According to the NIH and The National Cancer Institute, nearly all cases of cervical cancer are caused by infection to the human papillomavirus, or HPV. Getting a pap smear used to be an annual appointment most women needed to make. However, in recent years many doctors believe a yearly appointment isn't necessarily needed and depending on your age, sexual health, and family history you may not have to go for a couple of years.
In this segment, Maryam Ardalan, MD, discusses HPV and pap smears, and why it's important for women of all ages to discuss with their physician the need for an annual pap smear and their risk of HPV and cervical cancer.
Selected Podcast
The Latest Information on the HPV Vaccine and Pap Smears
Featured Speaker:
Maryam Ardalan, MD
Dr. Maryam Ardalan, MD is an Obstetrician/Gynecologist and a member of the medical staff at Henry Mayo Newhall Hospital. She practices in Valencia, CA. She is 52 years old and has been practicing for 25 years. Transcription:
Melanie Cole (Host): According to the NIH and the National Cancer Institute, nearly all cases of cervical cancer are caused by the infection of oncogenic or high-risk types of human papilloma virus or HPV. Getting a pap smear used to be an annual appointment most women needed to make, however in recent years many doctors believe a yearly appointment maybe isn’t necessarily needed and depending on your age, sexual health, family history you may not need to go for a couple of years. My guest today is Dr. Maryam Ardalan. She’s an Obstetrician/Gynecologist and a member of the medical staff at Henry Mayo Newhall Hospital. Welcome to the show Dr. Ardalan. So what do we know as of now about what causes cervical cancer?
Dr. Maryam Ardalan, MD (Guest): Hi, thank you very much for this interview, I’m very honored to talk about this topic and this is one of the most important part of the women’s health. The reason of the cervical cancer now is found to be mostly related to HPV. We in the past did not have any technology in order to identify high risk HPV but recently we’re able to find HPV and that helps to identify cervical cancer in the very early stage.
Melanie: So typically women have been getting their pap smears every year, but now with the advent of this new research and the discovery of HPV as one of the main causes and we’re seeing this HPV vaccine being given to our girls as young as 9 years old, what are we seeing now as the relationship? How often are we supposed to get our pap smears now and does it depend on your age and whether or not you’ve had the HPV vaccine?
Dr. Ardalan: So the answer to this question is based on the patient's past history. If the patient did not have any history of abnormal Pap smear or HPV in the last at least three prior paps you may not need to do the Pap smear every year. So basically the American College of Gynecology recommends if you have negative Pap smear in the last 3 paps and HPV is negative you may need to repeat your pap in 3-5 years depending on your age.
Melanie: So for women who are nervous about not getting that Pap smear should they be asking for an HPV test when they go in for their yearly? Because they should still go in for a yearly gynecological visit, yes?
Dr. Ardalan: Right, yes. We still recommend that patients have an annual exam because it’s not only for doing cervical cancer screening, just the annual exam gives the opportunity to the patient to see their gynecologist and address some other issues besides the Pap smear. So in the annual visit they can discuss about their sexuality, they can discuss about their menstrual cycle, and basic pelvic examination and reviewing their past history can give us an opportunity to discuss with them if they require to have a pap smear on that visit or not.
Melanie: And Dr. Ardalan in your opinion what do you see will happen with the women who are under the age of 26 and have gotten the HPV vaccine. Is Pap smear still going to be recommended for them at some point, will they have them at all? What do you think is going to happen?
Dr. Ardalan: So basically in the women below the age of 24 technically, because there’s a certain age that basically starting screening which is the age of 21. And because HPV is so common we may not test for HPV up until age of 24 and even after 24 even up until 30 we can only do the test for high risk HPV based on the pap results. So technically when the patient comes in for the checkup I will review their past history, I look at their age and based on their pap history I can give them more recommendations on what type of pap smear they should have, whether they need to have an HPV testing or whether they need to do the reflex HPV which means if their pap smear is abnormal then we run for HPV. The reason HPV is so common in the young age especially below the age of 24 that we don’t necessarily test for HPV in that age group. The majority of women in this age group carry HPV because of their young age and because they have a good immunity the body may basically clear the HPV over time.
Melanie: So what about the women in that middle age that are maybe above the age of thirty, so they are too old to have gotten that HPV vaccine, and yet they’re sexually active or up until you know in their fifties and sixties, what do you tell them about getting that Pap smear or getting tested for HPV?
Dr. Ardalan: So women are technically above the age of 30 we routinely test them for high risk HPV. And these women because as you get older the possibility that the HPV resolves by itself is less so it’s important for us to know if they have a HPV positive we basically keep an eye on them and we repeat their pap smear based on the guidelines and based if there is any abnormalities in their pap smear or not. So technically if they’re above the age of thirty as I say this if they have normal Pap smear and a negative HPV in the last prior 3 paps they need not require to have pap every year or every three years depends on their risk factors. If they are very low risk they can do it even in five years with the high risk HPV. So if you as a physician decide to run the HPV test for a woman above the age of thirty and if their pap smear is negative and their HPV is normal you may not need to do it up until five years if the prior three paps are normal and negative for HPV. But if they show any abnormalities let’s say in the prior pap is normal but only shows HPV then we’ll decide to repeat the pap in a year. It just depends case by case and based on their risk factors.
Melanie: And what do you tell women that ask you about the HPV vaccine and Gardasil and risks involved and does it really help prevent cervical cancer?
Dr. Ardalan: Basically as far as Gardasil or HPV vaccine, we can offer the patient of a certain age group, technically at the age of 11-12 American College of Cancer and American College of Obstetrics and Gynecology or American Cancer Society recommends to offer the patients in this age group from 9 to 26. Ideally 11-12 is the age that girls can see their pediatrician and they can be offered the vaccine through that age but if they have not been vaccinated they can have a catch up vaccination after the age of 11-12 between the ages 13-26. So HPV vaccine has a 70% prevention against cervical cancer and there is different types of vaccine. When I see the patient I counsel them and tell them that this is protecting 70% and there’s three different types. The latest one is the HPV 9 that is protective against HPV types 6, 11, 16, and 18 and five more HPV viruses and prevents again genital warts and cervical cancer. This is the newest type of vaccine that is available and that’s the recommendation to get this series of three vaccines. As I said if they have not received it after age 26 it is not recommended to get it because then there is a possibility that they’ve already been exposed to HPV. This is what I talk to the patient about in my encounter when I counsel them.
Melanie: How early should a girl come in to see a gynecologist for the first time?
Dr. Ardalan: They can do it anytime starting at age of 9. Normally age of 13 they can have their first visit. They can also see their pediatrician and they can receive the vaccine, but that’s only for immunization, but because girls they start their periods between age of normally as early as 8 to 16 some of them they encounter some abnormality in their cycles or problems with menstruation and that’s the main reason that pediatricians refer to us for consultation. They can discuss about the HPV vaccine and those sort of things with their pediatrician but if their pediatrician is not comfortable they can refer to a gynecologist.
Melanie: If a mother or a parent brings a young girl to you to discuss the HPV vaccine Dr. Ardalan and the parent has a concern that by discussing this vaccine it will somehow girl the girl permission to be sexually active what do you tell them about the studies that have looked into this question?
Dr. Ardalan: So it is not a matter of encouraging the patient to be sexually active, as far as the HPV if they receive the vaccine before they’re exposed to HPV they will have the highest protection rate. So it’s better just to receive the HPV vaccine before they have exposure. And because as they are already infected with HPV the protection against HPV and cervical cancer is obviously less. That’s what I discuss with the parents and tell them that it’s better just before they’re sexually active and they start their sexuality to receive this vaccine.
Melanie: So wrap it up for us Dr. Ardalan with your best advice about the HPV vaccine, HPV virus, pap smears, women’s health in general give women your best advice.
Dr. Ardalan: My advice is that the women see their gynecologist once a year and that’s the opportunity for them to have the breast examination, they bring up all the important information about their sexuality, about their cycles, about their cervical cancer screening, about the breast examination and all that gynecology health questions that they have with the gynecologist. And that visit the past history will be reviewed with the patient and they can discuss about all these questions that they might have and that’s a good opportunity for them to come and get checked and based on their risk facts and prior history we can discuss with them whether they need or require a pap smear in that examination. Or how often they need to have it and then we can discuss about some other health issues that they didn’t have any other opportunity to bring up at the gynecologist. And I always recommend them to try and set appointment with their birthday so in that way they don’t forget and to make sure that their next birthday they will already have an appointment scheduled and seen by the gynecologist.
Melanie: Thank you so much Dr. Ardalan for being with us today. You’re listening to It’s Your Health Radio with Henry Mayo Newhall Hospital. And for more information you can go to HenryMayo.com. This is Melanie Cole, thanks so much for listening.
Melanie Cole (Host): According to the NIH and the National Cancer Institute, nearly all cases of cervical cancer are caused by the infection of oncogenic or high-risk types of human papilloma virus or HPV. Getting a pap smear used to be an annual appointment most women needed to make, however in recent years many doctors believe a yearly appointment maybe isn’t necessarily needed and depending on your age, sexual health, family history you may not need to go for a couple of years. My guest today is Dr. Maryam Ardalan. She’s an Obstetrician/Gynecologist and a member of the medical staff at Henry Mayo Newhall Hospital. Welcome to the show Dr. Ardalan. So what do we know as of now about what causes cervical cancer?
Dr. Maryam Ardalan, MD (Guest): Hi, thank you very much for this interview, I’m very honored to talk about this topic and this is one of the most important part of the women’s health. The reason of the cervical cancer now is found to be mostly related to HPV. We in the past did not have any technology in order to identify high risk HPV but recently we’re able to find HPV and that helps to identify cervical cancer in the very early stage.
Melanie: So typically women have been getting their pap smears every year, but now with the advent of this new research and the discovery of HPV as one of the main causes and we’re seeing this HPV vaccine being given to our girls as young as 9 years old, what are we seeing now as the relationship? How often are we supposed to get our pap smears now and does it depend on your age and whether or not you’ve had the HPV vaccine?
Dr. Ardalan: So the answer to this question is based on the patient's past history. If the patient did not have any history of abnormal Pap smear or HPV in the last at least three prior paps you may not need to do the Pap smear every year. So basically the American College of Gynecology recommends if you have negative Pap smear in the last 3 paps and HPV is negative you may need to repeat your pap in 3-5 years depending on your age.
Melanie: So for women who are nervous about not getting that Pap smear should they be asking for an HPV test when they go in for their yearly? Because they should still go in for a yearly gynecological visit, yes?
Dr. Ardalan: Right, yes. We still recommend that patients have an annual exam because it’s not only for doing cervical cancer screening, just the annual exam gives the opportunity to the patient to see their gynecologist and address some other issues besides the Pap smear. So in the annual visit they can discuss about their sexuality, they can discuss about their menstrual cycle, and basic pelvic examination and reviewing their past history can give us an opportunity to discuss with them if they require to have a pap smear on that visit or not.
Melanie: And Dr. Ardalan in your opinion what do you see will happen with the women who are under the age of 26 and have gotten the HPV vaccine. Is Pap smear still going to be recommended for them at some point, will they have them at all? What do you think is going to happen?
Dr. Ardalan: So basically in the women below the age of 24 technically, because there’s a certain age that basically starting screening which is the age of 21. And because HPV is so common we may not test for HPV up until age of 24 and even after 24 even up until 30 we can only do the test for high risk HPV based on the pap results. So technically when the patient comes in for the checkup I will review their past history, I look at their age and based on their pap history I can give them more recommendations on what type of pap smear they should have, whether they need to have an HPV testing or whether they need to do the reflex HPV which means if their pap smear is abnormal then we run for HPV. The reason HPV is so common in the young age especially below the age of 24 that we don’t necessarily test for HPV in that age group. The majority of women in this age group carry HPV because of their young age and because they have a good immunity the body may basically clear the HPV over time.
Melanie: So what about the women in that middle age that are maybe above the age of thirty, so they are too old to have gotten that HPV vaccine, and yet they’re sexually active or up until you know in their fifties and sixties, what do you tell them about getting that Pap smear or getting tested for HPV?
Dr. Ardalan: So women are technically above the age of 30 we routinely test them for high risk HPV. And these women because as you get older the possibility that the HPV resolves by itself is less so it’s important for us to know if they have a HPV positive we basically keep an eye on them and we repeat their pap smear based on the guidelines and based if there is any abnormalities in their pap smear or not. So technically if they’re above the age of thirty as I say this if they have normal Pap smear and a negative HPV in the last prior 3 paps they need not require to have pap every year or every three years depends on their risk factors. If they are very low risk they can do it even in five years with the high risk HPV. So if you as a physician decide to run the HPV test for a woman above the age of thirty and if their pap smear is negative and their HPV is normal you may not need to do it up until five years if the prior three paps are normal and negative for HPV. But if they show any abnormalities let’s say in the prior pap is normal but only shows HPV then we’ll decide to repeat the pap in a year. It just depends case by case and based on their risk factors.
Melanie: And what do you tell women that ask you about the HPV vaccine and Gardasil and risks involved and does it really help prevent cervical cancer?
Dr. Ardalan: Basically as far as Gardasil or HPV vaccine, we can offer the patient of a certain age group, technically at the age of 11-12 American College of Cancer and American College of Obstetrics and Gynecology or American Cancer Society recommends to offer the patients in this age group from 9 to 26. Ideally 11-12 is the age that girls can see their pediatrician and they can be offered the vaccine through that age but if they have not been vaccinated they can have a catch up vaccination after the age of 11-12 between the ages 13-26. So HPV vaccine has a 70% prevention against cervical cancer and there is different types of vaccine. When I see the patient I counsel them and tell them that this is protecting 70% and there’s three different types. The latest one is the HPV 9 that is protective against HPV types 6, 11, 16, and 18 and five more HPV viruses and prevents again genital warts and cervical cancer. This is the newest type of vaccine that is available and that’s the recommendation to get this series of three vaccines. As I said if they have not received it after age 26 it is not recommended to get it because then there is a possibility that they’ve already been exposed to HPV. This is what I talk to the patient about in my encounter when I counsel them.
Melanie: How early should a girl come in to see a gynecologist for the first time?
Dr. Ardalan: They can do it anytime starting at age of 9. Normally age of 13 they can have their first visit. They can also see their pediatrician and they can receive the vaccine, but that’s only for immunization, but because girls they start their periods between age of normally as early as 8 to 16 some of them they encounter some abnormality in their cycles or problems with menstruation and that’s the main reason that pediatricians refer to us for consultation. They can discuss about the HPV vaccine and those sort of things with their pediatrician but if their pediatrician is not comfortable they can refer to a gynecologist.
Melanie: If a mother or a parent brings a young girl to you to discuss the HPV vaccine Dr. Ardalan and the parent has a concern that by discussing this vaccine it will somehow girl the girl permission to be sexually active what do you tell them about the studies that have looked into this question?
Dr. Ardalan: So it is not a matter of encouraging the patient to be sexually active, as far as the HPV if they receive the vaccine before they’re exposed to HPV they will have the highest protection rate. So it’s better just to receive the HPV vaccine before they have exposure. And because as they are already infected with HPV the protection against HPV and cervical cancer is obviously less. That’s what I discuss with the parents and tell them that it’s better just before they’re sexually active and they start their sexuality to receive this vaccine.
Melanie: So wrap it up for us Dr. Ardalan with your best advice about the HPV vaccine, HPV virus, pap smears, women’s health in general give women your best advice.
Dr. Ardalan: My advice is that the women see their gynecologist once a year and that’s the opportunity for them to have the breast examination, they bring up all the important information about their sexuality, about their cycles, about their cervical cancer screening, about the breast examination and all that gynecology health questions that they have with the gynecologist. And that visit the past history will be reviewed with the patient and they can discuss about all these questions that they might have and that’s a good opportunity for them to come and get checked and based on their risk facts and prior history we can discuss with them whether they need or require a pap smear in that examination. Or how often they need to have it and then we can discuss about some other health issues that they didn’t have any other opportunity to bring up at the gynecologist. And I always recommend them to try and set appointment with their birthday so in that way they don’t forget and to make sure that their next birthday they will already have an appointment scheduled and seen by the gynecologist.
Melanie: Thank you so much Dr. Ardalan for being with us today. You’re listening to It’s Your Health Radio with Henry Mayo Newhall Hospital. And for more information you can go to HenryMayo.com. This is Melanie Cole, thanks so much for listening.