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Ask an Oncology Expert with Dr. Kimberly Levinson

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Laura Zabriskie

January 13, 2021
Kimberly Levinson, MD, MPH, Director of Johns Hopkins Gynecologic Oncology at GBMC, is passionate about building relationships with the women she treats and empowering them to understand their disease. With so much misinformation about HPV, cervical dysplasia, and cervical cancer, she makes it her mission to educate each woman on her individual diagnosis and unique care plan. Dr. Levinson joined Mary Beth Marsden for an interactive discussion about these topics and gynecologic (GYN) cancer care at GBMC.

While cervical cancer is the most well-known GYN cancer, it is not the most common. Uterine cancer, specifically endometrial cancer, is the most frequently diagnosed GYN cancer. Fortunately, it is often caught in its early stages because it causes bleeding. “In post-menopausal women, any instance of bleeding is something that should be investigated,” Dr. Levinson said. She also noted that pre-menopausal women should watch for unusual bleeding or bleeding between periods and go to their doctor if they are concerned.

Cervical cancer has less obvious symptoms, which is one of the reasons screening is so important. Advanced screening technologies have allowed physicians to catch cervical cancer in its early stages – sometimes before the cancer has even formed. This precancerous stage is called dysplasia. Patients are diagnosed with dysplasia when abnormal cells are found in the area of the cervix. “We can remove those abnormal cells and ensure that they don’t go on to form a cancer,” Dr. Levinson explained. “The whole point of preventive screening practices is to identify these abnormal cells when they are dysplasia and are not yet able to invade other cells.”

Over 99% of dysplasia and cervical cancer diagnoses are caused by Human Papillomavirus, which is commonly known as HPV. Dr. Levinson described HPV as the common cold of sexually transmitted diseases. Because it is so prevalent, almost everyone who hasn’t been vaccinated and is sexually active contracts the virus. The immune system is usually able to fight off the virus with no negative effects – the person may never know that he or she was infected. Unfortunately, there are cases where HPV persists and can go on to change into cancerous cells.

Widespread vaccination against HPV has led to a significant reduction in the risk for cervical cancer; however, this vaccination must be given during childhood prior to sexual activity. “Ideally, we want patients to be vaccinated around age 11 or 12,” Dr. Levinson described, “but it can be as early as 9 years old.” When asked if she believed that vaccinating all children against HPV would eliminate cervical cancer, she simply answered “Yes.”

Regular screening is still suggested for women who have received the HPV vaccine. “Recommendations for screening have only become more complicated over time,” said Dr. Levinson. “I think it’s really important that each individual patient have a good conversation with their practitioner to determine their own individual risks.”

The discussion ended with Dr. Levinson answering viewer questions that were submitted beforehand and during the conversation. She covered topics such as preserving fertility during treatment for GYN cancers and dysplasia, the effects of recurring treatments, and whether or not she recommends the COVID-19 vaccine to her patients who are eligible.
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