed what she already felt in her gut. Carney, who has three children, had advanced cervical cancer that had spread to her pelvic wall and lymph nodes, and she had probably been living with the cancer for two or three years.

Who is at risk

According to the Centers for Disease Control and Prevention, all women are at risk for cervical cancer, but it occurs most often after age 30. It is considered the most preventable female cancer, yet 12,000 new cases are diagnosed in the United States each year.

“The problem in the U.S. is that the people who are developing cervical cancer are in areas where they are not getting regular screening,” says Dr. Dineo Khabele, assistant professor of cancer biology, obstetrics and gynecology at Vanderbilt-Ingram Cancer Center. “Tennessee has some of the highest rates of cervical cancer and cervical cancer deaths in the United States, and a disproportionate burden is among Latina and African-American women, and rural white women. And this is primarily due to lack of regular screenings.”

All the causes of cervical cancer are not certain, but one that is known is the human papillomavirus, which is common and passed through sexual contact.

At least half of sexually active people will contract HPV in their lives, although few of them will get cervical cancer. There are more than 40 types of HPV — only some cause cancer — and most people never know they even have it, as the immune system can naturally rid the body of it within two years.

By age 50, at least four out of five women will have been infected with HPV at least once.

Scans crucial to catching cancer

Cervical cancer is highly curable when caught early. Carney is embarrassed to admit that it had been five or six years between her last Pap smear and her diagnosis, but it isn’t actually all that uncommon for women to go that long, or even longer, despite Pap smears being so crucial for catching cancer.

“Pap smears are the most economical and best chance to catch a condition while it is still pre-cancer and easily treatable,” said Dudley, who has been treating patients with cervical cancer for 30 years.

“But the problem with Pap smears has been the lack of access to medical facilities for some of the lower socio-economic people in the country. People get busy working, raising kids and don’t take the time to go to the doctor. We still see very advanced cases of cervical cancer in women who have not had a Pap smear in 10 or 15 years. Some of them have never had a pap smear.”

Cervical cancer treatment

If the condition is caught in its precancerous stage, treatment is minimally invasive. The most common treatment, the loop electrosurgical excision procedure, uses a thin, low-voltage electrified wire loop to cut out the abnormal cervical tissue. Other procedures involve lasering, or even freezing the cervix.

Once the condition has progressed to early-stage cancer, treatment still can be surgical alone, but it involves a full hysterectomy. Rarely, if the woman is young, the cervix can be removed and the uterus left. More advanced stages require chemotherapy and radiation.

“There are new targeted drugs coming down the pike that can be added to chemotherapy, so the treatment options have improved,” Khabele said. “If we can catch it early, we are more likely to cure it.”

Carney went through chemotherapy and internal radiation, finishing treatment in January 2013. Her first follow-up scans in March were clear, and there have been no signs of cancer since.

Today, Carney has to have Pap smears every four months to look for abnormalities, and she wishes she had been more diligent about them before her cancer diagnosis.

“Every bit of it could have been caught and stopped if I had just gone for my yearly Pap smears,” Carney says. “But I was one of those people who, if I wasn’t sick, I didn’t go to the doctor, and that was the biggest mistake I could have made.

“I thank God I went when I did because I had no clue it could be anything that bad.”