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Ask the Doctor: July 2008

Question: I am 23 years old and my pap smear came back positive for HPV and had some abnormal cells. I am very worried about this. Can I still get the vaccine for HPV?

Answer: The vaccine for HPV (human papilloma virus) is marketed under the name Gardasil. When they studied the effectiveness of Gardasil before it was approved by the FDA, they studied women who were already infected with one strain of HPV. Gardasil contains the 4 strains of HPV most likely to cause cervical cancer and genital warts. The women who had previously been diagnosed with one strain of HPV were still protected from the other three strains, and the FDA has approved Gardasil for women who have already been infected with one strain. Make sure you talk to your gynecologist about getting the vaccine series. Also, make sure you are getting treated for the abnormal cells on your pap and you follow through with your repeat pap smears, as they will have to be more frequent than once a year of a while.

Question: Last month when you talked about screening for breast and ovarian cancer, you mentioned the CA-125 test. I have read about this in my women’s magazines, which say I should have it done, but my gynecologist has never ordered that test for me. Do I need this test done?

Answer: This is a great question and my patients ask about this test all the time. Ovarian cancer is a rare cancer, with most women only carrying a 1.7% lifetime risk (compared to 13.2% lifetime risk for breast cancer). Unfortunately, due to the location of the ovaries deep within the pelvis, it is difficult to screen for ovarian cancer, thus ovarian cancer is not usually found until it is at a later stage and is harder to cure. Many studies have been done, and no effective screening test has been found for ovarian cancer. The CA-125 blood test is supposed to be used after a woman is diagnosed with ovarian cancer, to follow to see if the cancer has come back. Not all women with ovarian cancer have a positive CA-125 before surgery, so this does not help all patients. In addition, not all patients with a high CA-125 have ovarian cancer, so the false positive rate is quite high; too high for a screening test. As an example, a patient of mine had severe pelvic pain, an ultrasound was done showing an ovarian mass and the CA-125 was very high, around 1700 (normal is less than 25). However, when she went into surgery the results showed that she did NOT have ovarian cancer, and she had endometriosis instead. She is a very lucky woman, but this just illustrates why we don’t use the CA-125 as a screening test for all women. All of that being said, for the women who are at very high risk for ovarian cancer, we have to screen somehow. For my patients with a first degree relative (mother, sister, or daughter) with ovarian cancer, I recommend a pelvic ultrasound every year to look at the ovaries and the CA-125 blood test. This however is not standard of care and generally not covered by insurance for screening purposes. With women that are such high risk, usually the expense is worth the possibly of early diagnosis and a chance at a cure. I would discuss your personal risk with your gynecologist and determine if the CA-125 is right for you.

Dr. Karen Lockwood is a graduate of University of Oklahoma College of Medicine.  She completed her residency in Internal Medicine at Henry Ford Hospital in Detroit.  She is board-certified in Internal Medicine and is currently in private practice in Troy, MI.

If you would like to submit a medical question to Dr. Lockwood, Please email your question to askthedoc@healthandleisureonline.com.

*Advice found within this article is for informational purposes only and should not replace the advice or recommendations of your physician.