VIDEO TRANSCRIPT: THIS TRANSCRIPT WAS GENERATED USING AN AUTOMATED SERVICE SO WE APOLOGIZE FOR ANY TYPOS AND SPELLING ERRORS.
[00:00:00] Hello. Okay, it's Halloween. It's pouring rain. It's such a bummer. That means there's gonna be too much candy in my house and I'm gonna have to get rid of it, but I'm wearing, can you see this? My Halloween tights and I am about to go into the hospital, so I'm doing a quick pap smear video and by quick, I probably mean 10 minutes because you know how much I don't Talk quickly.
Okay. I decided to talk about pap smears cuz I've gotten a lot of requests about it. Cuz I think it just in inspires anxiety and that word, I hate fear. So let's talk about the basics. The pap smear is the guideline, is the screening test where we look for changes in your cervix. Why would you have an abnormal pap smear?
Because of the HPV virus, human papilloma. Very common. 90% of us carry it. You guys might remember when we talked about herpes, that 50% of us carry herpes. 90% of us in our lifetime, men or women can carry hpv. How do we get it? We get it from having sex and we get it from skin to skin contact. [00:01:00] So in fact, even if you use a condom, which is covering the entire shaft of the penis, the virus can live on the outside of This is the penis.
The virus can live all around and it can live all around the skin of the vagina. The V. So you can transmit it that way. You can also transmit it orally, which is why the vaccine, which is beyond the scope of this discussion because of its controversy, but I'm a huge advocate for the vaccine, especially in the its ability to decrease the risk of head and neck cancer, which is increasing in our time and colorectal cancer.
So getting back to H P V, that is the virus that can cause cervical. The vast majority of us in our lifetime will have hpv. 90% of us will be exposed to it, even if we've had one partner. Even if we do, we've used condoms. Okay? The vast, vast, vast minority will actually ever have cervical cancer, okay?
Majority HPV minority cervical cancer. Who is [00:02:00] more at risk for cervical cancer, unfortunately are smokers because nicotine increases the ability of the virus to get into the cervix and cause changes. Patients who have a significant immune compromise like HIV or certain immunecompromised patients, if they were getting, um, chemotherapy, stem cell transplants, things like that.
Otherwise, the majority of us, if we are general, And if we stick to the screening guidelines, we will find out we have hpv, maybe find out we have abnormal changes from the HPV V, but never, ever, ever have cervical cancer. And even if we ever get cervical cancer, the vast majority of us with cervical cancer will be found early where the doctor can find it and fix it.
So follow me along this time. hpv, very common. 90% of us, the majority of women or men with HPV don't even know they have it. For men, there is no pap smear test. There's no test for hpv. They will only know they have hpv if they happen to have warts [00:03:00] or God forbid. problems in their head and neck or their, or their rectum.
Okay, so for women, 90% of have hpv. Most of us don't know it. Even when our tests, meaning our pap smear test comes back negative, if our pap smear test is slightly abnormal. We have a follow up test called a coloscopy that I'll talk about in a minute. Even if the coposcopy is the most abnormal, meaning changes that are more likely to turn into cancer, those changes.
Found and fixed by your gynecologist. So again, the likelihood of cervical cancer. Small. So from HPV to cervical cancer, huge spectrum. Okay? So just let that sink in. 90% hpv, very rare risk of cervical cancer. So this is what happens. You go into your doctor screening guidelines or beyond the scope of this conversation because they are, um, complicated ish and doctors sometimes adapt different guidelines.
Um, my patients know my guidelines. I will let you guys all defer to your [00:04:00] gynecologist for her guidelines and what American College of OB GYN recommends. You don't start until you're 21, so you get your pap smear. What is the pap smear? It's a test where the. Looks at your cervix that looks like this. They use that speculum.
Remember that thing I said that is not a clamp? They use the speculum to look at your cervix. They take a little brush to swab the cervix. They put it into a vial of liquid. That vial gets sent to the lab where the lab doctors look at it and then send it back to your doctor and say, Hey, completely normal, or, Hey, some abnormal cells.
Then we call the patient and say, Hey, the cells are abnormal. You need to come in for a cold. That is a test with a little microscope. Copo means cervix and Latin. We look at your cervix. We bathe it with a vinegar like solution. That's how I describe it to patients. Then we use, um, these little instruments that take a couple of little samples, I say, which is my euphemism for biopsies because the word biopsy.
Makes you guys crazy scared and it shouldn't. So we take a [00:05:00] couple little samples after we've used the vinegar like solution to show us where to sample. We take a little scrape of the inside of the cervix. We send those samples to the lab. The lab then sends us back a result saying, Hey, mildly abnormal pap smear, but all these changes look okay and just mildly abnormal.
Leave that patient alone. Instruct her not to smoke. Instruct her to take good care of her body nutritionally and make sure she's keeping her immune system robust and have her come back at six to 12 months depending on the interval that you and your doctor and the guidelines have decided. Okay? And those mild changes will regress back to normal in the vast majority of patients All the.
No, the vast majority of patients, which is why we look again, and the HPV virus, as smart as it is, that it gets into 90% of our systems is dumb. It doesn't cause changes in the vast majority of us, and even when it cause changes, it does not progress into abnormalities in the vast majority of us. Okay, so the signals you should be [00:06:00] getting from all this conversation, where I'm being really dramatic, is hpv, hpv, hpv, so common cervical cancer, very rare.
So again, mild, abnormal pap smear, coloscopy, let's say the doctor calls and says, you have more than just mild abnormalities on your pap smear. You're still just coming, gonna come in for the coloscopy because the coloscopy is the way the doctor can do the diagnostic test to take these little samples and see what's going on.
After the coloscopy, you'll be divided into two. Mild changes, wait and watch more. Severe changes do something about it to prevent cervical cancer, but it is not because these changes are pre-cancerous, as in they will turn into cancer. They are changes that if left alone may turn into cancer more likely than the mild change.
Therefore, your doctor will talk to you about different ways to prevent that. Often by removing a little part of your cervix that looks like what we call a cone biopsy, [00:07:00] because you take a circular part on the outside, but if you looked at it from the side, it will look like a cone. So a cone biopsy, which most women will get done by what is called a leap, L E E P, which is just the instrument we use to remove the cone biopsy.
Some people have it done under anesthesia, some people have it done in the doctor's office. They're both valid ways. That then gets sent to the lab. And that is not just to diagnose, that is to treat. That is to remove the onerous changes so that they don't turn into cervical cancer. But listen to what I said.
90% of us have hpv. Not that many of us will have abnormal pap smears, though a lot of us will. Most of us from the abnormal pap smear with a colonoscopy will have mild changes. Goodbye. See you later. Come back in six to 12 months. Don't smoke. Small portion will have severe changes where they need the cone biopsy.
That doesn't mean they have cancer. That doesn't even mean they were going to have cancer. That just means that waiting and watching is not as prudent for that group of patients. Okay, we're gonna go back a step and talk about the vernacular. For [00:08:00] HPV V, the virus, human papilloma virus. Again, that can cause cervical cancer, but rarely does, but it is the culprit.
So in America, in developing nations, we have largely been able to get rid of cervical cancer by doing pap smears, and even more so in the future by vaccinating with the HPV VI vaccine. So unfortunately the vernacular they've chosen is high risk HPV versus low risk hpv. HPV is a virus that has thousands of strains, probably though they've defined.
Several dozen strains of H P V. The current vaccine guards against nine strains. Okay? The vaccines are, I mean, the virus is broadly separated into two GA categories. One is low risk, H P V, implying. There's no risk involved as far as danger, but it can cause warts. So how would you know you have low risk hpv?
Well, believe it or not, many of us have it. We don't know about it because we have no symptoms. But if you [00:09:00] ever found a genital wart down there on your penis or vulva, That is how you would know you have H P V low risk type. How would you know you have high risk type, terrible vernacular? I hate that they did it, but they did.
High risk is the broad category that can cause cervical cancer. So if you're called and told that you have abnormal pap smear, that is how you know you have high-risk HPV V. Now, high-risk HPV does not mean you're at high risk for cervical cancer, still at low risk for cervical cancer. But it is the broad strain of HPV virus that might turn into cancer of the high risk HPV strains.
There are, again, many different strains, so they further, further stratified it into the ones that are the most concerning. And those are the ones that people get vaccinated against. Depending on your doctor's pap smear and where they get it done, in what lab, you may actually be told, oh, you have the high risk strains, but you do not have these most concerning strains.
We're lucky that our lab does that. Not every lab does it, [00:10:00] and believe it or not, it doesn't exactly change management. So it's okay for you not to know, but again, low risk will cause warts. High risk can cause abnormal pap smears, which rarely will lead to cervical cancer. Okay, can I drive? point home enough.
Here's a really important point for women to know. men cannot be tested for hpv. They have no pap smear equivalent. So the only way a man will know if he has HPV V is if he's found a wart and remember it, that's low risk hpv. Or if God forbid he has head and neck cancer or a, an anal cancer, then he would know that he has HPV V because those are not always caused by hpv, but are.
Increasingly found to short of that, a man won't know. So if you, as a woman call your partner and say, Hey, it turns out I have hpv, please don't think that you are doing this in a Mia Culpa. I've, I have it and I must have given it to you because many men will, um, unfortunately, because they don't know, say, I don't have it.
I've been tested for everything. Well, guess what, buddy? [00:11:00] You've never been tested for HPV because it is not testable. So just know that men and women please know and educate your partner that he does not know that he doesn't have it. And he might have been exposed to it the very first time he had sex when he was.
you know, 18 or 19 years old with a condom without realizing that that girl might have had sex with someone previous, with a condom. Very, very common. Doesn't mean anyone cheated. The virus can stay dormant in our system for decades. Decades. Decades. Okay. Important not to smoke because smoking can de can increase the chance of the virus to cause.
More changes important to be very good about your pap smear guidelines. So make sure that you and your doctor discuss what you're gonna be doing next. And she may stick to the very strict guidelines, or she may be a little bit more, um, strict with regard to how often she wants you to come in. Guidelines are not rules.
They are merely guidelines. What else can I tell you about the virus? Not likely to cause cervical cancer. There are rare circumstances. [00:12:00] Unfortunately, in our 16 years of practice that I've been practicing, we did have a most delightful patient who had a very unusual strain that even Sloan Kettering couldn't figure out, and she ended up passing of cervical cancer, and that made all of us really anxious.
But it was one of those rare events that fortunately as a doctor we have to remind ourselves, doesn't happen. But unfortunately makes us all a bit more anxious. Um, I know that right now there is a patient in our community who's not my patient. I don't know her, and I don't know all the details, but I have heard that there's a similar situation.
But I wanna remind all of us, if we stick with the guidelines generally, We will be okay. It's like driving. Driving is nerve-wracking and bad things happen when people drive, but for the most part, if you don't drink, if you don't text, if you make sure you're in a safe car, you're wearing your seatbelt, the likelihood of something bad is very small.
And by the way, might I add the likelihood of a bad car accident? It's far more than the likelihood of cervical cancer or of dying from cervical cancer because again, the majority of patients who will, who will find [00:13:00] out they have cervical cancer, as rare as it is, will be found early and will be cured.
Okay, so HPV Common Men don't get tested. Please get your vaccine or vaccinate your daughters and sons because not only is cervical cancer, but head and neck and colorectal cancer. Please don't smoke. Please be good about getting your pap smear test when your doctor tells you to. And please, please, please more than anything, lose the fear.
Please don't have fear. Fear is not helpful. It is not beneficial. In fact, I will. It is harmful. Nerves and anxiety are very normal. They're unfortunate. Fear is unnecessary. Okay.