The chances are pretty good that you—or someone you know—is infected with the human papillomavirus (HPV). It’s the most common sexually transmitted infection in the United States, currently affecting a whopping 79 million Americans, most of them in their late teens and early 20s.
In some cases, HPV infection can prove deadly, leading to an estimated 33,700 cases of cancer each year in both men and women.
Here’s what you need to know to protect yourself and your loved ones.
Understanding the virus
Rather than one specific virus, HPV is actually a group of more than 200 related viruses. More than 40 of them can be spread through direct sexual contact, whether vaginal, anal or oral sex. Of these types of HPV, 13 strains are can lead to certain forms of cancer, including cancers of the cervix, vagina, penis and anus as well as cancers of the head and neck. As a result, these viruses are considered high-risk strains. (Keep in mind: the HPV strains that cause skin warts around the genitals and anus typically don’t go on to cause cancer.)
Before you panic, keep in mind that HPV is so common that 80 percent of people will get an HPV infection during their lifetime, according to the Centers for Disease Control and Prevention (CDC). About ninety percent of the time, HPV goes away within two years on its own.
But in some cases, it can linger and lead to cancer:
Cervical cancer: Virtually all cases of this disease are caused by the HPV virus, says Nadine Zekam, MD, an OBGYN at Medical City Arlington in Arlington, Texas. Each year, nearly 13,000 women are diagnosed with cervical cancer and more than 4,000 die from the disease, according to the CDC.
Throat cancer: In the U.S., it’s estimated that 3,400 women and 14,800 men are newly diagnosed with HPV-associated oropharyngeal cancers each year in the United States, the CDC reports.
Anal cancer: Every year in the United States, 5,900 people are diagnosed with anal cancer.
Penile, vulvar and vaginal cancer: Some 3,300 women are diagnosed with vulvar and vaginal cancers annually in the United States while 800 men are diagnosed with penile cancer each year.
Who’s at risk for HPV?
You’re at increased risk for HPV infection if you:
Have multiple sexual partners. The more partners you have, the more likely you are to be exposed to HPV. But even if you’re monogamous, you may be more susceptible if your partner has multiple sex partners.
Start having sex at a young age. “The earlier you become sexually active, the more likely you are to come into contact with HPV,” explains Dr. Zekam.
Smoke. While smoking itself doesn’t raise risk for HPV, it appears to make it more likely that it will progress to cancer, says Zekam. Women who smoke, for example, are about twice as likely to develop cervical cancer as non-smokers, possibly because compounds in tobacco smoke damage the DNA of cervix cells. Smoking also makes it harder for the immune system to fight off HPV infections.
Signs to watch out for
If you have the type of HPV that causes genital warts, you may see small cauliflower-like bumps on your vulva if you’re a woman or on your penis or scrotum if you’re a man. Warts can also crop up near your buttocks or in your throat if you’ve had oral sex. They don’t usually hurt, but they can itch.
Your healthcare provider can prescribe medicine to boost your immune system to help your body fight off infection as well as topical treatments to prevent wart cells from growing. Your doctor can also remove growths by cutting them off, freezing them off—a procedure called cryotherapy—or destroying them with electric currents or lasers.
If you have the type of HPV that can cause cancer, there aren’t any symptoms until you begin to develop a disease such as throat or cervical cancer, says Zekam. That’s why taking steps to protect yourself and avoid getting HPV in the first place are so important. Here’s how:
It’s recommended that all boys and girls receive the two-dose vaccine by age 11 to 12.
“Ideally, you want to give the vaccine to someone a few years before they become sexually active, so that they’re protected,” explains Zekam.
Women and men (not previously HPV vaccinated) can also receive the vaccine up to age 26, and in some cases, as old as 45. If you’re in this age group, ask your doctor what is right for you.
The HPV vaccine protects against nine strains of the virus, including seven of the most common cancer-causing types as well as the two responsible for genital warts. It could prevent more than 90 percent of related cancers from ever developing and not only protect against infections that cause six types of cancer but also help people avoid uncomfortable testing and treatment, which in some cases, can affect fertility, the CDC advises.
All women between the ages of 21 and 65 should be screened for cervical cancer. Women in their 20s should get a Pap smear every three years. “We don’t do HPV testing in this age group,” Zekam explains. This is because while HPV infection is common in this age group, about 90 percent of the time the virus disappears on its own within two years. But if a young woman has a positive HPV test, it will require more follow-up testing and procedures that can be stressful and that may ultimately result in impaired fertility.
Women over the age of 30 have two options: either a Pap smear every three years or screening with a combination of both a Pap smear and HPV testing every five. You can stop screening after age 65 if you don’t have a history of cervical cancer and if you’ve had either three negative Pap tests in a row or two negative combination results within the previous ten years with the most recent one having been performed within the previous five years, according to the American College of Obstetricians and Gynecologists.
But while doctors can screen for cervical cancer, keep in mind that there aren’t screening tests for the other 20,000 cases of cancers caused by HPV infections each year, according to the CDC. That’s why it’s so important to get the vaccine if you can.
Get condoms—and use them. The only way to protect yourself 100 percent against HPV is to avoid sex completely. But that may not be a realistic option for most people.
If you’re not in a mutually monogamous relationship, your next best bet is to always use condoms, even if you’re on other methods of birth control such as an IUD or oral contraceptives. Just keep in mind that since HPV can infect areas not covered by condoms, they don’t offer complete protection.
Sourcing: UptoDate, CDC, American Cancer Society, National Cancer Institute, American Academy of Dermatology
Some 93 percent of cervical cancers could be prevented through HPV (human papillomavirus) vaccination and screenings, including regular Pap tests (also known as Pap smears), which help doctors detect and treat unhealthy cells before they become cancerous or spot cancers early when they’re more effectively treated.
As a result, the number of women being diagnosed with cervical cancer or dying from the disease has dropped dramatically over the past few decades. After age 45, though, screening rates steadily decline as women get older, according to a November 2019 analysis of three large national surveys led by the University of Michigan Rogel Cancer Center. This is concerning since the National Cancer Institute reports that more than 60 percent of all cervical cancers are diagnosed in women age 45 and older.
The University of Michigan research, which was published in the journal Preventive Medicine, also found lower screening rates among women with less education and those living in rural parts of the country.
In 2019 alone, it’s estimated that about 13,170 women will be newly diagnosed with invasive cervical cancer. More than 4,000 will die from the disease, according to the American Cancer Society. Most women diagnosed with cervical cancer had not been screened for it.
Whether you’re new to Pap tests, or you’ve been getting them for a while, it’s important to understand how often you need one, and how essential they are for your health and well-being. We talked to OBGYN Thomas Zarka, MD, of Parkland Medical Center in Derry, New Hampshire to learn the most important facts about Pap smears: how it’s done, risk factors that affect frequency and what it means if your test results are abnormal.
What is a Pap smear?
In a nutshell, a Pap smear is an in-office procedure that allows your gynecologist to clearly see your cervix and collect cells from it. From there, lab technicians study them under a microscope to see if any pre-cancerous or cancerous cells exist.
During the actual exam, your gynecologist will insert a metal or plastic speculum into your vagina to keep it open. Next, your doctor uses a small spatula to gently scrape the cervix for cells and mucus. After that, a cotton-tipped swab is inserted into the opening of your cervix to gather samples.
How often should you have one?
While cervical cancer recommendations vary slight from organization to organization, most gynecologists follow the pap smear guidelines set forth by the American College of Obstetricians and Gynecologists (ACOG) and US Preventive Services Task Force. How often you need one may depend on your age and health history. Here’s the basic breakdown:
- Women ages 21 to 29: Pap smear every three years
- Women 30 to 65: Pap smear and human papillomavirus infection (HPV) test every 5 years (continuing to have a Pap smear alone every three years or an HPV test every 5 years are also options, too)
So how does Zarka advise his own patients? “I recommend that the test be done every three years until the age of 65 and then, if you’ve have had three consecutive negative tests in a row and you don’t have a history of abnormal cervical cells, you don’t have to have them anymore.”
You and your gynecologist should discuss what’s best for you. More often than not, your gynecologist will use these interval recommendations because there is science to back them up, says Zarka.
You may need more frequent Pap testing if you’ve had abnormal Pap smears in the past, or if you have human immunodeficiency virus (HIV or AIDS), have had any organ transplants, or your mother took diethylstilbestrol (DES), a synthetic form of the female hormone estrogen, passing it to you in the womb.
An abnormal Pap isn’t always cause for worry
Zarka says that many women get upset if their Pap smear comes back abnormal, and he wants women to know that it does not necessarily mean that you have cancer. “In fact, because we have such a rigorous screening process in this country, cervical cancer really is a rare disease. We don’t see it very often.” According to the American Cancer Society, cervical cancer death rates have decreased by more than 50 percent in the last 40 years, thanks to this screening procedure.
So, what do your Pap smear results really mean? Typically, they are categorized into three types, based on a system called the Bethesda System (TBS). Here’s what the results indicate:
- Negative for intraepithelial lesion or malignancy: there are no signs of cancer, pre-cancer or other abnormalities, but other non-cancerous conditions may be present, such as a yeast infection or herpes
- Epithelial cell abnormalities: cells lining your cervix or vagina indicate there may be a cancerous or pre-cancerous condition present
- Other malignant neoplasms: Non-cervix related malignant conditions such as melanoma, sarcomas and lymphoma
You should still see your gynecologist every year
You may not need a yearly Pap smear, but don’t take it as a free pass to skip seeing your gynecologist. A yearly checkup is recommended by some, but not all, expert groups. At your yearly exams (whether it’s the year for your Pap smear or not), your gynecologist may perform a physical exam to check the health of your ovaries, uterus and breasts. Depending on your age, you may also discuss fertility issues, perimenopause or menopause symptoms.
Help ensure accurate results
Pap tests are the most well-known and effective method of detecting cervical cancer. Here are ways to ensure that your results are accurate:
- Avoid seeing your gynecologist for a Pap smear during your menstrual period. If possible, schedule it at least five days after your period ends.
- Refrain from using any products or medications that are inserted into the vagina two to three days before your test: this includes tampons, birth-control foams or gels and vaginal creams, lubricants and medications.
- Avoid douching, especially two to three days before your Pap smear.
- Abstain from vaginal sex two days before your Pap smear.
Sourcing: American Cancer Society, National Cancer Institute, Office of Women’s Health, UptoDate
Have you ever thought your period was over, only to see spots of blood in your underwear a few days later? If you didn’t pack a panty liner, you’re not alone.
Menstrual cycles usually last somewhere between 24 and 38 days, and a regular period can run anywhere from a few days to about a week. If you bleed between periods, however, it’s considered irregular, and referred to as either spotting or intermenstrual bleeding.
“Spotting can happen at any point in the cycle, but it’s not a steady flow,” says Ma Lourdes Mina, MD, an OBGYN from Coliseum Medical Centers in Macon, Georgia. Spotting can include pink blood on your toilet paper after sex or urination, or spots of blood in your underwear either before or after your period.
Although most reasons for spotting are benign, like switching birth control, others are more serious, and spotting along with certain other symptoms might point to an underlying condition. In general, if you notice spotting, it’s never a bad idea to go to the doctor. “Any bleeding that is concerning needs to be checked,” says Dr. Mina. Your OBGYN might point to one of these as the reason.
Birth control pills stop a woman’s egg from being released. If the egg is not released, the male sperm has nothing to fertilize, which prevents pregnancy. This happens because the pill contains hormones—usually estrogen and progestin—which stop you from producing the hormones that tell your body to ovulate.
“If you miss a pill, change birth controls in the middle of a pack or skip your placebo pills, you’re adjusting your body’s hormone levels,” says Mina. And that manipulation of hormones can cause spotting.
If you notice blood, and your menstrual cycle lasts longer than 38 days or is shorter than 24 days, it’s a good time to see your gynecologist. Always remember to tell your OBGYN if you take other medications, since certain drugs can interact with the pill to cause spotting.
Emergency contraception is a type of birth control that temporarily stops your ovary from releasing an egg, or prevents that egg from being fertilized. It is effective within five days of unprotected sex, and many pills work best when used within three days. If you choose to use it, be sure to check with a health professional about timing.
Mina says that it’s not uncommon to have spotting or bleeding like a period, or anything in between when using an emergency contraceptive. She says, “If your spotting lasts longer than a few days, or becomes heavier, you should speak with your gynecologist.”
When you do get your period afterward, it might come earlier or later than what you consider normal.
SEXUALLY TRANSMITTED DISEASES
Any sexually transmitted disease (STD) affecting the cervix can cause bleeding, especially after sex. Two common examples are chlamydia and gonorrhea. If you have painful urination or increased discharge along with your irregular bleeding, it’s important to see your gynecologist. Both STDs can be treated with antibiotics—so the sooner you see a doctor, the better off you’ll be.
If you’re sexually active, speak with your gynecologist about STD screening and a pap smear—especially because STDs can lead to infertility if left untreated.
One of the symptoms of both menopause and perimenopause is that a woman’s cycle becomes less predictable than it once was. In some cases, it could get shorter, going from 28 days to, say, 26 days. Some women might skip periods, or they may become heavier or lighter. Other symptoms can include night sweats and mood swings.
However, after menopause, it’s never normal for a woman to spot or bleed vaginally—so see a doctor if you start. Some common causes for bleeding after menopause include endometrial atrophy, which is when estrogen levels drop and cause the endometrium to thin, or endometrial hyperplasia, a condition causing the lining of the uterus to thicken. Treatment for post-menopausal bleeding will depend on the cause.
Fibroids are tumors that grow in the wall or inside the cavity of the uterus. They’re actually pretty common—especially amongst women in their 40s and early 50s. If the growth occurs within the innermost layer of the uterus (endometrium), then spotting between periods can result. Other symptoms might include heavy and painful periods, frequent urination and painful sex. Treatment will vary depending on where the fibroid is located, as well as symptoms and size, and might include over-the-counter medication for less severe symptoms.
Other uterine conditions like endometriosis and pelvic inflammatory disease may also cause spotting, though their most noticeable symptom is often pelvic pain. If you experience pain and spotting, talk to your gynecologist.
MISCARRIAGE OR PREGNANCY COMPLICATIONS
A miscarriage, or a loss of pregnancy, can happen at any time, but usually occurs in the first trimester, sometimes before a woman even realizes she’s pregnant. “When people who typically have regular, predictable periods miss a period or have less bleeding than normal, it can be a sign either of pregnancy or a miscarriage,” says Mina. Other symptoms of a miscarriage might include lightheadedness, pain in the abdomen, brown discharge or other irregular bleeding.
It’s important to note: if a woman knows she’s pregnant and experiences irregular bleeding, it doesn’t mean it’s a miscarriage. Spotting during pregnancy isn’t uncommon, and can happen at any time. However, if you’re pregnant and you’re spotting, call your doctor to discuss any symptoms.
Most cancers of the reproductive organs—including vaginal, cervical, uterine and ovarian cancer—can all have intermittent, abnormal bleeding as one of the symptoms. But Williams says that that irregular periods or a prolonged absence of a period can lead to cancer in a hyperestrogenic environment, so these situations should be evaluated regularly.
If you experience any symptoms lasting two weeks or longer, such as pelvic pain, bloating, frequent urination or itching/burning in the vulva, you should see your gynecologist. The symptoms for each gynecological cancer varies from person to person and depends on the type of cancer. (For a full list, check the CDC Gynecologic Cancers page.)
Pap smears can help detect cervical cancers. Other cancers, like ovarian cancer, are harder to detect because there is no formal screening. If the cancer is at a more advanced stage, surgery and chemotherapy might be used for treatment.
Sourcing: UpToDate, The American College of Obstetricians and Gynecologists, Office of Women’s Health, U.S. National Library of Medicine, Cleveland Clinic
When a friend or family member is diagnosed with breast cancer, many people don’t know how to react—or help. What can I really do? Will I say the wrong thing? Does she or he even want my help?
While there’s no one-size-fits-all answer, it’s vital to support your loved one throughout diagnosis, treatment and recovery. In fact, one study showed that women with breast cancer who had support from their friends, families and even online groups had better outcomes following treatment, as well as higher rates of survival. Increased support from family may also help to prevent depression following a breast cancer diagnosis.
Not sure how you can help? We spoke with Ioana Hinshaw, MD, a medical oncologist with Presbyterian/St. Luke’s Medical Center in Denver, Colorado, to learn the best ways to help a loved one with breast cancer.
A cancer diagnosis is scary for a patient’s loved ones, too. But during this daunting time in your friend or family member’s life, being present and offering to talk—about any subject, from their diagnosis to why the sky is blue—is key.
“Many people feel uncomfortable because they don’t know what to say to a patient diagnosed with cancer. They don’t know how to react. I’ve seen a lot of people avoid contact simply because they don’t know what to say,” Dr. Hinshaw says.
Reaching out to your friend or family member and even saying something as simple as “I’m thinking of you” or “What can I do to help?” can be tantamount to their mental and emotional well-being.
Many people worry that they will be treated differently or that their relationships will be altered as a result of their illness. It’s also important to ensure your loved one knows they have your support, despite changes in their mood, abilities or appearance. “The most important thing is to be there to talk and reassure them that nothing has changed in the relationship—you’re there to support them,” says Hinshaw.
GO TO THEIR APPOINTMENTS
After a breast cancer diagnosis, doctor appointments can be overwhelming. Some patients are so flooded by information about their condition, treatment options and prognosis, they actually can’t remember many of the details of their conversations with their doctors, according to Hinshaw.
Offer to attend doctor’s visits with your friend or family member and take notes throughout; be sure to capture minute details, so your loved one can feel fully informed about their course of treatment and prognosis.
If a friend or family member is undergoing chemotherapy, never let them attend alone. Offer to drive to and from their treatments. Some gossip, Netflix, adult coloring pages or board games can be a welcome distraction. Even if they just rest of sleep through their treatment, a friendly face may help make the session feel less scary.
HELP WITH CHORES
When someone is undergoing treatment for breast cancer, household chores are likely the last thing on their mind—especially in the days following a chemo session. Hinshaw says: “The first two days after chemotherapy are very hard on patients—they can use the help.”
Prepping a few heat-and-eat dinners, doing a grocery run or pharmacy pick up, taking care of children and pets or cleaning her house will save your loved one a few hours of work and, more importantly, the energy they need to heal. Set up an online calendar among your friends and family members so you can divide up the good deeds among each other.
If you’re going to stop by their house, however, be sure to call or text ahead and ask for a good time. If he or she is feeling tired or under the weather, they may not be up for even a quick visit. Try to find times other than weekends to visit as well—getting through a week day may be a lot tougher and lonelier.
RESPECT THE DOCTOR’S ADVICE
Your role, as a friend or family member, is to be supportive and encouraging of the treatment recommended by your loved one’s medical team. “People without medical backgrounds offer opinions about what they’ve heard [about treatments] or alternative treatments. They may even discourage their friends from undergoing the recommended treatment,” says Hinshaw.
Despite your best intentions, you shouldn’t sway your friend or family member from following their doctor’s advice, recommend alternative treatments or share your own research into treatment options. You can show an interest, however, by asking questions about her treatment process, along with how she is feeling.
It is important to be a patient advocate, but you can do so by taking notes at their appointments, attending treatment sessions or simply lending a listening ear.
Your loved one has a lot on her mind—she has cancer, after all—so distract her! Take her thoughts off of her treatment with small surprises, like flowers, gifts she can actually use (such as comfy slippers, a journal or a new book) or even her favorite baked good.
If you know she has a treatment appointment coming up or has had a particularly hard week, take her on a coffee or tea date for a gossip session, see a funny movie or get a manicure and pedicure. Think about her day-to-day and the small things you can do to make it a little bit better—even if it’s something as simple as listening.
BE THERE AFTER TREATMENT IS OVER
The prognosis for many forms of breast cancers, especially with early detection, can be good. But even if your loved one is lucky enough to beat the disease, they will still need your love and support.
In the months following treatment, your friend or family member may worry that their life will never be the same. Chemotherapy can have lasting impacts on fertility, sexual health, body weight and physical appearance. She may become depressed while struggling through these changes.
Your loved one may get anxious before follow-up medical tests or worried that small aches and pains are because of a relapse. She may also continue to feel fatigued, long after treatment is over.
Don’t disappear when your loved one’s cancer does. Instead, continue to ask where they need help in their life, whether it’s reassurance that they are healthy and a kind ear to listen to their worries. If they feel up to it, encourage them to continue any hobbies or activities they may have stopped while treating their breast cancer.
“As a good friend, you have to be there and tell them nothing has changed—they’re the same person they used to be,” says Hinshaw.
Sourcing: American Cancer Society, National Cancer Institute
By the end of 2019, it’s estimated that almost 270,000 American women will be diagnosed with invasive breast cancer, a number that’s climbed 0.3 percent for the last 10 years. More than 41,000 women are expected to die of the disease. And even though awareness and survival rates are improving, many of us still have misconceptions about this increasingly treatable condition.
“There’s a lot of hope for you,” says breast surgeon Renee Quarterman, MD, FACS, from St. Mary Medical Center in Langhorne, Pennsylvania. “There’s a lot of hope for all patients with breast cancer.” Find out the truth behind popular breast cancer myths, along with what Dr. Quarterman wishes everyone knew about the condition.
MOST CASES ARE NOT INHERITED
There’s no doubt: you have a stronger risk of breast cancer if there’s a family history of the disease. This includes having at least one close relative diagnosed before age 45, or multiple cases on the same side of the family—and it doesn’t have to be your mom’s. “A lot of people think, ‘Well, that breast cancer’s on my dad’s side so it doesn’t matter,'” says Dr. Quarterman. “But it does matter.” When assessing your risk, she adds, it’s important to get both family histories.
But overall, just 5 to 10 percent of breast cancers are directly related to genes inherited from a parent. In fact, approximately 15 percent of women who have breast cancer have a family member with the disease, according to the American Cancer Society. “Most breast cancers are not caused by genetic mutations,” says Quarterman. Rather, many cases can be linked to lifestyle factors.
IT’S LINKED TO LIFESTYLE
While family history plays a role, breast cancer is influenced in large part by lifestyle choices, says Quarterman. These include:
- Drinking alcohol in excess: The more you imbibe, the higher your risk; according to the American Cancer Society, women who have two to three drinks daily have about a 20 percent greater risk than those who don’t drink at all.
- Post-menopausal obesity: Though the relationship between fat and breast cancer is still being sussed out, it’s thought that excess weight after menopause ups your estrogen levels, raising your chances. Obese women are also more likely to have type 2 diabetes, which likely plays a role in cancer risk.
- Smoking cigarettes: Both first- and second-hand smoke may be linked to an increase risk of developing breast cancer, although more research is still needed. Some groups have higher risk, including women who began smoking before their first child or those who have been heavy smokers for many years.
- Breastfeeding: An analysis of 47 studies found that for every 12 months of breastfeeding, women reduced their breast cancer risk by 4.3 percent. Most American women breastfeed for less than a year, but it is not clear if a shorter duration is linked to reduced risk.
On the flip side, exercising—150 minutes of moderate or 75 minutes of vigorous activity weekly—and maintain a healthy weight through diet and activity might lower your chances of developing the disease.
IT DOESN’T NECESSARILY HURT
Though mammograms can pinch and treatments like radiation and chemotherapy often come with uncomfortable side effects, breast cancer itself isn’t typically painful. “Women will tell me that they have a lump, and we find out that it’s cancer,” says Quarterman. “They say, ‘It didn’t hurt. I didn’t think it was cancer.'”
While pain is possible, you may notice other symptoms first. Lumps and masses are the most common signs of the disease, though you should also keep an eye out for changes in the appearance of your breast. These include:
- A lump or mass
- Skin irritation, thickening, scaling, redness or dimpling of the breast or nipple
- Nipples turning inward
- Nipple discharge that isn’t breast milk
- Changes in shape and size
It should be noted that while a lump or mass may be a sign, most of them are not cancerous. However, if you’re experiencing one or more of these symptoms, contact your doctor as soon as you can.
YOUR BRA AND ANTIPERSPIRANT DON’T CAUSE IT
You may have heard from a friend—or, more likely, Facebook—that your antiperspirant can give you breast cancer. The theory goes that chemicals seep into your skin, or your roll-on prevents you from sweating, leading to a build up of toxins. Some even think that antiperspirant is absorbed through underarm shaving cuts, causing the disease. But it’s just not true.
“There has been concern about certain types of deodorants, or maybe having aluminum in your deodorant,” says Quarterman. “But that hasn’t been borne out yet in any study.” She suggests wearing whatever deodorant/antiperspirant works for you. And if you’re still worried, try brands that are labeled as natural or less processed.
The same goes for bras, which some say cause cancer by preventing lymph nodes from draining correctly. “We don’t have any evidence that the type of bra that you wear causes breast cancer,” says Quarterman. “Again, wear what works for you.”
EARLY DETECTION IS CRUCIAL
With treatment, the five-year survival rate of someone with localized breast cancer is 99 percent. Those with regional breast cancer—meaning the cancer has spread to nearby areas—have an 85 percent chance of surviving for five years. When breast cancer spreads to distant parts of the body, the survival odds drop to 27 percent. “The earlier we find breast cancer, the more successful we are in treating it,” says Quarterman. “So, I encourage women to stay on top of their mammograms.” Mammograms remain the most effective way of detecting the disease.
The official recommendation for mammograms is to have an informed talk with your doctor about the best time to begin screenings, based on family history and risk factors. Annual mammograms should start for most women at age 40 to 50. After that, screening guidelines vary a little.
IT’S DEADLIER FOR AFRICAN AMERICAN WOMEN
Black women are diagnosed with breast cancer at about the same rate as white women. However, black women are around 41 percent more likely to die of the disease. Access to healthcare and racial disparities in treatment each play a role; breast cancer is often detected at later stages, and follow-up care may be delayed. They are also more likely to develop the disease at a younger age. It’s not the only factor, however, says Quarterman.
“When you control for the stages of breast cancer, African American women still have worse outcomes than their white, or Latina, or Asian counterparts,” she says. “There’s something about the biology of breast cancer in a lot of African American women that confers a worse prognosis.” For example, black women are more likely to develop triple-negative breast cancer, which has a lower five-year survival rate than other kinds of the illness.
MEN CAN—AND DO—GET IT
Breast cancer isn’t just a woman’s health issue. In 2019, an estimated 2,670 American men will be diagnosed with the condition; it will kill around 500. Men don’t often realize they have it—or that they can develop it at all—and may be uncomfortable discussing the issue with their doctor.
“If you have a nipple, you could get breast cancer,” says Quarterman. “It’s important to check yourself and not be afraid to talk to somebody, not be embarrassed to talk to your doctor and get examined.” This is especially true if you find a lump in your breast area, which is the most common sign, or have other symptoms typical to breast cancer. Much like African American women, black men are less likely to be diagnosed with breast cancer but face worse outcomes.
IT’S NOT A DEATH SENTENCE
Thanks to a combination of increased awareness, early detection and better treatment, breast cancer death rates have dropped big-time in recent decades. Between 1989 and 2015, they fell about 39 percent.
“I tell my patients that you don’t need to change any of your long-term plans, because there’s a lot that we can do,” says Quarterman. That’s largely because treatment can be customized to the patient, now more than ever. “We can tailor therapy; we can predict who should have chemotherapy and who really doesn’t need it.”
Safety and technological advancements have helped, as well. “Our radiation delivery has become better and safer. Our surgery has become better and safer,” she says. “All of that comes together to improve outcomes.”
Sourcing: American Cancer Society, Breastcancer.org, National Cancer Institute, CDC, UptoDate, National Institutes of Health, National Breast Cancer Foundation, US Preventative Task Force
Metastatic breast cancer is cancer that began in the breasts but has spread to other areas of the body.
Hearing that you or a loved one has MBC is a difficult diagnosis to receive and a difficult topic to talk about. You are not alone; more than 150,000 people in the U.S. are currently living with MBC. Although there is no cure for MBC, there are effective treatments that can slow the progress of the cancer, minimize symptoms, improve quality of life and prolong a person’s life. Knowing what questions to ask at an appointment with your healthcare provider can help you make an informed decision about treatment.
Your healthcare provider may not have answers to all your questions just yet, and additional diagnostic tests may be required. In either case, the questions below can serve as a starting point to understanding what is known and what you’ll need to learn about the cancer in order to decide on the best treatment option.
What parts of the body has cancer spread to?
Breast cancer cells can spread to any part of the body, though the most common areas are the liver, lungs, bones and brain. To learn where cancer has spread, your healthcare providers will likely use an imaging test or a combination of imaging tests, such as CTs, MRIs, PET scans, bone scans or X-rays. These diagnostic tests will also help determine the location and size of the tumors.
Do the cancers need to be biopsied?
MBC can be present when you are initially diagnosed with breast cancer, but often occurs when the original cancer relapses. Your doctor may want to do a biopsy of the suspected metastasis for confirmation before a treatment plan is formulated. However, a biopsy may not be necessary, depending on your situation. In most cases the metastatic tumors will be similar in type to the original tumor. Occasionally, the tumor receptors will change over time or after the original treatment. As you probably remember, your original tumor was tested for various receptors:
- ER/PR-positive: When a cancer is estrogen-receptor/progesterone-receptor-positive—or ER/PR-positive—it uses the hormone estrogen to fuel its growth. There are a number of treatments that prevent these cancer cells from getting the estrogen they need to grow.
- HER2-positive: Human epidermal growth factor receptor 2, or HER2, is a protein that promotes the growth of normal cells. Some cancers produce an excess of this protein, which makes them more aggressive. Specific treatments are designed to target these cancer cells.
What treatment options are available?
Chemotherapy, hormonal therapy and biologic therapy are all used to treat MBC, but treatment depends on a number of important factors, including the biology of the cancer. Your treatment may change over time. If your cancer stops responding to one or more treatment types, it may respond to another. If you have side effects that are hard to control, another treatment may be recommended. Surgery and radiation therapy are not common treatments, but may be needed to remove or shrink specific tumors that are causing severe symptoms or are life threatening, such as tumors in the brain or the spinal column. Your treatment plan will include medications to help with pain management and side effects of therapy. Many patients prefer to get a second opinion before committing to a treatment plan.
Early on, ask your doctor about palliative care to help you address spiritual and emotional issues, get support for making decisions about treatments and other care, and access counseling. Care teams may include your traditional healthcare providers, counselors, dieticians, social workers and chaplains. Palliative care helps with managing symptoms and has been shown to improve quality of life. Palliative care is different than hospice or end-of-life care.
How will they know if the treatment is working?
Your doctor will monitor your symptoms and follow your scans periodically. Your blood work will also help to follow your blood counts and liver function tests. In some patients, there may be tumor markers present in the blood. Ask your doctor how often you should have various tests.
What is my prognosis?
Prognosis is different for every patient and depends on many factors. Your healthcare provider will explain what your prognosis is and what that prognosis means. Remember that there is still much to be learned about breast cancer, and researchers are constantly working to find new ways to treat this condition. Patients today have access to treatment options that did not exist even a few years ago and survival times are improving. In fact, more than a third of women live more than five years—and some live 10 or more years after being diagnosed with metastatic breast cancer.
Sourcing: UptoDate, National Institutes of Health, American Cancer Society, National Cancer Institute
Almost 270,000 new cases of breast cancer are expected to be diagnosed in 2018. Aside from skin cancer, it is the most common form of cancer in the United States. Given that a woman in the US has a one in eight chance of developing the disease, being able to identify changes in your breasts and signs of the illness are key to prevention and early diagnosis.
“Just as we’re worried and aware about other aspects of health, like weight, exercise or diet, it’s important to be self-aware of your breast health,” says Sean Edmunds, MD, an OBGYN at St. Mark’s Hospital in Salt Lake City, Utah.
Breast self-awareness and unusual changes
In years past, experts suggested women perform breast self-exams once a month. Research, however, has found that these exams don’t reliably detect cancer in average-risk women, and lead to a greater number of false positives. Now, many official guidelines recommend breast self-awareness, or knowing what your breasts typically feel like. Having this baseline makes it easier to identify changes that could be signs of breast cancer. Guidelines vary on the value of having regular breast exams done by your healthcare provider, so talk to your doctor to make an informed decision together.
The most common symptom of breast cancer is a new or changing lump, either in the breast or closer to their underarm. “Notice if you have a lump that’s getting bigger, harder or stuck in place,” says Edmunds. Lumps can present either with and without pain and can vary in size. While 90 percent of lumps found in women between their 20s and early 50s are benign, it’s important to rule out the chance of breast cancer if you discover anything abnormal.
Abnormal skin changes are also important to take note of. These include itchiness, irritation, redness, scaling, swelling on part of the breast, pain or dimpling. “If you’re noticing any skin or tissue distortion where the skin’s puckering in or there’s any distortion in the natural contours of the breast, those are all abnormal things, and you should come be checked out,” says Edmunds. Be aware of nipple skin changes that occur outside of pregnancy or menopause, as well, like discharge, inversion, pain, crusting or color change.
If you do feel or see anything abnormal, or are worried about sudden breast changes, schedule an appointment with your doctor. Your doctor can evaluate changes and suggest a next step, which is typically imaging in the form of a mammogram and a breast ultrasound.
Who is at greater risk for breast cancer?
While all women should be self-aware, there are certain groups at a higher risk for breast cancer than others.
A personal or family history of breast cancer is one factor. “If you have a first-degree relative under age 50 when they were diagnosed, then we tend to do early screening,” notes Edmunds. Doctors will recommend early screenings starting at 30 for individuals who have a hereditary risk of the disease, such as BRCA1 and BRCA2 gene mutations.
Less than 15 percent of women diagnosed with breast cancer have a family history of the disease, however, so it’s important to note other risk factors. The odds increase with age, for example. Early menstruation, becoming pregnant at an older age, late menopause, obesity and a history of radiation treatment on your chest are associated with a higher risk. Some studies cite that lifestyle habits, such as heavy drinking and tobacco use, can affect your likelihood of getting the disease, but the evidence is still unclear. However, many women who develop breast cancer may not have any risk factors, so don’t ignore any changes in breast health.
Women with dense breasts have a greater chance of being diagnosed with breast cancer, as well. Edmunds notes that due to the density of the tissue, women with dense breasts may also not catch any changes as early as others. “Be conscious of the fact that it can be harder to feel changes within your breast, so you may need to take a little bit more time,” he says.
For women of average risk, make an informed decision with your doctor about when to begin breast cancer screenings after age 40. All women should begin receiving mammograms no later than age 50 and continue screenings every one to two years thereafter, depending on guidance from their doctor. Women with a high lifetime risk of breast cancer are encouraged to get mammograms and MRIs beginning at age 30, or an individualized schedule based on family history and guidance from their doctor.
How can you stay healthy?
Besides knowing what types of changes to look for, there are many other steps you can take to reduce your risk of developing breast cancer.
Keep an open dialogue with your doctors about the frequency of screenings and when to begin getting mammograms. A healthy lifestyle is also a factor in keeping your risk of breast cancer lower. “Eat a healthy diet, maintain a healthy weight, exercise, don’t smoke and don’t drink alcohol to excess. These are the things that are within our control,” Edmunds says. Choosing to breastfeed may also reduce a woman’s risk.
Most of all, if you are concerned that anything is abnormal with your breast health, don’t hesitate to schedule an appointment with your doctor for a consultation.
“Be self-aware and don’t ignore changes,” says Edmunds. “Come in if you notice something. You may have just seen your doctor, but you don’t want to assume ‘Oh, it wasn’t felt then, so it’s fine now.’ If you notice changes, make an appointment.”
The human papillomavirus (HPV) is the most common sexually transmitted virus in the United States. It is so prevalent that most people will get it at some point in their lives, says Gretchen Homan, MD, a pediatrician with Wesley Medical Center in Wichita, Kansas. 79 million Americans are infected with HPV.
There are 200 strains of HPV, but only about a dozen have been linked to cancer.
While most HPV infections show no symptoms and eventually go away on their own, sometimes the virus remains inside the body and can cause genital warts or cancer. In fact, the Centers for Disease Control and Prevention (CDC) estimates that someone is diagnosed with an HPV-related cancer every 20 minutes.
Cancers linked to HPV
“Basically, all cervical cancers are caused by HPV virus strains,” says Dr. Homan.
In addition, 91 percent of anal cancers and 72 percent of cancers of the throat, tongue and tonsils (oropharyngeal cancers) are caused by HPV.
HPV has also been linked to penile, vaginal and vulvar cancers.
How to prevent HPV
Fortunately, HPV can be prevented with a vaccine. Doctors recommend that boys and girls get vaccinated at age 11 or 12. Those who aren’t vaccinated can get catch-up shots up to age 26, or sometimes up to age 45.
And while practicing safe sex with condoms is always a good idea, they cannot provide complete protection against HPV since HPV can infect areas that aren’t covered by the condom.
How is HPV detected?
The Food and Drug Administration (FDA) has approved several tests that can detect the strains of HPV that cause cervical cancer in women. The CDC recommends that women 21 and older get the HPV test in certain cases as a follow-up to an abnormal Pap test. And, women 30 and older should get either a Pap test alone every three years, an HPV test every five years, or a Pap test and HPV test every five years.
Just because you test positive for HPV doesn’t mean you will get cancer. And, most of the time, problems that are detected early can be treated before they develop into cervical cancer. If you do test positive for the infection or have an abnormal Pap test, your doctor will do follow-up exams or perform a cervical biopsy to see if the cells are cancerous.
Unfortunately, there are no HPV tests available for men, and there is no routine screening to check for anal, penile or oral cancers unless a doctor sees the presence of genital warts, says Homan.
3 treatments for HPV
There aren’t any treatments for the HPV virus itself, but there are procedures doctors can perform to remove abnormal, precancerous cells before they grow into cervical cancer, including:
- Cryosurgery: a type of surgery that freezes the abnormal cell tissue.
- Loop electrosurgical excision procedure (LEEP): a procedure that uses a hot-wire loop to remove abnormal cell tissue.
- Surgical or laser vaporization conization: surgery that uses a scalpel and/or laser to eliminate a cone-shaped piece of cervical tissue.
Since removing the cells doesn’t necessarily kill the virus, you may need to get Pap tests more often to make sure the abnormal cells don’t grow back. Usually, the virus will go away by itself.
Benign respiratory tract tumors or genital warts caused by HPV may be treated with topical chemicals or drugs or removed surgically through excision or by cryosurgery, electrosurgery or laser surgery.
If you’re sexually active, talk to your doctor about the HPV test and whether it is right for you. And, if you have kids, talk to your pediatrician about getting the vaccine.
Sourcing: American Cancer Society, National Cancer Institute, CDC, American Sexual Health Association, American Medical Association