The EngagED Midwife
The EngagED Midwife
Beyond the Pap: How Primary HPV Testing Is Changing Women's Healthcare
The cervical cancer screening landscape is undergoing a seismic shift, and it's time everyone knows about it. From the revolutionary PAP test that changed women's healthcare decades ago to today's primary HPV screening methods, we're witnessing a transformation that promises less invasive care with better outcomes.Did you know that high-risk HPV causes 100% of cervical cancer cases? This fundamental connection has reshaped our approach to screening. Where women once faced the prospect of 47 lifetime PAP tests, today's evidence-based guidelines recommend as few as 9 HPV tests throughout adulthood. We break down the science behind these changes and explain why primary HPV testing is proving more effective than traditional cytology alone. Cara and Missi explore the historical context that unnecessarily tied birth control access to invasive pelvic exams, and how modern approaches are finally separating these unrelated aspects of care. Beyond cervical cancer, we discuss HPV's role in head/neck, anal, and rectal cancers, making vaccination against this virus truly a cancer prevention strategy. For healthcare providers, we offer clear talking points to communicate with patients about these changes. For everyone else, this episode provides the knowledge to advocate for appropriate, evidence-based screening. The days of annual PAP tests are behind us, and understanding why represents a crucial step forward in women's healthcare. #HPVTesting #HPVAwareness #CervicalCancerPrevention #MidwivesMatter #EBP #CervicalCancerScreening #VaccinesSaveLives #Swifties #WDNCClub #WeDoNotCare #TSITP @americancancersociety @justbeingmelani @newheightshow @taylorswift @killatrav @thesummeriturnedpretty @brynne_weaver
Welcome to the Engaged Midwife Podcast. This is Missy, this is Kara. I can't even stand myself. I want to turn all of our logos orange and glittery.
Speaker 2:Let's do it.
Speaker 1:Because every single person whose social media team has turned their logo orange and glittery makes me so happy and has won all of my business in the last 24 hours.
Speaker 2:Yeah, we went to get frozen custard last night and I almost got something with peaches in it just because it was orange.
Speaker 1:Orange food. I know Delta posted a social media ad that had orange glitter. I was like go Delta, Like some of my M&Ms in my orange era. Come on, M&M all the way.
Speaker 2:I know, I know, I can't wait, I can't wait.
Speaker 1:For those of you who are not obsessed, like Kara and I are, Taylor Swift just announced her new album, Life of a Showgirl. We are it's not even low-key obsessed. We are a thousand percent, have the Swifty Zoomies and we cannot stand ourselves.
Speaker 2:Well, also, you know, we have professed our love for all of the Kelseys and Taylor, and we are recording this before the podcast episode is released for New Heights. And I can't think about anything like I'm actually shocked that my job would expect me to do anything today, like I'm just waiting on pins and needles.
Speaker 1:I happened to be working the night that the drop happened and I was working on central time and I like logged onto my phone and I was like, oh my gosh, it's you know five after 11. And I was waiting for like what? 11, 12, right, isn't it? When it was going to drop. So I watched the whole countdown on my phone and I was like what am I going to be able to buy? What am I buying? What is happening in my life? And then I was like the vinyl. So bought the vinyl, if it tells you anything.
Speaker 1:I clicked on it the minute it popped up and I still had to wait like 19 minutes to check out like that's how many, how much traffic was like on her website at the time. But um, and then Bob's like, did you buy more than one? And I'm like, no, it's not like limited edition, it really is for the fun of like being able to like have the vinyl. Right, I do have a record player. So there's that. Yeah, funny enough, I have a record player, but probably nothing. I could put a CD in, which is so freaking funny that's crazy for our generation.
Speaker 1:Right like so crazy yeah, because we were at the end of the 8-track era, right into the cassette era, right into the CD era, and now I don't have anything I could put a CD in, which is wild, I mean, did people?
Speaker 2:just like create a playlist for each other and send it to each other, because, I mean, there was something special about creating a cassette tape that you recorded songs for your boyfriend and there was so much Kara Kara.
Speaker 1:Kara, a mixtape. Honey, it's called a mixtape, You're like oh, my God mixtape.
Speaker 2:I love it. You have on the radio like for that song to be played, so crazy.
Speaker 1:Now you have to create playlists. Yes, you have to go to Spotify, create your playlist and be like this playlist made me think of you.
Speaker 2:I don't think it has the same effort behind it and so clearly they're not as much in love as we were in the 90s.
Speaker 1:No. Or remember when we had to wait on hold to like request songs at the radio station.
Speaker 2:Yeah, I do, I do, I do remember it. I'm very excited. It's hard to think about anything else, but we do have work we have to do. I know that you do not have the same luck that I do for Chapel Rome, but my family is going to see Chapel. We got tickets. That's my excitement for the week. We've all bought outfits. I can't wait to see what it's going to be like. It's in October. Prepare to hear about Chapel a lot between now and then.
Speaker 1:I will just say shout out to T Swift for taking back the color orange.
Speaker 2:I'm so happy I saw someone post orange is the new black, for sure, and I was like, yeah, that's true.
Speaker 1:Also, orange is the new, pink Orange is the new, everything, and I am so happy it's so good. My husband is so tired of hearing about it that he just heard us talking about it on the podcast and walked by and like big, big eye roll, big eye roll, huge even, and I'm like I am who I am whatever I mean, there's still a few things in life that bring us this much joy.
Speaker 2:Let us have it like um and we would be remiss. We're not going to um purposefully objectify anyone, but I just want to mention that Travis Kelsey may have a GQ spread that makes me think things, feel things, and hubba hubba.
Speaker 1:There might have been a conversation in our house last night about hall passes and you know it might have had to do with a certain Kelsey brother that wasn't Travis.
Speaker 2:I mean okay, so here's my other obsession the Summer I Turned Pretty. Have you watched it? No, because you know I'm like basically a teenage girl. I love all the things, but you have to check it out, because people are either Team Conrad or Team Jeremiah, and I was just going to say I could be like Belly and have both brothers, it's whatever gonna say I could be like belly and have both brothers, it's whatever.
Speaker 1:Yes, no, I am um almost elbows deep into the hunting lives and um, it's bob turned it on one night and now I'm like I gotta find out what happens. Um, it is not for the faint of heart. It has a lot of sexual content in it and it's be careful who you watch it with.
Speaker 2:Okay, I'm adding it to my list right now.
Speaker 1:Yeah, please do. Every menopausal woman in the history of the world is like ooh, the Hunting Wives maybe.
Speaker 2:PS. You introduced me to Brynn Weaver as an author and Audible. I've listened on Audible. She has a new book out. Ps. I haven't gotten it yet.
Speaker 1:Okay, so those of you who didn't get my tip to Kara, also the tip to my sister, because I sent my sister that trilogy as three of her books of the month for this year. It is Butcher and Blackbird is the series. It's the ruinous love series and it starts with Butcher and Blackbird. And then it's the ruinous love series and it starts with Butcher and Blackbird and then there are two other books that follow it Leather and Lark and yeah, sparrow and Scythe, that's it.
Speaker 1:So if you are into, like you know, spicy books that also might have a murder component, that's it.
Speaker 2:I think you sold it to me as, oh, you really like true crime and I think you'd like this spicy book series. Let's just say it's a little more than just true. It's not true, but like there's a crime component to it.
Speaker 1:Crime component with some spiciness. If you need spicy books, come to missy stack, literally slide into my dms. I'll tell you all the spicy books that's awesome.
Speaker 2:Okay, we've talked about a lot of things. People are caught up on what we're watching and what we're listening to. It's been. You know it's time. It's nice to have someone escape every so often, but we do have important stuff to talk about for midwifery practice Okay, fine.
Speaker 1:What are we talking about today?
Speaker 2:I want to talk about cervical cancer screening and how the recommendations are changing and moving away from one of the most revolutionary screening tests that has ever been introduced and has drastically changed our world over the last 50 years, which was the PAP test from Dr. Is it Papa Nicolaou?
Speaker 1:And going to primary HPV screening as our way to screen people for cervical cancer. Okay, let's just talk about this for a second from a historical context of our lifetimes, of us Gen X women who are in perimenopause and menopause, right as members of the we Do Not Care Club, we do not care club, we do. That girl, that woman oh my gosh, she probably does not care about this particular topic. Let me talk about how we could not go get birth control back in the day without having a, even at times, if we weren't sexually active.
Speaker 2:Yeah, I always talked about how it was held hostage. Birth control was held hostage until you like, put your feet in the stirrups and had a speculum inserted so they could test you for cervical cancer, although there's no link between cervical cancer and protecting yourself against pregnancy.
Speaker 1:It's crazy I think that that was a form of abuse of women back in the day that we could not protect ourselves from pregnancy without having a speculum inserted and having some sort of intimate exam. That was completely and totally unnecessary.
Speaker 2:Yeah, I remember as a midwifery student I did a fair amount of clinical in my women's health rotation at Planned Parenthood, which I am so thankful for the time that I got to interact and practice at Planned Parenthood. It was such a great experience that I got to interact and practice at Planned Parenthood. It was such a great experience. But it was revolutionary that they had this HOPE program. That was basically that you could come in and get birth control without a physical exam and it was revolutionary that you didn't have to have a pelvic exam or I mean just like totally revolutionary, and that was early 2000s, Crazy.
Speaker 1:Wild Wild. So in our lifetime there have been so many changes and those changes have completely changed what we we look at cervical cancer screening, what we should be doing in our clinical practices, how we should disassociate the link between tap screening and contraception, Like they do not belong together, and I think today's episode is going to give us sort of some background about that.
Speaker 2:Yeah, so let's start off by talking about cervical cancer a little bit and HPV. I'm curious, missy, because you and I went to school around the same time, but I remember learning in midwifery school that HPV was very much like HSV. Once you had it, you had it for the rest of your life, and it really wasn't until I had been out in practice a couple of years that they started to really say well, actually, the body, the immune system, can clear it for most people at some point, and it's not something that you always will have, but certainly if you've been exposed, almost everybody will test positive for HPV at some point in their life. But their body clears it and the immune system takes care of it. Do you remember that time period as well, or am I making something up in?
Speaker 1:my head. I totally remember that like oh, hpv can clear itself in a couple of years, which is actually true, right.
Speaker 2:Yeah, but I mean, I remember initially it was you have it forever, but then it was no absolutely, absolutely.
Speaker 1:It's like the thing where we were like, oh the h things right, hsv, hpv, hiv, they all are lifetime things. They don't go away. Yes, okay, so and we also.
Speaker 2:That is really when I feel like it really became quite evident that HPV is the cause of cervical cancer. High-risk HPV causes cervical cancer. Before that it was like, oh, there's these risk factors, there's these people that are more likely to get cervical cancer. But finally the connection was made of high-risk HPV strains are what cause the cellular changes at the transformation zone on the cervix that can lead to cervical cancer, and so that is also when the vaccines started being developed. These things were going to be really drastically changing the future landscape of cervical cancer, because we now knew exactly what the cause was, and I mean it's mostly preventable, right? And so it's just good to know. Let's set that foundation of high-risk HPV causes cervical cancer.
Speaker 1:That's it. And you don't have cervical cancer without having HPV period. You don't. And so that is the basis, I think, of the entire conversation today, which is you have to have HPV to have cervical cancer. And that is the basis for every recommendation that there is right now. And if you are a practitioner and you're seeing women in the office and you're doing well-woman exams and you're doing counseling and somebody has had a history of abnormal PAPs, they have had HPV or have HPV.
Speaker 2:Yeah, okay. So now let's talk about kind of like how much cervical cancers are happening in the US and the world, that kind of thing, because I think that's also good to think about. But HPV high-risk strains mostly 16 and 18, cause cervical cancer and the really interesting thing is that in general the progression from having HPV, possibly having some dysplasia or abnormal cells and getting eventually to invasive cancer is a really long process. It's not a fast-growing cancer kind of thing. And so they say that HPV cells take about five to 10 years to become abnormal precancerous cells and then from there they can take another 20 years to actually develop into invasive cancer. But if we can catch it really really early, then we prevent that progression entirely and obviously can, you know, prevent people from having that really horrible diagnosis and having all the treatments that aren't pleasant and so forth. But if someone had a weaker immune system like maybe they had an immune condition, hiv, something like that it can progress much more quickly. But still it's usually more over like 5 to 10 years versus the 20 plus that can happen in someone with a normal immune system.
Speaker 2:And in the world, across the globe there's about 650,000 new cases each year of cervical cancer and around 350,000 deaths. That sounds like a lot across the world, but in the US there's only about 13,000 cases a year and only around 4,000 deaths. But when we think about the fact that this is like preventable, 4,000 deaths obviously is 4,000 too many, and so, while worldwide is much more significant, in the US it's still something that we can test easily for HPV, and so if we can do that and prevent the progression before it would ever get to dysplasia or then to cervical cancer, we want to do that, do that. So I did mention that HIV makes someone more susceptible. People with HIV are six times more likely to get cervical cancer if they have HPV than people without. So that is something of significance.
Speaker 2:And then the other thing that we should just mention although we don't have to delve deep into we've talked about it in other topic areas is the inequity in who is being diagnosed, and that the risk is significantly greater in some of our underserved communities, our at-risk communities. It is significantly higher in Black women and Native women than it is in white women, in the US in particular, but worldwide that we see that as well. So something to know that it's really about, because the risk is greater when people aren't regularly screened, when they don't have early diagnosis. It really is more about are people being screened? So good baseline information to think about screened.
Speaker 1:So good baseline information to think about. I want to put a little plug in here. When we talk about HPV and as we're talking about cervical cancer screen, because I think it's super important and I know we're going to get to this when we talk about vaccinations, but there are really, when we talk about HPV, no outward signs of HPV unless you have a low risk or high risk type of HPV that causes warts. So, whether those be like any kind of genital warts, they can be anywhere. They can be labial, vulvar, perineal, anal, all of the kinds of warts. So let's I just also want to lay some groundwork.
Speaker 1:Hpv is sexually transmitted. It is, it absolutely is, but the only outward signs that we would possibly see are genital warts. There are lots of types of HPV that do not cause genital warts. So the unfortunate part for women is, hpv manifests itself for us in cervical cancer, right or abnormal pap screen, abnormal cervical cytology. But for men, there is a large population of men who have HPV with no outward signs of HPV disease. So no kinds of general rewards, right, and so when we talk to women about condom use, right and protecting themselves against STI, stds, this is why right, this is one of the reasons. This is something that could have negative impacts on your health.
Speaker 2:Right cause cervical cancer and abnormal cervical cytology cause genital warts, and it's something that you can get, that you would never see, never know that anybody has well, and I think it's interesting that it's not even just um, uh, you know it's not bodily fluids, it's skin to skin, and so it can be digitally. You know it's not bodily fluids, it's skin to skin, and so it can be digitally. You know, passed. We know that it's leading to rectal and anal cancers. We know that, like an unbelievable amount of head and neck cancers are due to HPV. So while we're talking today about cervical cancer screening and HPV testing, like it is massive how much of an impact HPV has on all kinds of cancer rates.
Speaker 1:I used to have patients that were in a younger demographic who would be like oh, I don't have sex, I have oral sex, I don't have penetrative oh my gosh penetrative sex and I'm like that.
Speaker 1:Still, if you are putting things in your mouth and there's HPV involved, like you just said, it can cause head and neck cancer. We also seen babies, right, and young children who end up with, and young children who end up with, hpv lesions and warts in their airways, in their necks, in their mouths, in their throats, and so this is more than just cervical cancer, right? This is all the things, and so sometimes I find that women will come in and they'll be like, oh my gosh, I don't know how I got HPV. My husband's the only person I've ever had sex with. Well, are you the only person that your husband or your partner has had sex with? Because that's the result of these kinds of things, right, right, right. So, as we continue to talk about this, I think these are all points that we need to be like super clear as we're counseling people about HPV, about the why of HPV, and you know, I'll have more to say, I think, when we talk more about vaccines.
Speaker 2:Yeah, yeah, okay. So we said that our main topic today was talking about cervical cancer screening. So let's talk about, like, historically, the introduction of the PAP test really changed the world, like drastically reduced the number of people diagnosed with cervical cancer. Early identification was really important to pick up on those cellular changes before they progressed to cancer. Drastic changes, especially from the 1970s on, like drastic.
Speaker 2:And then in the I think it was 2012 is when the kind of consensus all came out of like, okay, people, we're not starting popping people at 18. We're not doing three years after sexual debut although I really love saying the term sexual debut and so I'm sad that we don't have that related to pap testing anymore. But it was okay, start at 21. And that's the earliest age we're gonna do pap testing and then we're gonna do it a little bit more frequently in the decade of their 20s. And then we can start to space it out if we start to combine cytology, which is looking at those cells, the pap tests, along with the high-risk HPV testing, and it gives us a better picture for people 30 years and older of you know what is their risk of cervical cancer. How often do we need to be screening, knowing that it's not a fast-growing cancer, that sort of thing.
Speaker 2:And so 2012 is when things changed big in pap testing. But now we have a new change and we have some new recommendations and maybe we don't even need to be doing the pap test at all, which is just like mind-blowing to those of us that I remember my mom. You know, you guys know I have a twin sister. Girls, you're 18. It's time to go get a pap test. And I'm like Mom, I'm pretty sure it's 18. Or when you're sexually active. And she's like, yes, and I'm like, well then, I should go have sex so that I can make it worth my while. And she just kind of shook her head and I mean, I think my sass started a little early. But anyway, the recommendations have changed a lot, a lot. When I think about when I was 18 and getting my first pap and you were supposed to do it every year, at that point I could have ended up with like more than 45 pap tests in my lifetime.
Speaker 1:Yeah. So I think you should talk about that here. I think you should talk about the progression of what that looks like. So us Gen Xers, right, had we gotten a pap every time that we had followed the guidelines of when we should get a pap, we would be papped essentially every year until we were 60.
Speaker 2:65, yeah, so when I look at that and I started at 18 because I was a good girl, I had not had an early sexual debut 47 paps between 18 and 65. Ridiculous, crazy, okay. So then things kind of went along with that pattern until 2012. And that's when we should start at 21 and do pap testing, which is cytology, every three years until 30. And then, once someone was 30, we would do a pap test along with HPV co-testing it was called co-testing for high-risk HPV and you would do that every five years as long as your cytology and your HPV co-tests were fine. And so if you never tested abnormally, everything was totally fine. In someone's lifetime, between 21 and 65, they would have 11 pap tests and eight of those would be a pap test and an HPV test Vastly different than 47 pap tests annually for your life.
Speaker 1:Yeah, I mean, who wouldn't agree to that?
Speaker 2:100%. But how many people do you remember people arguing with us of like no, I need a pap test.
Speaker 1:I have. I had little old women who used to be like I still need a pap. I'm like you're 70 years old, you don't need a pap. Are you even using your vagina anymore?
Speaker 2:We were also paping people that didn't have a cervix every year. It was insane. It was insane, anyway, all of that. So now there's relatively new recommendations and there's two different bodies that have slightly different recommendations, although they're pretty similar. And one is the American Cancer Society and they say HPV primary screening primary screening so screening for HPV high risk every five years between age 25 and 65, is as good and has less harms than doing pap testing. Now they do talk about you could also do cytology co-testing along with it if you wanted to, but there's not really a need to do that.
Speaker 2:And so HPV primary testing, primary screening between 25 and 65, you would end up with nine HPV tests and no pap tests. Sounds great to me, yeah. The other one is the United States Preventative Services Task Force Big puffy heart you know I love my USPSTF and they've been doing some pretty big changes lately. But they say still start your pap at 21. Do your pap every three years until 30. And then, at 30, you can start doing HPV primary screening every five years and you can let the pap go. And so with that you would have three paps in your life 21, 24, and 27. And then, starting at 30, you would have your HPV tests, and so you would end up with three pap tests and eight HPV tests in your lifetime so still around the same amount of testing as what the 2012 recommendation said.
Speaker 2:It's just going from taking cytology to just doing HPV primary screening, and then you know we could talk some about. It can even be self-collected, and self-collection, even at home, is shown to be just as good as provider collected. That's a whole nother topic, but the main thing being we don't need nearly as many tests as we once thought, and it doesn't have to be cytology. It can actually be just the hpv test, which we can collect with a specimen, like with a speculum and doing a swab, or it can even be tested similar to like the urine tests that we have for gonorrhea and chlamydia, and those tests are shown to be just as good.
Speaker 1:It's wild to me how much this has changed.
Speaker 1:I know Really really much I absolutely thought this was never, ever going to change. And I'll tell you, one of the phrases that I have repeated a lot in clinical practice is it's never going to change until the insurance companies get on board right. So a great example of this is the idea about colonoscopy and doing home right screening for colon cancer, and I was like it's never going to change until the insurance companies get behind it. So the insurance companies got behind it right now and your insurance company will pay for your coligard at home versus your colonoscopy right, because they know it's safe and effective and it picks up all the things. And I thought like until insurance companies stop paying for pap smears every year, everybody's going to keep doing that. And that is really the driver as to why we say people need pap smears. It's a reimbursement thing. We are still getting reimbursed for pap smears and I think insurance companies are going to stop paying for it.
Speaker 2:Well, we also thought that might happen in 2012 with the change in recommendations, and I don't know. I agree with you, I, you know. I think the other thing that I feel like I say it all the time but just because we have a test doesn't mean we should do it all the time, like we need to be good stewards of our resources, and I'm also telling students all the time, as well as all of my friends, there are risks to doing screening. It could be, you know, false results, it could be way more biopsies. I mean it's the same is true for breast cancer screening as other things. Just because we have a test doesn't mean we should just like apply it widely to everyone every year, and so I really love that.
Speaker 2:People have looked at the evidence, they've looked at what the additional harms are, they've looked at what the benefits are, how many years of life are saved by doing screenings, all of those different things and weighed the net benefit and the net risk and said we don't need to be testing people as frequently. We can do this less invasive testing and people are more likely to seek care if they know that we're not like not only trying to nickel and dime them, but also we're not putting them at risk of all that additional worry, that additional testing, those sorts of we're not holding their birth control hostage because we want them to have a speculum exam or something like that. I love that we have moved to the idea of evidence-based care and shared decision-making, helping people understand their risk.
Speaker 1:Yes, and we are the stewards of all of that. Now, right, as nurse midwives, as nurse practitioners, our physician colleagues need to be the stewards of these recommendations and guidelines. Right, we need to be the ones saying like, the guidelines say X, y, z and I'm ready for you to shine here.
Speaker 2:Talking about the vaccines, the recommendations are going to change even more in the future, because we probably won't even need as much testing as what they're recommending right now if more and more people are vaccinated against high-risk HPV.
Speaker 1:Okay, yay, vaccines. Yes, I think we need to do a whole episode on just vaccines, and then I can rant about vaccines, because I would love to hear you rant um.
Speaker 1:Vaccines save lives period. Vaccines make adults period, like the reason that we don't have polio anymore, right, is because of vaccines. Smallpox yes, well, we were doing a great job with some of these other things too, until people decide like, yes, like measles, mumps, rubella, until people decided that they thought that there were all of these links to vaccines, and that there were all of these links to vaccines and you know, things like autism, right, childhood illness, et cetera, et cetera. There are huge, huge randomized control trials with millions, that's, with an M millions of participants that show no links to childhood vaccines and things like autism. We can just put that right to bed right now because there are zero links. It does not. It is not the thing.
Speaker 1:Now I'm going to put in my little plug about autism, adhd, because I have a whole house full of ADHD people and I have been dealing with ADHD since my kids were very young, right? Adhd is not new. Autism is not new. All of these things that we are seeing a ton of prevalence of in our society now, in 2025, are not new. It is just something that is now recognized at a different level than it was in 1965, in 1985, in 2005. It used to be.
Speaker 1:You didn't do well in school and you couldn't pay attention. It's just that you were a bad student and school wasn't for you. Now we know that those people, probably in the 70s and 80s and 90ss, had ADHD or ADD or they were on an autism spectrum there's all kinds of things right, but back then we didn't call it something and we only noticed that people had these kinds of things if they physically, right or emotionally showed signs that they had those things. Okay, yeah, don't get me started. Don't put me in a room full of anti-vaxxers. I will not be able to like. I will not be able to control myself, so we'll set that aside. Yes, vaccines.
Speaker 2:Let's talk about the benefit HPV vaccine vaccine.
Speaker 1:We have just heard you say in the context of this podcast that hpv is what causes cervical cancer. Period. That's the. That is a complete sentence, and there is a vaccine that will prevent high-risk hpv. Why would you not want that for yourself, for your children, for?
Speaker 2:your children's future partners. Yeah, I wish there was a vaccine against cancer. There is Yep.
Speaker 1:Yeah, yep, there is a vaccine against HPV. There is a vaccine that will keep you from getting high-risk cervical cancer. Now, does the vaccine cover every strain of HPV? No, but I want to talk again. This is the vaccine thing, just like the flu. There are a hundred strains of flu and what we put in a flu vaccine is the things that we think are going to be most prevalent in society in any given year. Right, the HPV vaccine? It covers what we know are high risk strains of HPV that cause cervical cancer.
Speaker 1:And a few low risks that cause warts Correct and a few low risks that cause warts. But why wouldn't you give yourself, your children and their future partners every opportunity to not get HPV, and at a time in their lives when they're not sexually active, when they're 11, 12, 13 years old? So when our, when my, the doctors were like, oh, do you want your kids to have an HPV vaccine? Abso-fucking-lutely, I do yes, I do yeah.
Speaker 2:Julia was an infant when the vaccines were first introduced and I remember telling her pediatrician like we're going to want those vaccines and he was like okay, kira, she's one. And I'm like, no, no, I know, but I just want you to know I'm pro-vaccine.
Speaker 1:I cannot stress enough I'm raising boys, right. I want to raise boys that other people's daughters are safe around. I mean, that's it, that's one of my end goals in life, and that includes sexually safe around, and that is why I think HPV is important for boys, right? Oh, the old adage is and I think that this is kind of like a gross way to think about it is like if you have a girl, you have to worry about all the dicks, and if you have a boy, you only have to worry about one. And I'm like not really because I'm worried about all the girls that my sons might have sex with, like right, yeah, well, and we talked about that.
Speaker 2:There's so many ways that it can be shared and yeah, I mean, there's just so many things, right, I'm also I mean, I know I mentioned it earlier that like had a neck cancer and anal cancer and those sorts of like. I'm a big fan of having a tongue. I'm a big fan of like breathing through my mouth and nose and not through a hole in my. You know, not to say like, not to say that people can't live very wonderful lives. But if I could prevent, like a major disfigurement or I could prevent a cancer in my head and neck, or I think those are great things to try to avoid. And so the fact that you can have a vaccine when you're around 11 or 12, I just I don't understand not protecting our children against that, because it's like lifelong protection. We think, right, like the times when they would have the most exposure. If they're vaccinated before that time where they would have the most exposure, why wouldn't we want to do that?
Speaker 1:I'm so upset with the current Health and Human Services Administration. Right now we're going to cut funding for mRNA vaccines. We're not. Basically they're saying like we don't care about vaccines that could prevent cancer. That is infuriating, not just as a mom, but like as a healthcare professional, as somebody who cares about public health, who cares about health and wellbeing of future societies. The whole thing is just blowing my mind.
Speaker 1:But as a nurse, midwife, or as a nurse practitioner, there are some key things I think you need to be able to say to your patients that come from this conversation, which is HPV causes cervical cancer. There is a vaccine that you can get that will prevent right a risk and some low risk HPV Right. Essentially, that means there's a vaccine that will prevent you from getting cancer. Yes, and you do not need to have a pap every year for us to determine whether or not you have cancer. You need to have an HPV test and this is how often we need to do it and that is what is best in us determining whether or not we think you will ever have invasive cervical cancer period, and I think you can ever have invasive cervical cancer period and I think you can get those sentences out in about 60 seconds.
Speaker 2:I mean, I think you really just said it in three or four sentences. That's insane right it's great.
Speaker 1:It is revolutionary in terms of what? The kinds of advances in medicine that we have even seen since we were in our 20s, which honestly wasn't that long ago. Let's just be clear I mean we're, I mean in our 50 era. I'm not quite in my 50 era yet, but I mean this is 20, 25, 30 years ago.
Speaker 2:I have 11 months. Leave me alone. I think 50 is lovely because you definitely get your membership card to the we Do Not Care Club.
Speaker 1:That is absolutely true.
Speaker 1:But I'm just saying, in 30 years, look at how far we've come, from thinking that you have to have a pap every year to determine whether or not you're going to get cervical cancer to knowing that you really don't need a pap and you can just do HPV testing and there's lots of ways to do that.
Speaker 1:I mean, we also probably never thought a million years ago that we could screen for gonorrhea and chlamydia and urine. Right, it's just the advancements. And when we talk about, like the funding that goes into right research that supports these kinds of things, I think we need to be really clear what we're funding. And we're funding things like this, right, and we're saving money and we're saving girls from unnecessary intimate exams and we are able to do a better job at what we do every day, which is like try to keep our patients healthy Right, and prevent their not prevent, but I mean prevent disease but encourage wellbeing, right, the things I'm just like. And maybe I bet I would venture to believe that there are a ton of women who have at some point felt victimized by a speculum exam.
Speaker 2:Oh, a hundred percent. Yes, absolutely, absolutely.
Speaker 1:And it has happened to me in the last seven years me in the last seven years and so that means to me that, as a 40-something-year-old person, that that happened to me. Imagine just what has happened to 21, 25, 28-year-old women. And we have some friends, you and I, that do a lot of research on consent and intimate exams and those kinds of things. And again, another conversation for another day. But if we can prevent that kind of reaction, right, women don't want to go to the gynecologist it's like going to the dentist, it's like the things that we put off because we don't want to do it. Right, you and I are now in the era where like, oh, I don't want to go get a mammogram because it's not going to feel great, but we know we have to because of what the guidelines say. But preventing harm, doing no harm to our patients, I think is at the top of my list when it comes to things like pap screening and speculum exams.
Speaker 2:Yeah, agreed, and I just want to mention this.
Speaker 2:We're not going to go down this road right now. But if we have better screening and more appropriate, good use of our screening tests and we're avoiding those harms, like all the additional testing and biopsies and that sort of thing, it does have the potential to have a reduction in our preterm labor rates. We have better pregnancy outcomes because people's cervixes haven't been scarred and biopsied so frequently. We have less, you know, leaps and cones and that sort of thing that can cause problems, and so it's so much bigger than just cervical cancer screening and I think Missy's demonstrated that to you in our conversation. I hope this also adds to the conversation. But we want everyone to really think about the evidence, to help patients understand the science behind the evidence, behind why the recommendations have changed and how we can work with them with good shared decision-making to figure out the right plan for their screening so that they can have less cancer in their lives, less harms in their life and they can reduce the risk, not only for themselves but for the people that they love.
Speaker 1:Such a good conversation, relevant bullet points for people who are listening to us, who are in practice to just like integrate into their well woman exams and their counseling of women every day.
Speaker 2:Yeah, absolutely Well. Thanks, missy. This was a really good conversation and I hope it's helpful, maybe open some eyes, turn on some light bulbs, that there's so many things that we do as midwives and that can change the world, help improve people's lives.
Speaker 1:Well, thanks for joining us for the Engaged Midwife Podcast. We can't wait to talk to you again.