DEAR DR. ROACH: I was diagnosed with stage 3 cervical cancer in my 70s. I read that HPV causes this cancer, but I have never been diagnosed with that. I also haven’t been intimate with anyone since my 60s, when I became a widow. What could explain my cancer diagnosis? — J.R.
ANSWER: I am sorry for your diagnosis. Essentially, all cervical cancer is caused by the human papillomavirus. It normally takes 10 to 20 years (sometimes longer) from the time of exposure to the time cancer is detectable. It is almost certain that you were exposed years ago to HPV, but I can’t say exactly when that happened.
Even women who have been in a monogamous relationship or who have not been sexually active in years should continue to get regular screening tests for cervical cancer (such as a Pap smear, HPV test or both) until at least age 65. A Pap smear should have picked up the early stages of cellular abnormality (called cervical intraepithelial neoplasia, or CIN), ideally even before there was cancer. An HPV test should have identified the high-risk HPV strains even before there were cellular abnormalities.
It is remotely possible that the tests missed the abnormalities, but most women in your situation just don’t get the tests done because they thought they weren’t at risk (or weren’t able to go due to the pandemic). Even though the tests aren’t perfect, it takes so long to develop cervical cancer that one of the tests over the years should have picked it up.
Once a woman is over 65, if she has never had cellular abnormalities (CIN grade 2 or worse) and has had multiple negative screening tests in the past 10 years (a negative HPV test in the past five years or a negative Pap smear in the past three years), then screening may be stopped — although some experts continue to screen until age 74 in healthy women.
In the age of the HPV vaccine, eventually no woman will need to fear cervical cancer again.
DEAR DR. ROACH: In a recent column, you mentioned megesterol as a drug to counter hot flashes associated with prostate cancer treatments. I was prescribed this medication, and as a result, I developed life-threatening blood clots from my right calf up to my lungs.
I spent numerous days in intensive care while I received clot-busting drugs, and I am now on blood thinner medication (Eliquis) for life. The urologist no longer prescribes this medication because of my case, and the hematologist said that he doesn’t prescribe megesterol for this exact reason.
Please add a warning about this drug to your column. — G.K.
ANSWER: I thank G.K. for writing. Megesterol is known to have the potential to stimulate prostate cancer, so I recommend against it unless it is used as a last resort, but G.K. is absolutely right. Since megesterol has estrogen effects, it increases the risk of blood clots. Men with prostate cancer are already at a higher risk for blood clots, so the combination is particularly dangerous.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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