PAP Smears Essential for Cervical Health
by Kay Rios
Thanks to diligent women who get their yearly Pap smears, cervical cancer rates have dropped dramatically over the past four decades.
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Before Pap screens, “carcinoma of the cervix was the number one killer of women in the U.S.,” says Arlene Libby, M.D. and medical director for cytology services and breast pathology at Summit Pathology. “Now that’s not true, but in countries where they don’t have Pap smears, it’s still number one.”
In fact, the National Cervical Cancer Coalition reports that worldwide 473,000 women are diagnosed each year, with 85 percent of the cases occurring in developing countries. Currently in the U.S., about 10,000 women are diagnosed with cervical cancer each year. That number was considerably higher in the 50s but, with the increased use of the Pap test, the death rate declined by 74 percent.
Findings of a study published in the New England Journal of Medicine reaffirmed that fewer and fewer American women are diagnosed with cervical cancer every year because of the use of the Pap test, and newer screening tools and treatments continue to reduce incidences. But any test is only good if it is used and, the study said, most women who got the disease had either never had a Pap smear or had not taken one for five years.
The Agency for Healthcare Research and Quality (AHRQ) reports that, in 2005, almost 13 million women age 18 to 64 had not received the Pap test within the last three years. Insurance, education, and ethnicity all played a role in that decision, according to AHRQ’s study. Twenty-five percent of uninsured women failed to receive a Pap test within three years. Asian women were less likely to have consented to the test than other ethnic groups. Lesser-educated women registered higher numbers of those not receiving the test. Twice the number of single women had not received a Pap smear, compared with those who were married.
It’s important to get a Pap test, says Jacqueline Fields, M.D. and founder of Healing Gardens. “Cervical cancer is extremely treatable, but we need to know what is happening in the cervix to be able to treat any abnormalities.”
She adds that, “Within one year of being sexually active or beginning at age 21, women need to have a Pap smear. Once people are married and monogamous, and they have had normal Pap smears, they can have their Pap smear every two years.”
Having a yearly test is usually recommended until age 30. After that, the human Papillomavirus (HPV) test is usually given at the same time. If the HPV test is negative and the Pap smear is normal, the test may be skipped for up to three years, Dr. Libby says.
“That approach isn’t really used on a widespread basis,” she says. “One reason is that doctors are afraid the patients will not come in for the rest of the exam. They still need to come in for a breast checkup and have their ovaries checked and, if not for the Pap smear requirement, the rest of the exam may not happen.”
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The Pap smear, says Fields, looks for abnormal cells in the cervix. “We have a higher risk for having abnormal cells at the cervical junction, where one cell type tranforms to another. In a Pap, you swab that junction zone and then look at the cells under a microscope. Are they normal or not?”
The majority of abnormal results come from HPV, she says. “There are 60 strains of HPV, but only a handful of them are associated with cervical cancer and that’s what we are concerned about. The idea is to find this before cancer evolves.”
The cells taken in the exam are sent to a pathology group such as Summit Pathology. Summit is an independent group of doctors that work out of North Colorado Medical Center, Medical Center of the Rockies, Poudre Valley Hospital, McKee Medical Center, East Morgan County Hospital, and Estes Park Medical Center. At those sites, pathologists review the matter sent to them and provide the analysis.
Dr. Libby says that cells from the Pap smear were previously looked at on a slide. The newer method is to place them in a solution where they are easier to view. There are less false positives and less false negatives with this procedure than in the past. “The change to liquid occurred about 10 years ago and has increased the reliability of the test,” Dr. Libby says.
“The main thing we look for is a preneoplastic condition (dysplasia) that is a condition prior to cancer. That is the beauty of the Pap. Cervical carcinoma has a long phase that we can detect in its early stages. A woman’s cells can be infected by HPV and, depending on the type of HPV and the woman’s immune response to that virus, it can either disappear or progress over a period of years. So we want to catch it at the preneoplastic stage,” she says.
About seven years ago, the HPV test was developed and its use along with the conventional Pap has become more common in the past five years. “There are still clinics that just do the basic tests with a conventional Pap on a slide. That’s primarily in indigent clinics because it’s less expensive.”
But the point remains: Pap smears are essential in reducing incidence rates. “Cervical cancer is very treatable but, again, you have to come in to have your screening,” Fields says. “I’ve never had anyone die of cervical cancer but that’s because I have very diligent patients. And I think the game is always prevention. Information is never the enemy.” +
What Every Woman Should Know about HPV:
- HPV is a very common virus, like chicken pox
- Certain types of HPV are the primary cause of cervical cancer
- Up to 8 out of every 10 women get HPV by age 50
- Regular screenings can protect you from HPV
Kay Rios, Ph.D., is a freelance writer in Fort Collins. She writes for a variety of publications and is currently at work on a collection of creative non-fiction and a mystery novel.