By David W. Feld, MD, Jupiter Obgyn –
Cervical cancer is a dreaded, but largely preventable disease. Unfortunately, in the coming year, it is estimated between 11,000 and 12,000 American women will be diagnosed with it and nearly 4,000 will succumb from an advanced form of the disease. What can be done about this, and how can we increase the odds for early diagnosis and treatment?
As we enter the new year, many of us will be making amends. As family and neighbors make resolutions to quit smoking, exercise more, eat healthier, and the like, why not commit to something a little off the beaten path? This month, take some time out of your busy schedule and do something for yourself, your children, your partner– ensure your gynecological health with a full exam and a Pap test. There is no better time to do this, as January is Cervical Health Awareness Month.
The Pap test was developed by and named after the prominent Greek physician Dr. Georgios Papanicolaou , around 1928, after experimentation on his own wife. While the technology has been updated and it is a much more accurate test than ever before, the basic technique remains the same.
The collection of the specimen is painless and simple when done by your obstetrician/gynecologist. A speculum is inserted into the vaginal canal and it is opened slightly to allow collection of live cells from the cervix. There are two parts to the collection, as the cervix contains two areas that need to be sampled– the exocervix(or outer surface), and the endocervix(the internal canal). The exocervix is made up of “squamous” or flat cells, while the endocervix has “columnar” or tall cells. As important as it is to get the Pap test done on a regular basis, it’s imperative that you get the result! That is to say, you should be notified either by a phone call or a letter, within 2 weeks of the exam. Furthermore, should there be an abnormality, learn about what it means, and what you can do about it. No news isn’t good news, so be proactive when it comes to your health.
Women must continue to have regular gynecological exams throughout their lives. The first Pap sampling should be done by age 21, or sooner if you are sexually active. I encourage my teenaged patients to have a consultation regarding sexual activity, menstrual issues, contraception, sexually-transmitted diseases(STDs) and the like, before they become sexually active. This helps to educate and reduce the risk of unwanted pregnancies and STDs. It’s not unusual to find abnormal Pap results in patients who say they’ve never had intercourse, so doctors must take the time and ask questions and wait for the answers look for subtle clues. Once an exam is done, followup care is key. Cervical cancer is usually slow to develop, and half of the women diagnosed with cancer of the cervix are between the ages of 35 to 55 years of age. Almost 20 percent are diagnosed when they over 65 years old. The frequency with which the Pap is performed depends upon multiple factors, especially if there has been an abnormality in the past. The American College of Obstetrics and Gynecology recently set new guidelines for Pap frequency in the general population. These recommendations vary between 3 to 5 years apart, but don’t apply to high-risk populations. You should ask your own physician what’s applicable for you. In general, I see the average patient yearly, and if they have had a recent abnormal report with subsequent treatment, I would plan to repeat the Pap every 6 months, for at least a year.
HPV is epidemic, with carriage of HPV DNA on many studies as high as 60% in woman and 50% in men. The lifetime cumulative risk is at least 80%, but fortunately, in younger woman especially, the duration of HPV positivity is shorter, and the likelihood of spontaneous clearance is higher.
HPV is not new, it’s been around since time immemorial. However, with research and new diagnostic techniques, we can now better understand its significance and relationship to other illnesses, especially cancer of the cervix and other organs. More than 40 types of HPV are typically transmitted through sexually contact, but most do not cause disease. However, 5% to 10% of infected woman, as evidenced by Pap smear, are at risk for developing precancerous and invasive lesions. While specific treatment is beyond the scope of this article, the take-home message is that Pap smears save lives, so be vigilant.
Cervical cancer is an absolutely preventable disease. You should discuss this with your obstetrician/
gynecologist, and stay informed with the latest news on prevention and screening. Informed consent should be part of the sexual experience, and it starts with a dialogue with any sexual partner, and liberal condom use. It is much better to prevent and avoid infection, than to treat it. These are just simple, basic steps to reduce the risk of developing cervical cancer. It’s all about education and about making the right choices.
David W. Feld, MD
210 Jupiter Lakes Blvd, Suite 101
Jupiter, FL 33458