Pap smear test first line of defense against cervical cancer

Maryville, TN

Don't be telling Dr. Kim Collins you don't have time for your Pap test, or that it's uncomfortable, or that you don't like going to the doctor. She's not buying those excuses.

“Just woman up and do it,” Collins said.

Collins, an obstetrician/gynecologist with Women's Care Group in Maryville, said the importance of having a Pap test cannot be overemphasized. This simple test can detect potential problems in their earliest stages, allowing treatment to begin before the condition becomes cervical cancer. Cervical cancer is a slow growing cancer caused by certain strains of the human papillomavirus (HPV), an extremely common sexually transmitted disease among women and men.

Cervical cancer has no warning signs in early stages. This is why Pap tests are so important. In the Papanicolaou (Pap) test, cells are gathered from the cervix and then examined closely under a microscope for abnormalities. Collins said cervical cancer rates in the United States have fallen more than 50 percent in the past 30 years thanks to the widespread use of the Pap test.

New guidelines for Pap screenings were released in December 2009. Rather than an annual Pap test, women ages 21 to 29 may be screened every two years, and women 30 and above every three years as long as they have had three negative Paps in row. Collins emphasized that an annual physical exam is still indicated because it involves much more than the one test.

According to the Tennessee Department of Health, risk factors for cervical cancer include high-risk sexual behavior; a personal and/or family history of cervical cancer; cigarette smoking; and previous HPV infection. African-American women are more prone to develop cervical cancer than Caucasian and Hispanic women are.

As for having Pap tests, Collins won't accept any excuses for avoiding them.

“I tell my patients this about mammograms and Pap tests,” Collins said. “Is this your favorite thing to do? No. But, when they say this is painful or uncomfortable, my response is, ‘Not as uncomfortable as surgery and radiation and chemotherapy.' There are worse things. If you eventually get diagnosed, you're headed for far more discomfort and pain.”

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Importance of Pap Smear Test cervical cancer screening emphasized by Missouri doctor

Osage Beach, MO

During Cervical Cancer Screening Month and Cervical Health Awareness Month in January, physicians with Lake Regional Health System in Osage Beach, Mo., are encouraging women and parents of young girls to learn more about early detection and prevention.

“It’s important that women know about this disease,” said Gynecologist Becky Simpson, M.D., with Lake Area Women’s Center in Osage Beach. “It can be treated if detected early, and most cases now can be prevented.”

According to the American Cancer Society, nearly 12,000 U.S. women are diagnosed with cervical cancer each year, and about 4,000 die from it. However, more lives are being saved thanks to increased use of the Pap test — the screening procedure used to find changes in the cervix before cancer develops — and a recently approved vaccination.

Almost all cases of cervical cancer are caused by the Human Papillomavirus — the most common sexually transmitted disease. If an HPV infection isn’t treated or doesn’t clear on its own, it eventually can result in cervical cancer.

“The fastest, easiest way to detect HPV is through an annual Pap test,” Dr. Simpson said. “During this test, we take a sample of cells from the cervix, which is the bottom part of the womb. The cells then are examined for abnormalities or infections, which can be early signs of cancer.”

If an HPV infection is detected and the abnormal cells are treated early, most cases of cervical cancer can be prevented. For this reason, doctors recommend annual Pap tests and pelvic exams for women ages 18 and older, or those who have become sexually active.

Doctors also encourage women ages nine to 26 to get vaccinated against HPV. The vaccine, Gardasil, is a series of three vaccines. They help protect against four types of HPV, two of which cause 70 percent of cervical cancer cases.

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Cervical cancer testing guidelines revised

Washington, D.C.

A national physician’s organization has revised its cervical cancer screening guidelines, saying that women in their 20s can have a Pap smear every two years, instead of every year.

The statements follow closely after the start of an ongoing discussion on regular mammograms, stemming from debate on when women should start having the procedure — in their 40s or 50s.

The proximity of the two items has prompted some to worry about a perceived drift toward future health care rationing, fueled by debate over health care reform.

But the American College of Obstetricians and Gynecologists, which released the new cervical cancer guidelines last week, said women younger than 21 are at very low risk of cancer — and screening them may lead to “unnecessary and harmful evaluation and treatment.”

The organization said women should have their first cervical cancer screening at age 21 and can be rescreened less frequently than previously recommended. The new guidelines say most women younger than 30 should undergo cervical screening once every two years instead of annually.

Those age 30 and older can be rescreened once every three years, according to an ACOG news release.

Abilene physician Peter Norton said that in some ways, issues behind the new guidelines stretch back to the 1940s. In 1945, the test gained the support of the American Cancer Society.

Cervical cancer is a slow-growing cancer caused by certain strains of the human papillomavirus (HPV), a common sexually transmitted disease among women and men that also causes genital and anal warts, as well as oral and anal cancer.

“It’s the first time you really know the cause of a cancer — that it’s a virus,” Norton said.

The ability to discover abnormalities earlier, and to find premalignant cells early on, sounds “very logical and very good,” he said.

But in the last 10 years, it’s become known that not all of the infections progress to a cancerous state. So a certain percentage of women may not need to be treated at all, since their own immune systems are able to handle the infection.

“When you couple that with the fact that the cervix is important to maintaining a pregnancy to term, anything that we do to treat premalignant cells might damage the cervix to a certain extent,” he said. “So that becomes an issue.”

All such things considered, Norton worried that because of the suggested guidelines, some patients would be left untreated, leaving them open “to expose other people to HPV.”

“That’s not isolating the disease the way infectious diseases have been traditionally isolated,” he said.

Sexual activity — skin to skin contact, not necessarily intercourse — is what spreads HPV, Norton said.

“We know that there are certain groups of women who probably do not need Pap smears,” he said. “I feel age 21 was used because they feel most girls, probably 60 to 80 percent, are going to be sexually active by the time they’re 18 or 19 years old.”

But that number isn’t accurate for everyone, he said.

Women should start receiving Pap smears three years after the initiation of intercourse, he said.

And for some women, waiting as much as three years between screenings might be “too long,” he said.

Cervical cancer rates have fallen more than 50 percent in the past 30 years in the United States because of the widespread use of the Pap test, according to ACOG, which said in its statement that the majority of deaths from cervical cancer in the U.S. are among women who are screened infrequently or not at all.

Vaccination against HPV is expected to cut cervical cancer rates in the future, but for now, ACOG’s guidelines say vaccinated women should follow the same Pap guidelines as those who are unvaccinated.

Norton dubbed it “interesting” that the guidelines were coming out around the time of the national health debate, though ACOG has said that its similarly timed release is simply coincidental.

Helen Teague, coordinator for women’s health/community initiatives with Hendrick Health System’s Vera West Women’s Center, said she worried that both the breast cancer debate and the revised screening guidelines might herald “the beginnings of the rationing of health care.”

Teague said cervical cancer is preventable with screening and she touted the procedure as safe.

“My question in this whole thing, not only with the mammogram suggestion and now this, is why is it advisable to keep women, in this case, young women, in the dark about their health?” she said. “If we have the technology, why aren’t we using it? Why would we delay in using it?”

An initial cervical cancer screening sets an important baseline for future screenings, she said.

“Most of the folks who make these decisions do not see the faces of those these decisions impact,” she said.

Nationally, some sought to connect the mammogram recommendations to the health-care overhaul, contending that such findings are the way that medical rationing starts.

Under the pending legislation, “nothing would prohibit the federal government from deciding if tests, treatments and procedures are too expensive, and therefore, unnecessary,” Sens. Jon Kyl of Arizona, the Republican Whip, and Tom Coburn of Oklahoma, a physician, said in a joint statement.

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Liquid-Based Cytology Is Not Superior to the Conventional Papanicolau (Pap Smear) Testing

A recent research featured in the October edition of the Journal of the American Medical Association presents a Dutch investigation that studied approximately 90,000 women who underwent the Papanicolau test.

The investigators state that the liquid-based cytology which represents an alternative to the traditional Papanicolau test provides no advantage in comparison with the latter in finding pre-cervical cancer symptoms or the actual disease.

The medical world thought the Papanicolau test to be under the detection standards because it sometimes provided false- positive or negative results for the patients who underwent it. Regarding the usage of body cell entitled liquid-based cytology, the cells coming from the cervix are gathered thorough the use of a common sampling gadget and are put into a vial containing some preservation substance compared to the process of putting the sample on a glass slide, a thing which was used in the past. However, even if this represents a new detection method, various researches showed that the accuracy of the detection was not always a certain fact.

The team of scientists undergoing the investigation was led by Albertus Siebers from the Radboud University Nijmegen Medical Centre located in the Netherlands state Nijmegen. He and his colleagues started the research by comparing the screening accuracy of the Papanicolau tests and the liquid-based cytology. They looked at the positive results rate, the histological detection ones and the PPVs (positive predictive values). The investigation had a random character and comprised a number of 89,784 females who aged between 30 years and 60 years. All of the women were included in a screening process for cervical cancer which comprised 246 family Dutch clinics. From these family practices, 122 used liquid-based cytology and verified 49,222 women and the rest of the medical facilities used the traditional Papanicolau testing and verified 40,562 women. The females were controlled for CIN (cervical intraepithelial neoplasia) and were monitored for eighteen months until January. This took place in the year 2008.

The group of investigators discovered that the adjusted detection rate for cervical intraepithelial neoplasia garde 1+ was of 1.01, for the cervical intraepithelial neoplasia grade 2+ it was 1, for cervical intraepithelial neoplasia grade 3+ it was 1.05 and for carcinoma, the ratio was 1.69. As the investigators explain, this adjusted ratio did not vary very much from one for certain results of cervical intraepithelial neoplasia in the cases of some cytological call-off.

Due to the random character of the investigation, it can be thought that the propensity of cervical intraepithelial neoplasia was the same for both of the tested samples. This is why the inexistence of variation in the detection ratios and the positive predictive values during the specific research proved that the liquid-based cytology is not more sensitive or more accurate in discovering the cancer affecting the cervix compared to the traditional Papanicolau method.

The scientists concluded that there was not a significant variation in the positive rates provided by the cytological testing mechanisms. However, the evidence provided by this innovative detection process does not bring enough proves to state a similar accuracy in diagnosing women who suffer from cervical cancer. The analysis comprising the intent to treat and the way in which doctors can do this showed that the liquid-based cytology was not better than the Papanicolau test in the matter of finding positive rates of the already studied under the microscope results.

The same outcome came from the positive predictive values. In conclusion, the evidence provided by the investigation states that if the cytological testing is done in a very organized and qualitative screening for cervical cancer process, it does not differ from the traditional Papanicolau test.

Mark Schiffman and Diane Solomon, both medical doctors from the National Cancer Institute state their opinion regarding this research. Nowadays, being a doctor involved in the prevention of the cervical cancer seems to be a very challenging position. Even if the methods and tools used in the cervical detection process are updated and come in high numbers, no corroboration of vaccines, humanpapilloma virus tests, cytology, colposcopy and innovative ways would apply in the same way for all the women. They state that if we deal with areas around the Globe in which the health rates and quality of life are very high, the vaccines, liquid-based cytology or humanpapilloma virus tests could be a waste of resources if they are not taken out in a planned manner.

In addition, the medical doctors believe that the research undergone by Siebers team has made things simpler in the means that those persons involved in cervical cancer screening, monitoring and treating can use one of the two detection methods: the traditional Papanicolau test or the liquid-based cytology. Even if this decision-making process became more complex at the moment when the cytology appeared on the health market, the investigators managed to make the doctors see the exact role of this new detection method in applying treatments to their patients.

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Pap Tests and menopause

Atlanta, GA

A Pap test, or Pap smear, is a pelvic exam that checks the cervix fluids and cells for possible cancer and precancerous cells. Typically they are given to every woman of childbearing age after they become sexually active to check for cervical cancer and other items. These tests help in finding precancerous cells early so that there is a greater chance of treatment options that will work for the survival of the patient. But what about those out of childbearing years, those in menopause? Should they still be getting a yearly Pap test?

Getting the Pap Test
Those getting a Pap smear should prepare two days in advance so that they can get the best possible result, mainly an accurate one that will not do false results. Things that a woman should not be doing for two days prior to the Pap smear pelvic exam are:
Do not have sex
Do not take tub baths
Do not use douches, artificial lubrication, or feminine hygiene products
Don’t use tampons (don’t even have a Pap smear while on your period)
Do not use foam, cream, or jelly birth control
Don’t use vaginal medication or creams

Pap Smears and Menopause
Usually women can stop having a yearly pelvic Pap smear exam after reaching age 70 if they meet one condition. They must have had the past 10 years of normal Pap Smear results. They are still asked to have pelvic exams, but the pap smear doesn’t need to be included.
If the woman goes into early menopause prior to the age of 70, it is usually recommended that they continue to get one to test for the cervical cancer risk. After reaching the age of 70 they will then be able to relax the need for pap smear pelvic exams if the woman has had normal results for the prior 10 years of testing.

How often a woman gets a pap smear is completely up to many different things. Whether or not she has a history of cancer, her age, whether she smokes, or if she has HPV (human papillomavirus) are some of those factors that will increase her need for more frequent pap smears and other pelvic exams. But if the woman continues to have a thorough exam and get normal results, they will relax the need to see her as often as before. The need for early detection is still key in having these types of tests.

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New advanced DNA test could make pap smears obsolete

Lufkin, TX

Annual pap smears could soon move to medical history books. Dr. Kay Carter said the new advanced dna test could save women's lives. "It can tell whether the DNA is high risk or low risk DNA for the HPV virus," said Dr. Carter.

She said the DNA test will make gynecologists' jobs easier. That is because it is a one step screening process

"If a woman has a high risk HPV virus then we will automatically go directly to biopsies and test that gives us more accurate information than the pap smear screen does," said Dr. Carter.

Dr. Carter believes most women get an annual pap smear out of routine and don't really understand its purpose. "I don't think that women classically understand the pap smear and why we have to do it," said Dr. Carter. She said the new DNA test makes it easier to understand that there is a virus that causes cervical cancer and women need to be checked for that virus.

Women over 30 could drop the annual pap smear and instead get a DNA test every three, five or ten years. The women we talked to said the pap smear does not bother them. "It's better to be safe than sorry, waiting three years is a long time, once a year is pretty accurate," said Becca Tatum, patient.

"You're going to have to come in for a yearly exam anyways, a breast exam, a pelvic exam so you mine as well get the pap smear done while you are," said Wendy Burger, patient.

Dr. Carter said over time, the DNA test will also cut yearly medical expenses.

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Baltimore County offering free Pap tests

Baltimore, MD

In honor of January being Cervical Cancer Awareness Month, the Baltimore County Health Department is offering free Pap tests, mammograms and breast exams for eligible women between 18 and 65.

The department also screens for eligibility, schedules appointments and manages the cases of women with abnormal test results.

About 11,000 women in the United States are diagnosed with cervical cancer each year, and more than 3,500 women will die from the disease. A Pap test, which is recommended annually, is one of the most effective ways to detect cervical cancer, health officials said.

For more information on these free tests, call 410-887-3432 or visit baltimorecountymd.gov/go/cancerprogram.

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What does an abnormal Pap Test mean?

Tampa Bay, FL

Nearly every day, I see patients who have received an abnormal Pap test result in my gynecology office. These abnormal results can trigger tremendous anxiety, so I spend significant time educating my patients about what the results may mean.

A Pap test, or Pap smear, looks for changes in the cells of the cervix that may indicate cervical cancer or other conditions that could develop into cancer. Cervical cancer is the third most common gynecologic cancer in the United States, after endometrial (first) and ovarian (second) cancers. If caught early, cervical cancer can be cured. A Pap test, part of a woman's routine physical exam, is a very effective screening tool for detecting precancerous conditions and small tumors that can lead to cervical cancer.

Women are advised to begin Pap tests about three years after becoming sexually active or by age 21. The tests are usually performed yearly, unless you are told otherwise by your physician. If no dysplasia (pre-cancer) or cancer of the cervix is detected, the result comes back negative. If your doctor says your result was "abnormal," it means the test found some cells on your cervix that do not look normal - it does not necessarily mean you have cancer. In fact, the likelihood that a woman with an abnormal Pap result has cancer is actually quite low. There are other causes for abnormal Pap results, including human papilloma virus, other types of infections and natural cervical cell changes related to menopause.

An AS-CUS Pap, otherwise known as atypical squamous cells of unknown significance, means that the laboratory detected some abnormalities, but cannot exactly classify the changes. Many physicians will ask the lab to further test this specimen for high-risk HPV - certain types of HPV associated with cervical cancer. If a woman with an AS-CUS Pap also tests positive for high-risk HPV, low-grade intraepithelial lesions (LSIL), high-grade intraepithelial lesions (HSIL), or atypical glandular cells of unknown significance (AGUS), she will be advised to undergo a colposcopy to further evaluate the problem.

A colposcopy allows the physician to look more closely at a woman's vagina and cervix with a lighted magnifying device. A vinegar solution is often applied to bring out changes on the cervix. If abnormalities are found, a cervical biopsy may be performed.

Depending on the woman's age and health and the severity of the abnormality, observation or treatment may be recommended. Most women with HPV or low-grade lesions will be watched closely, since these types of abnormal cell changes frequently go away on their own over time. They will repeat a Pap test every six months for several years and resume yearly screening only when the precancerous condition resolves.

Women with moderate to severe cell changes or persistent low-grade dysplasia are often advised to undergo a cervical conization. This procedure, performed in the office or an operating room, removes a cone-shaped piece of abnormal tissue from the cervix and cervical canal. It may be used to diagnose cervical cancer or to treat a cervical abnormality.

If you are notified that your Pap test is abnormal, follow your physician's instructions for follow-up and testing frequency. Make sure to find out the results of your Pap test, even if they are negative.

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Pap smear after 70 up to patient, doctor

Orlando, FL

Question: I am 75. During my last checkup, my gynecologist said I do not need to continue getting Pap smears. This has me concerned as I have done this faithfully all of my adult life. Is it safe to stop?

Answer: This question cannot be answered for you in a column such as this. Only a doctor who does Pap smears and knows you can tell you if it is safe to stop or not. I can, however, try to provide you with some information and context that may help you take this question back to your doctor.

"Pap" stands for Papanicolaou, the name of the doctor who developed this test in the 1940s. Until then, we had no good screening test for cervical cancer, one of the most common cancers among women. The cervix is the opening of the uterus into the vagina.

This is an excellent screening test -- simple and relatively painless, inexpensive, and very sensitive and specific. Countless lives have been saved by this simple test. Medicare pays for Pap smears every other year, but this might not continue.

The Pap smear is done during routine pelvic examinations. A device called a speculum is inserted into the vagina to aid exposure and the surface of the cervix is scraped to obtain cells. These are examined under a microscope for abnormalities.

Pap smears can detect the earliest changes in cervical cells preceding the development of cancer. This offers the possibility of treatment options other than a hysterectomy -- removal of the entire uterus and cervix -- in cases such as when younger women wish to preserve the ability to conceive.

In 2006, new Pap smear guidelines came out. According to these, women at low risk can probably discontinue having Pap smears after 70. Women qualifying as low risk should have had regular Pap smears for years preceding that birthday with no abnormalities. They also should be sexually abstinent or in a mutually monogamous, long-term relationship. One reason for this is the association of cervical cancer and human papilloma virus (HPV), a sexually transmitted infection.

It is important to emphasize that not needing a Pap smear does not mean you can avoid regular pelvic examinations. These are more than just a means of doing a Pap smear. They check for pelvic tumors, ovarian cancer and other pelvic problems. A rectal examination is part of a pelvic and checks for problems in that area.

Women who might not need a Pap smear include those who have had a total hysterectomy, which includes removal of the cervix. Sometimes, however, Pap smears might be advisable even in the absence of the cervix, such as when there might be precancerous changes in the wall of the vagina itself. When a partial hysterectomy is done, the cervix is preserved and taking a Pap smear with the pelvic exam should still be done.

This is not an exhaustive list of who does and who does not need a Pap smear. Ultimately, the decision to discontinue Pap smears should be made between you and the physician who knows you best.

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J. Matthews, MD: Pap Test Explained

Muskogee, OK

If you were asked to conjure up one phrase to represent what gynecologists do with their time day in and day out, what could you come up with? If you’re like most of my patients, you would immediately reply “Pap smear.”

How many of you, though, could explain just what a Pap smear consists of, or what its purpose is? This just isn’t a topic that often gets tossed around at casual lunches or over coffee.

The Pap smear is a medical test which is actually one of the most effective cancer-screening methods ever devised. It’s done by removing some cells from the surface of the cervix with a plastic “spatula” or brush. These cells are then sent to a pathologist, a doctor who specializes in microscopic examinations of tissue.

What the pathologist looks for are changes in the cells that are abnormal, changes that are referred to as dysplasia, which is significant because it can signal the first steps in a transformation to cervical cancer. That is what makes this test so useful: it detects changes in cells before cancer has begun.

Many women, when contacted by a doctor about an abnormal Pap smear, incorrectly conclude that they already have cervical cancer. Fortunately, this is very rarely the case. Cervical cancer tends to develop very slowly, and so women who have annual Pap smears can find precancerous changes early and get treatment before cancer strikes.

The Pap smear has been around for many decades, and for most of that time it has been our best weapon against the fifth most deadly women’s cancer worldwide. The incidence of invasive cervical cancer has dropped more than 50 percent since Pap smears began to be widely used.

In just the last few years, though, two new weapons have appeared which may eventually make the Pap smear obsolete. That doesn’t mean that your gynecologist can start throwing away all of those speculums, but we may be able to drive the number of deaths from cervical cancer even lower than it already is.

Doctors now know that cervical cancer is almost exclusively caused by a virus, called the human papilloma virus: HPV for short. This fact makes it fairly unique among cancers. Unlike breast cancer, ovarian cancer, colon cancer, or almost any other cancer, cervical cancer could potentially be defeated.

In the meantime, you should be checking your memory for the date of your last encounter with that speculum. If it’s been more than a year, give your doctor a call.

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Pap test awareness: Pap-A-Thon promotes women's health

South Bend, IN

It's an important test that could save a woman's life, a pap smear. But many don't have the tests done either because their too busy or don't have healthcare.

That's why the Women's Task Force at St. Joseph Regional Medical Center held a "pap-a-thon" Wednesday.

They performed free pap tests and enrolled women in need in a federal program that provides free healthcare.

Joan Lennon from the Women's Task Force says, "We are helping woman, many woman, young mothers often, who just don't have the resources or they have to put their children first and are not able to come in and get their screenings or other woman who find themselves without health insurance which happens to be a large population of our society today.

The tests were held at eight different sites across Michiana Wednesday. Nearly a thousand woman were tested.

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Pathologist lobbies congressman for local lab testing of Pap smear tests

Local lab makes its pitch when congressman comes calling.

Fredricksburg, VA

With a congressman in the house, Dr. Paul Hine lobbied for his laboratory.

His message: "The best practice is local practice."

Hine is chairman of the Department of Pathology and Laboratory Medicine at Mary Washington Hospital. Yesterday he and the laboratory staff hosted 1st District Rep. Rob Wittman, a Republican from Westmoreland County.

The Fredericksburg hospital officials talked with Wittman about federal funding for the Medicaid program, and about the testing requirements for laboratory technologists.

But the focus was on the benefits to patients of using a local, rather than national, laboratory. And to illustrate, the staff demonstrated for Wittman how it reviews Pap smears.

A Pap smear checks for cervical cancer and is usually part of a woman's annual gynecological exam.

Specimens are collected in doctors' offices and sent to laboratories such as Mary Washington's. There, slides are prepared and examined under high-powered microscopes.

A technologist peers through the microscope to find any abnormal cells. Hine compared it to hovering in a helicopter over a mall parking lot.

"Your task is to find which, if any, cars have left their doors open," he said.

Some of the slides are chosen randomly for a second look, and abnormal ones are checked by a pathologist.

"Over 50 percent of all slides are read by more than one person," Hine said.

The Pap test is seen as an effective way to identify abnormal cells that can become cancerous. Hine said it has been more than a year since he saw a slide from a patient with invasive cancer.

"The reduction in women's cervical cancer is phenomenal," he said.

Mary Washington's laboratory reviews 5,000 Pap tests each year. Yet that represents only 10 percent of the local market.

The rest are sent by doctors' offices to national laboratories such as LabCorp and Quest Diagnostics.

Patients have little choice in where the laboratory work is done. Health insurance companies, such as Anthem, believe they can get quality work at a lower price by contracting with national laboratories.

But Hine and Cindy Huffman, laboratory director, argued that patients and physicians benefit from the interaction that occurs at a local laboratory.

Huffman said it is common for a doctor to call or walk into Mary Washington's lab and ask the staff, "Can you pull this slide?"

"We believe quality is best measured by local knowledge," Hine said. "We're accountable to people in this community."

Wittman did not offer an opinion on the use of national laboratories, though he did appear comfortable in the hospital laboratory. He has an undergraduate degree in biology and worked for 26 years in the seafood safety division of the Virginia Department of Health.

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Examining the reason behind frequent Pap-smear tests

Examining the reason behind frequent Pap-smear tests

"Good luck, fellas," the attractive receptionist called out to us with a knowing grin as we filed into the office of Dr. Mons, the gynecologist who was to be the preceptor to four, third-year male medical students.

"Now, boys," Mons began, "it is important to understand that gynecology is a very . . . well . . . it's a sensitive area. It is vital that you appreciate how a woman feels under these circumstances."

He then proceeded to ask the studliest of this group to hop up onto the examining table. I explained my knee was sore and so Brad said he would do it. He jumped onto the table and, with a smirk, slipped his heels into the stirrups. "Sorry, Brad, but that's not terribly realistic. Remove your pants."

A little shaken, he tentatively removed his drawers. "Now assume the position," Mons ordered.

After a bit of coaxing, he finally reset himself in the stirrups and, as instructed, lay back on the table, no longer chuckling. Then, in a move I'll not soon forget, this wise/abusive specialist taught us a lesson for the ages.

"Cheryl!" he announced into the speaker. "You can come in now."

As the door opened and the receptionist appeared, Brad strained several muscles, a few organs and the richest part of the "Hallelujah" chorus as he scrambled to find some protective modesty-preserver in the room.

He succeeded in partially wrapping several torn pieces of paper off the exam table around his torso. To this day, I have nothing but the highest respect for the procedure a woman has to go through in order to have a Pap smear.

In 1935, George Papanicolaou of Cornell University discovered that by taking a wee scraping from the cervix (opening to the womb), he was able to determine if pre-cancerous cells were brewing. Before Dr. Papanicolaou's developing of de test that women detest, cervical cancer killed more women than breast or lung cancer. Before the Pap smear, cervical cancer was the leading cause of cancer death in women.

Consider these facts:

1. In 1999, 14 women died of cervical cancer each day in the U.S. and Canada.

2. 85 per cent of them had not had routine Pap smears.

3. Every 21/2 minutes, a woman on this planet dies of cervical cancer.

4. Because of a lack of screening facilities, cervical cancer is the leading cause of cancer death in women in Third World countries.

5. 15,000 women in Canada and the U.S. will be diagnosed with cervical cancer this year.

It is imperative that the Pap test, the most effective of all cancer screening tests, is not neglected.

Age 12 to 17 - There's no need to have the test before age 18 unless the girl is sexually active. If she's having sex, then her risk of contracting the HPV virus, that leads to cervical cancer, is high and she requires annual pap smears.

Age 18 to 50 - Annually. After three consecutive normal pap smears and assuming only one partner, the test can move to every two years.

Age 50 to 100 - Even though post-menopausal, the same criteria currently apply.

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HPV Vaccine Reduces Abnormal Pap Test Results

Birmingham, AL

A significant drop in abnormal Pap test results was seen after girls and women were given a human papillomavirus (HPV) vaccine to prevent cervical cancer, according to a researcher at the University of Alabama at Birmingham (UAB), Birmingham, Alabama.

These findings, presented on March 10 at the annual meeting of the Society of Gynecological Oncologists in Tampa, Florida, show the HPV vaccine (trade name Gardasil) appears to prevent the development of cell changes that lead to cervical disease. In testing, the vaccine reduced abnormal Pap test results by 43% compared with women not given the vaccine. The 43% reduction was for tests that found precancerous changes called high-grade squamous intraepithelial lesions (HSIL) more than 3 years after women were given the vaccine.

The HPV vaccine also reduced other abnormal Pap results, including milder premalignant cell changes, by 16% to 35% compared with women not given the vaccine. These findings are not definitive that the HPV vaccine prevents cancer; however, they do signal that the vaccine will spare thousands of women a diagnosis of cell abnormality or malignant changes that may lead to more tests and possibly surgery.

"Clearly the vaccine's benefits include something that can be appreciated by women and daughters fairly quickly," said Warner Huh, MD, Associate Professor, UAB Division of Gynecologic Oncology, and the physician chosen to present the data. "This is a positive first sign, and it will take many more years to know definitively if the vaccine prevents cancer."

The results are a compilation of 3 separate trials involving more than 18,000 women aged 16 to 26 years in the United States, Europe, and Asia. All test subjects had normal Pap smear readings at the start of the trial.

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Pap tests key to cervical cancer prevention

Natural Medicine: Pap tests key to cervical cancer prevention

Is it time for your annual exam? Annual pelvic exams are an important step toward reducing the chance of developing cervical cancer. Over the past 30 years, regular women's exams have significantly decreased the incidence of cervical cancer in many population groups studied in the United States.

Pap tests are one of the best cancer screening tests available, and one of the key reasons that annual exams are recommended by physicians. A Pap test uses a bristled tool to loosen the first layer of cells off the cervix in a procedure not often felt by the patient. A pathologist then examines these cells to determine the health of the cervix, and monitor any unusual cellular changes. Today, it is estimated that approximately 99 percent of changes caused to the cervix are due to the human papilloma virus (HPV). While these changes may take several years to progress to cancer, treatment is most effective and least invasive if the cellular changes are identified early. More >>

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DNA test could detect cervical cancer early: study

LONDON (Reuters) - A DNA test for the virus that causes cervical cancer helps detect potentially dangerous lesions earlier than the commonly used pap smear technique, Dutch researchers said on Thursday.

The test could mean fewer screenings for women and ensure that they receive earlier treatment for lesions that might lead to cancer, they said in the journal Lancet.

"It is a better test because you pick up more lesions," Chris Meijer, a pathologist at VU University Medical Centre in Amsterdam, said in a telephone interview. "And because you pick them up earlier, you have more time to treat the women."

In a pap smear, doctors scrape cells from the cervix and examine them under a microscope for abnormalities that could indicate precancerous lesions. The DNA test screens for evidence of infection by high-risk types of the human papillomavirus (HPV) that cause cervical cancer.

The Dutch study suggests the DNA test is better at indicating which women are at risk of precancerous lesions and should therefore have a biopsy, Meijer said.

"When you are HPV positive (in the test), the likelihood you have precancerous lesions is quite high," he said. "A (pap smear) is not sensitive enough to detect all the lesions."

Cervical cancer is caused by the HPV virus spread through sexual transmission and is the second most common type of cancer in women.

Merck and Co's. Gardasil and GlaxoSmithKline's Cervarix vaccines protect people against HPV infection. The tumors kill about 300,000 each year, mostly in developing countries. Continued...

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