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Pap test is an important cancer screening toolBy Byron Gatlin, M.D., F.A.C.O.G.Many women would say they do not particularly welcome their annual physical exam, which includes a Pap smear, and indeed some women decide not to undergo this essential test. But the fact is that the test, which is covered by insurance, is one of the most important cancer screening opportunities available. The goal of a Pap smear, which was developed in the 1940s by Dr. George Papanicolaou, is to identify pre-cancerous conditions or abnormalities of the cervix before cancer actually develops because treating a precancerous lesion of the cervix is much easier than treating cancer. Within the United States, cervical cancer is the tenth most common cancer, with 13,000 new cases diagnosed and about 4,500 deaths reported annually. World-wide, cervical cancer is the second most common cancer in women and the fifth most fatal cancer. The cervix, which is the opening to the uterus and allows for the flow of menstrual blood, conception and serves as the exit point for delivery of babies, is made of two important types of cells, called glandular and squamous. Glandular cells line the uterus and the inside of the cervix and the squamous cells line the vagina and the outside of the cervix. They meet in an area called the transformational zone. In the transformational zone cells are rapidly shed and reproduced and it is in this area where most cervical pre-cancers and cancers begin. When physicians perform the test, cells are collected from the transformational zone and the lower part of the cervical canal. The exam requires the physician to place a speculum inside the vagina to visualize the cervix and then rotate a brush, which looks like a pointed comb, in the cervical opening. The brush is mixed with a fluid preservative and the cells are placed on a slide for examination under a microscope. The examiner determines if the cells are normal or abnormal, also called dysplastic. If they appear abnormal, they are graded on the appearance of certain cellular characteristics and classified as mild, moderate or severely dysplastic or cancerous. Women who are at high-risk for cervical abnormalities include those have had three or more sexual partners or those whose partner has had three or more sexual partners. Women who begin sexual activities at an early age and women who have contracted other sexually transmitted diseases, such as herpes, Chlamydia or gonorrhea are also at risk. Women with weakened immune systems, such as transplant or HIV patients are more likely to develop cervical abnormalities, as are those who smoke or drink. Almost all of the precancerous or cancerous lesions found on the cervix are caused by the human papilloma virus, or HPV. There are more than 100 different strains of HPV and the virus is spread during physical and sexual contact. Some studies indicate that between 50 to 75 percent of men and women who have ever been sexually active could test positive for HPV DNA at some point in their lifetime. Fortunately, only about 20 of the hundred plus HPV strains actually lead to precancerous and cancerous changes. These types are called high risk. Unfortunately, if Pap smears are not routinely performed, these high-risk infections can remain undetected and develop into advanced cervical abnormalities or cancers. If abnormal cells are detected, the physician will call the patient and inform her of the need for a colposcopy, which involves examining the cervix using a large magnifying glass with a light source. Certain solutions might be placed on the cervix to determine where the abnormal cells are located or a biopsy could be performed for a more complete evaluation of the abnormality. Sometimes, Pap smears show atypical cells, which are not completely normal, but not abnormal enough to be called dysplastic. These specimens are tested for high and low risk HPV strains. If the cells test positive, a colpsocopy is recommended. If they test negative, then routine annual Pap smears are advised. Because Pap smears have been shown to be effective in reducing the incidence of cervical cancer, women should begin getting annual Pap smears within three years of starting sexual activity or when she turns 21 and continue receiving the exam until the age of 70. Some physicians may increase the testing interval to two to three years if a patient has had three normal pap smears in a row and does not have any other risk factors. Women who’ve had a hysterectomy with the removal of the cervix might not have to have Pap smears as long as there are no risk factors, does not change her sexual partner and discusses the matter with her physician. |
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New Ulm Medical Center
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