Written by Bren Cole of Fenway Health
Cervical cancer can be a devastating and fatal disease. Fortunately, modern advancements in screening techniques have made it much easier to prevent and treat this cancer early on. One of the most exciting advancements in cervical cancer prevention has been the human papillomavirus (HPV) vaccine.
Since HPV vaccines first become publicly available in 2006, there have been a number of improved versions developed, the most recent of which covers the widest range of HPV strains yet. As cervical cancer is almost universally caused by HPV infection, the lifesaving potential of this vaccine is profound.
“We’ve had a successful, multi-pronged approach to increasing HPV vaccine rates here at Fenway,” said Dr. Jennifer Potter, Co-Chair of The Fenway Institute and former Director of Women’s Health at Boston’s Fenway Health. “That includes standing orders for nurses to offer the vaccine routinely to all patients within the recommended age range. We also did a lot of work early on, particularly before the advent of the ACA, to find workarounds for people who did not have adequate insurance to cover the vaccine, which can be quite pricey.”
Administering the HPV vaccine can be somewhat of a race against time. For the vaccine to be most effective, it should be given before a patient becomes sexually active and is, as a consequence, exposed to HPV. The HPV vaccine is offered to patients through age 26, but its effectiveness declines after exposure to HPV has already occurred.
As the average age of first sexual encounter is typically somewhere in the teenage years, Dr. Potter notes, it can be challenging to make sure a patient receives the HPV vaccine in a timely manner.
“Technically, it’s the responsibility of both pediatricians and parents to make sure that the teen gets vaccinated, and many parents don[t really understand the importance,” she said. “Pediatricians have become much better at treating the HPV vaccine like any other preventive measure rather than getting lost in the intricacies of teenage sexuality, but parents sometimes falsely assume that just having access to sexual health measures – including condoms and birth control – will mean their child will become sexually active at a young age.”
The LGBT community – the focus of Dr. Potter’s work at Fenway Health – faces unique barriers to accessing cervical cancer prevention services. Many LGBT people have experienced discrimination in health care because of their sexual orientations or gender identities, which leads to avoidance of future medical check-ups. In fact, lesbians and bisexual women are 10 times less likely to seek regular cervical cancer screenings than their heterosexual counterparts.
“With sexual minority women, particularly lesbians, there is a false perception that they are not at risk for sexually transmitted infections,” Dr. Potter said. “Because of this, providers may not be encouraging them to be vaccinated, or the patients may not understand the need for vaccination.”
For transgender men, non-binary people, or anyone on the transmasculine spectrum who was assigned female at birth, cervical cancer screenings – including Pap tests – can be especially traumatic. It’s critical that providers remain sensitive to the fact that transmasculine patients may feel uncomfortable referring to their reproductive organs using female gendered terminology, such as “vagina.” This may be particularly difficult for patients experiencing gender dysphoria. Providers should ask for and use each patient’s preferred anatomical terms, as well as remain sensitive and respectful of the patient’s preferred pronouns.
“The important thing to remember is that these tests require people to be physically and often emotionally vulnerable,” Dr. Potter said. “If you have had negative experiences in health care, and if you’ve had childhood sexual abuse or sexual assault, this is all going to compound, so these exams may make you feel very exposed and frightened.”
Providers should take care to talk through the details of the exams prior to screening, making sure that the patient understands what will happen and why the test is important, and giving them the opportunity to ask questions and feel more empowered. Ask the patient what will help make them more comfortable during the exam, whether that may be explaining each step before it happens, or having a friend or partner in the room with them.
“You really want to make sure that when and if the patient decides to proceed with the exam, it’s being viewed as a partnership,” Dr. Potter emphasized. “The patient needs to know that the ball is in their court and they can stop the exam whenever they want.”
There has also been promising work done around self-swabs, particularly for transmasculine patients, which allow patients to perform frontal (i.e., vaginal) swabs themselves at home or in a private space at the clinic. However, it’s important to let patients know that these self-administered tests have not yet been shown to be as effective as in-clinic cervical swabs performed by a provider.
“I have a background in preventive health for people who were assigned female at birth– people with breast tissue, cervical tissue, and uterine tissue,” said Dr. Potter. “It’s my responsibility to make sure that these areas are properly cared for in order to prevent disease or catch it early enough to be successfully treated.”
Bren Cole is Content Creation and Social Media Manager at Fenway Health, where she oversees social media communications as well as email, website, and blog content for both Fenway and the AIDS Action Committee. She has served as an Ambassador for the Boston branch of the Young Nonprofit Professionals Network, a Co-Chair of the Fenway Health Dinner Party, and is a member of the Young Leaders Council at Fenway Health. Prior to joining Fenway Health, Bren was a technology journalist at media company TechTarget. She graduated from Northeastern University in 2008 with a BA in Journalism.