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HEALTHWATCH: Cervical Cancer and the HPV Virus

Dr. Nancy Towbin


Last month HMG-LCCN had the opportunity to sit down with one of the premiere Obstetrician / Gynecologists in Southern California, Dr. Nancy Towbin.

Dr. Towbin grew up in Fullerton, Ca. where she learned about the doctor-patient relationship from her father, who was also an OBGYN. Towbin cares for patients from adolescence to menopause and strongly believes that preventative care along with modification of risk factors are the key components to a healthy, quality life.

Towbin completed medical school at Keck USC School of Medicine in 1991 and had her residency at Los Angeles County/USC Women’s Hospital in 1995, where she was trained by some of the field’s top gynecologic experts. She then joined her father in private practice where she developed her passion for women’s healthcare. Ultimately, Dr. Towbin decided to dedicate her attention to gynecology only, specializing in the needs of women.

Although we discussed the many complicated issues in women’s health care, Towbin specifically wanted to concentrate on Cervical Cancer screening and prevention and talk about the new technologies for diagnosis and treatment of cervical cancer.

The Human Papillomavirus or HPV can be passed from one person to another by skin-to-skin contact, such as occurs with sexual activity.  The main way HPV is spread is through sexual activity, and can be spread even when an infected person has no visible signs or symptoms. The virus can also be spread by genital contact without sex, although this is not common.

HPV is a very common virus that infects nearly everyone at some point. It is divided into two categories: oncogenic and nononcogenic. Oncogenic is that which has a high risk factor. “There are many different strains of the virus, each identified with a number,” states Towbin, ”HPV 16 and 18 are high-risk types known to significantly increase the risk of cervical, vaginal, and vulvar cancer in women, as well as penile cancer in men.”  HPV-16 has the highest carcinogenic potential and accounts for approximately 55% to 60% of all cases of cervical cancer worldwide. HPV-18 is the second highest carcinogenic genotype and is responsible for 10% to 15% of cases of cervical cancer.

Towbin was reassuring when she stated that testing positive for HPV types 16 or 18 doesn’t guarantee you’ll develop cervical cancer, but it does mean that any dysplasia found in a PAP test carries a higher risk of becoming a cancer. “Based on the results of these two tests, your doctor can develop a plan to either treat the dysplasia, do more testing to rule out cancer, or recommend more frequent follow-up visits to look for additional changes,” adds Towbin, “PAP’s of the cervix have been tested for a long time, and we know the changes HPV causes in the cervix,” she notes.

There’s no sure way to prevent infection with all the different types of HPV. But there are things you can do to lower your chances of being infected. There are also vaccines that can be used to protect young people from the HPV types most closely linked to cancer and genital warts.

New medical guidelines have some doctors and HMO’s suggesting that women do not need PAP smears on an annual basis as was the custom. The guidelines state that a test every three to five years is sufficient. Towbin disagrees with this, “Most cases of cervical cancer occur in women who were either never screened or were screened inadequately. Estimates suggest that half of the women in whom cervical cancer is diagnosed never had cervical cytology testing and had not been seen five years before diagnosis. Just think of the health consequences that could be prevented by an annual doctor visit.”

Public health measures remain critical to improving access to screening for women who often are uninsured or underinsured.  Although the ratio of cervical cancer is decreasing, women who have migrated to the United States, those lacking regular source of health care are at high risk.