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In 2019, I got the news I was hoping for—I was having a baby! I realized I was pregnant right before running my 18th marathon. When I returned home, I headed straight to my OB-GYN to confirm that I was, indeed, expecting.
Excited and ready to embark on my new parenthood journey, I immediately scheduled my subsequent routine appointments, including a Pap test for cervical cancer screening. A Pap test and co-testing with HPV is recommended every five years from age 25 until age 65, according to the American Cancer Society guidelines.
The nurse called me a few days later. My test results were abnormal.
What an abnormal Pap smear means
I was a little surprised, but not alarmed. When a Pap smear is abnormal, it means that cells in your cervix don’t look quite right. It doesn’t mean you have cancer, though that’s one of the possibilities. There are a variety of abnormal results for cervical cancer screening with different next steps for further evaluation or management.
In my case, the abnormal cells were caused by a common sexually transmitted infection called human papillomavirus (HPV). “Approximately 80% of sexually active adults, both men and women, are infected with HPV at some point in their life,” says Kathleen M. Schmeler, MD, a professor of gynecologic oncology and reproductive medicine at MD Anderson Cancer Center in Houston.
For many, the infection doesn’t cause any problems. “The majority of people clear the infection on their own and never even know they had it,” Dr. Schmeler explains. “In a small proportion of women, the HPV infection persists and can cause cervical dysplasia, which can be picked up on an HPV test or Pap smear.”
Because my Pap smear showed irregular glandular cells that can indicate cancer, my OB-GYN wanted to take a closer look and get another sample with a colposcopy.
What is a colposcopy?
Like a Pap smear, a colposcopy is a pelvic exam that offers a close-up look at your cervix. A vinegar-based solution is typically applied to your cervix to make it easier to see any irregularities. And a colposcope, an instrument that looks like binoculars, is used to get a closer look. In my case, my OB-GYN was concerned about what he saw and decided to do a cervical biopsy to get an additional sample. At 13 weeks pregnant, I experienced more bleeding than is typical, but it wasn’t heavier than a period and only lasted a couple of days.
Finding out my biopsy results
My biopsy results showed that I had AIS, adenocarcinoma in situ, abnormal cells that can become cancerous. A second biopsy returned a Stage 1A1 cervical cancer diagnosis. Cervical cancer is the fourth most common cancer among women, according to a 2018 study by the World Health Organization (WHO), but it is significantly less prevalent in the United States. In other words, my situation—having HPV and cervical cancer—was not uncommon.
Since I was in my second trimester by the time I was diagnosed, I was immediately referred to a gynecologic oncologist who would take another look at my cervix and present me with a treatment plan.
Getting this diagnosis was one of the most stressful phone calls I’ve ever experienced. Finding out you might have cancer is awful, but finding out you might have cancer while carrying your first child is even worse. Luckily, I had a great support system and medical team that helped me through the process.
Treating cervical cancer while pregnant
According to Kellie Schnieder, MD, a gynecologic oncologist at Novant Health in Charlotte, North Carolina, my treatment plan was consistent with the typical recommendation for a pregnant patient with early-stage cervical cancer. I had appointments with my oncologist every three months to monitor my cervix and scheduled a cone biopsy after I recovered from childbirth.
The treatment varies based on the stage of pregnancy and the cancer progression. It can involve lymphadenectomy (removal of affected lymph nodes), trachelectomy (removal of part of cervix, vagina, and surrounding tissues), or neoadjuvant chemotherapy (medication to reduce a tumor’s size). Most cases detected during pregnancy are mild. The survival rate in this scenario is 99.1%.
In March 2020, eight weeks after I delivered my son, Parker, I went in for the conization procedure, which successfully removed the cancerous tissue. My son is now 11 months old, and I’m still cancer- and HPV-free. I go back for regular appointments every four months to make sure it stays that way.
Other types of treatment
There are several types of treatment for cervical cancer and dysplasia, which depend on the stage, and in most cases, fertility can be preserved. “The majority of women with cervical dysplasia (pre-cancer) do not need a hysterectomy,” Dr. Schmeler explains. “Women with high-grade cervical dysplasia usually need treatment and undergo a LEEP (loop electrosurgical excision procedure) where a small portion of the cervix containing the abnormal cells is removed, leaving most of the cervix and all the uterus in place.”
In more advanced stages, 1A2-1B2, a hysterectomy or radical trachelectomy (removal of the cervix, upper vagina, and parametrium, or tissue surrounding the cervix) may be considered, and according to Dr. Schnieder, “bigger tumors may be treated with chemotherapy combined with radiation therapy.“
The importance of prevention
Cervical cancer impacts thousands of women, but it’s preventable with regular screenings and the HPV vaccine. “The best thing women can do to prevent it is get the vaccine,” explains Dr. Schnieder. “HPV is the most common sexually transmitted infection, and almost everyone has it or has had it. There isn’t a great way to avoid it except to get vaccinated.” The vaccine is approved for ages 9 to 45 years old and is safe to receive during pregnancy.
Other important prevention measures include routine primary care, routine and timely cervical cancer screening, consistent condom use, and maintaining healthy habits such as not smoking, low or moderate alcohol use, healthy diet, regular maintenance, and achieving a healthy weight.
RELATED: Why you should get the Gardasil vaccine—even in your 30s or 40s
The coronavirus pandemic has also led many women to put off their screenings and routine appointments, though the impact on cancer diagnoses is as yet unknown. Clinics and hospitals are taking precautions right now, so if it’s been a while since your last screening, don’t forget to make an appointment. A little prevention can go a long way.
Life after cervical cancer
My biggest takeaway from my experience being pregnant with cervical cancer is the importance of prevention. Because HPV is an STI, it continues to hold a stigma, one that I hope I can help break down by sharing my experience. And, when my son is old enough, he’ll definitely be getting vaccinated!
