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Preventing and Treating Cervical Cancer

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Each year, 13,000 women in the United States are diagnosed with cervical cancer.

January is Cervical Health Awareness Month, a time to educate ourselves about this disease and how it can be prevented  and treated. 

What is Cervical Cancer? What Causes it?
Cervical cancer starts in the cells lining the cervix, the lower part of the uterus. It grows slowly; abnormal cells often take 10 to 15 years to turn into cancer. 

Leslie Sackschewsky, MD, has worked as an OB/Gyn for 25 years, the last 10 with Gould Medical Group at Sutter Gould Medical Foundation’s Stockton Medical Plaza. She notes that cervical cancer, unlike many other cancers, is not hereditary. Instead, it is caused by the human papilloma virus, or HPV, a group of more than 150 viruses, about a dozen of which can cause cancer.  

“HPV can be spread from one person to another during skin-to-skin contact, usually during sexual activity,” Dr. Sackschewsky said. “And unfortunately, condoms are not 100 percent effective in stopping the spread of HPV.”

Can Cervical Cancer Be Prevented?
Regular screening and early treatment can be very effective in preventing cervical cancer. In fact, incidence rates for the disease, which was at one time a leading cause of death of young women, have dropped by 50 percent in the last 40 years. The decrease is due to an increase in health screenings, which can find cervical changes before they turn cancerous.

An HPV test can be done on the same sample of cells collected from a Pap test, the procedure used to collect cells from the cervix so that they can be looked at under a microscope to find cancer and pre-cancer. “If a pre-cancer is found, it can be treated, stopping cervical cancer before it really starts,” Dr. Sackschewsky noted. “Most invasive cervical cancers are found in women who have not had regular Pap tests.”

Michelle Smith, an SGMF nurse practitioner, notes that cervical cancer often doesn’t cause symptoms until it is advanced, so it’s important to get screened, even if you feel healthy. “I tell my patients that many women get HPV, but few of them get cervical cancer as long as they get their recommended screenings,” Smith said. 

Pelvic Exam or Pap Test?
During a pelvic exam, your provider examines your female reproductive organs. A Pap test can be done during a pelvic exam, but not all pelvic exams include a Pap test.

While Pap tests are recommended at varying intervals, depending on a woman’s age and health, Smith says it’s still important to come in to see your provider annually for a well-woman visit. During the visit, your provider may perform a pelvic exam, discuss your menstrual cycle, birth control, breast health and menopause, among other things.

“Come in every year to see us,” Smith says. “And be honest. Whether you are having bleeding after sex or have had a new partner or partners, please tell us. We won’t judge you. We’re here to make sure you get the best care to meet your needs.”

What About the Vaccine?
Since it became available in 2006, more than 270 million doses of the HPV vaccine have been given worldwide. Both boys and girls can receive the vaccine as early as age 11 or 12. 

Smith remembers a young woman she treated recently who didn’t receive the vaccine as a girl. She contracted an extremely aggressive strain of HPV in her early 20s, and she wound up having a hysterectomy and losing part of her bowel, all before she turned 30. “When parents are waffling on the vaccine, I tell that story,” Smith said. “Every patient is a loved one to me, a daughter, a sister, a mother. I want you to be safe.”

What Are Treatment Options?
Many women with cervical cancer will have some type of surgery to help diagnose the cancer, determine how far it has spread, or help treat it. Gould Medical Group OB/Gyn Patricia Kennel, MD, performs these procedures at Sutter Stockton Surgery Center, an ambulatory surgery center, or ASC, a modern healthcare facility focused on providing same-day surgical care, including diagnostic and preventive procedures.

Dr. Kennel and her colleagues perform many procedures in the ASC to treat pre-cancerous lesions of the cervix. The two most common are LEEP, or loop electrosurgical excision procedure, and CKC, or cold knife conization. “The intent of both procedures is to remove the abnormal cells of the cervix,” Dr. Kennel noted. “The surgery center is also equipped for surgeons to do more advanced procedures, like hysterectomies, to treat cervical abnormalities.”

Stockton Surgery Center Administrator Katrina Holmes says ASCs provide patients a convenient setting for outpatient procedures and a commitment to excellence. “Because ASCs specialize in the procedures they perform, they are able to concentrate on patient safety and the patient experience, and have an excellent record of safety and quality outcomes for patients.”  

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Written by: Melissa Fuson

Prevention and Early 
Detection by Age

Age 21 – 29
Pap test every three years, with HPV test performed only during follow-up exam if patient has an abnormal Pap test.

Age 30-65
Pap test combined with an HPV test every five years. Women with suppressed immune systems may need to be screened more often.

Over Age 65
Women over age 65 who have had regular screenings in the previous 10 years should stop cervical cancer screening as long as they haven’t had any serious pre-cancers found in the last 20 years. Women with a history of serious pre-cancers should continue to have testing for at least 20 years after the abnormality is found.

Women Who Have Had Hysterectomies
Women who have had a total hysterectomy (removal of the uterus and cervix) should stop screening, unless the hysterectomy was performed to treat cervical pre-cancer or cancer. Women who have had a hysterectomy without removal of the cervix should continue cervical cancer screening according to the guidelines above.