Back in August, I wrote about men’s health. This time it’s the women’s turn. If you’re not a woman, read anyway; you probably know one or two of them and you can pass this important information on to them.
So, who’s this Dr. Papanicolau, anyway? In 1928, George Papanicolau invented a system of collecting cells from a woman’s cervix (the opening to the uterus) to detect cancer, but it didn’t become a commonly performed practice until the 1950s. This procedure became known as the Pap Smear - Pap is easier to say than Papanicolau and the cells are smeared onto a glass slide. A specially-trained physician called a pathologist looks at the cells under a microscope to determine if any of them are abnormal.
Why is it important to do? Sometimes all the cells are normal, but sometimes there are cells that are not exactly normal but not exactly abnormal. They are considered of “undetermined significance”. Sometimes there are cells that are clearly abnormal and indicate cancer. Of course, the earlier the abnormal cells are detected, the earlier treatment can begin and the greater the potential for complete cure. In fact, with early detection, 97% of cervical cancers can be cured. Waiting allows more cancer cells to grow, not only invading the cervix but sometimes extending into the uterus, bladder and other parts of the body. If the Pap Smear result is one of “undetermined significance”, the test is usually repeated. If the Pap Smear is clearly abnormal, then your health care provider will inform you of your treatment options and should help you decide on one. Often other tests are done at the same time to determine if there are infections present.
Who needs a Pap Smear? All women who are now or who have been sexually active should begin to make the Pap Smear a part of their routine annual physical. Women who are not sexually active should begin at age 18. The reason sexual activity is a consideration here is because the major cause of cervical cancer is a virus (human papilloma virus, or HPV) which is mostly transmitted through sexual activity. The virus may not show up right away, which is yet another reason to continue having screenings done annually, just in case it shows up later.
There are a couple of different ways a Pap Smear can be done. The traditional way involves a little wooden paddle and a brush. This is where the dreaded speculum, that instrument that looks like a duck bill and allows the provider to see the cervix, comes in. It’s only uncomfortable if you don’t relax. Easy for me to say, you’re thinking. If you can relax, the whole thing is a lot less traumatic. I promise! The cells are then scraped off the outside of the cervix. Next, the little brush goes into the opening of the cervix and is turned around inside to get some more cells. This may cause a small amount of bleeding after the procedure - very common and nothing to worry about. The cells are transferred to a glass slide and sprayed with a liquid that fixes them to the glass (that’s that little pffft! sound you hear). It gets packed up and sent off to the lab and in a few days or weeks you have your result. The other option is more expensive but is a newer way of collecting the cells. The procedure is similar but makes for a better, more easily interpreted specimen.
Be sure to ask your health care provider how you should prepare to have the best Pap Smear possible with the most accurate result. If you haven‘t prepared well, the result may be abnormal or of “undetermined significance” and you’ll have to go through the hassle of repeating it and worrying about it again. If it’s done without any interference the first time, you can have more peace of mind. It’s a good idea to ask your health care provider about which type of Pap he/she does and if you have the option to do one or the other. Not all insurance providers will pay for the newer type, but it is more accurate, so you may want to pay extra for it.
If a woman is found to have an abnormal Pap Smear, the next step is to do a biopsy of the cervix. A biopsy is a procedure in which little pieces of tissue are taken out and sent to a lab where a pathologist can determine the type of cancer and the extent of invasion. When discovered early, a non-invasive cancer can often be cured with a treatment called cryotherapy - cryo mean freezing. The area is frozen, which kills the cancerous tissue. This is generally done right in the doctor’s office. The biopsy sounds worse than it is. The cervix doesn’t perceive pain, only pressure, although some cramping may occur. There are other procedures that may be done on an ambulatory basis, or same day surgery, without spending time in the hospital. The more extensive the cancer, the more extensive the surgery. In some cases, a hysterectomy (removal of the uterus) may be required. This is particularly devastating for women who plan to have children. If you are finished having children or are menopausal, beware of the physician who says, “You don’t need that thing (your uterus) anyway,” and just wants to do a hysterectomy as long as he/she’s in there. Not a good basis for medical decision making. This is where you might want to get another opinion and/or read up on the subject online.
Many women put off having a Pap Smear because it can be embarrassing and uncomfortable. The important thing to remember is that, one way or another, you will have to deal with any bad news. It’s better to deal with it early on when there are more options. And if the news is good, congratulations! The doctor will say, “See you next year.”
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