A Woman's Best Defense:
Pap Smear
 
 

Introduction Cervical Risk Factors Cervical Cancer Facts How a Pap is Done   What the Results Mean
 

Introduction
Cervical cancer is largely preventable. Yet according to the American Cancer Society, an estimated 12,200 new cases of invasive cervical cancer will be diagnosed in 2003 and about 4,100 women will die of the disease. The good news is that cervical cancer is preventable and curable if it is detected early; in fact, the number of deaths from cervical cancer has decreased significantly over the last 20 to 30 years. The main reason for this change is the increased use of the Pap test (also known as a Pap smear), a screening procedure that permits early diagnosis of cancerous changes. The death rate continues to decline by about two percent a year.

Cervical cancer rates are higher among older women; however, pre-cancerous cells (cervical neoplasia or CIN), the cells that are seen before actual cervical cancer starts, most often occur among young women. Screening women using the Pap test is an important exam that can prevent cervical cancer from developing most of the time.

Cervical cancer, also known as cancer of the cervix, affects cells located at the point where the uterus joins the vagina.

Cervical cancer risk factors
Anything that increases a person's chance of developing a disease is called a risk factor. Researchers believe that, in many cases, cervical cancer develops when two or more risk factors act together. Though the exact cause of cervical cancer is unknown, the following risk factors may increase the likelihood of developing cancer of the cervix:

  • Infection from the human papilloma virus (HPV) – The greatest risk factor for cervical cancer is having this sexually transmitted virus. It is more common in those who are under age 18 for their first encounter or if they have had numerous partners.
  • Age – The average age of women newly diagnosed with cervical cancer is between 50 and 55 years, though this cancer can appear in women as young as in their twenties. The risk of developing cervical cancer does not go down until a woman is 65-70.
  • Sexual behavior – Intercourse at an early age, having many sexual partners, and/or having unprotected sex at any age can increase the risk.
  • Smoking – Smoking exposes the body to many cancer-causing chemicals that affect more than the lungs. Women who smoke are twice as likely as nonsmokers to get cervical cancer.
  • HIV – Testing positive for the virus that causes Acquired Immunodeficiency Syndrome (AIDS) may allow a cervical precancer to develop into an invasive cancer faster than it normally would.
  • Nutrition – Diets low in fruits and vegetables are associated with an increased risk of cervical cancer and several other cancers.
  • Family history – Women whose mother or sisters have had cervical cancer are more likely to develop the disease themselves. Some researchers suspect this familial tendency is due to an inherited condition that makes some women less able to fight off HPV infection than others.
  • Diethylstilbestrol (DES) – DES is a hormonal drug that was prescribed between 1940 and 1971 for some women thought to be at increased risk for miscarriages. Of every 1,000 women whose mother took DES when pregnant with them, about one develops clear-cell adenocarcinoma of the vagina or cervix.
  • Low socioeconomic status – Women who do not have ready access to health care services, including Pap tests and treatment of precancerous cervical disease, are at an increased risk.

Cervical cancer facts

Cancer of the cervix can be discovered early with a Pap test and pelvic exam, done yearly beginning at age 18. Some researchers estimate that noninvasive cervical cancer (very early surface-only cancer) is about four times more common than invasive (more advanced) cervical cancer.

Precancerous changes of the cervix usually do not cause pain. Symptoms of invasive cervical cancer can include abnormal bleeding or vaginal discharge.

Only a few HPV virus types cause changes that become cancerous. A new kind of Pap smear (liquid) can give more accurate results and help eliminate false negatives.

What is a Pap Smear? How is it collected?
Pap smears consist of cells removed from the cervix which are specially prepared for microscopic examination. The cells are removed by a health care provider by brushing or scraping the cervix during a pelvic examination. The removed cells are evenly spread on one or more glass slides or are suspended in a special liquid. Each slide typically contains hundreds of thousands of cells.

All Pap smears are sent to an accredited laboratory to be stained, examined under a microscope, and interpreted. Pap smears are read by cytotechnologists and pathologists. Cytotechnologists are specially trained to identify cell abnormalities. They systematically inspect the entire Pap smear for abnormal cells. Any abnormality is marked for further evaluation by a pathologist who confirms the type of abnormality present. After your Pap smear has been carefully examined, the results are reported to your physician, who should notify you.

What the results mean
A "normal" smear means there are no detectable abnormalities or problems. An "abnormal" result means you and your physician must discuss some follow-up treatment. Some abnormal results are:

  1. The effects of microorganisms or viruses (possibly sexually transmitted diseases) may be seen on the smear.
  2. The cells may be changed in reaction to an infection or a similar type of injury. These reactive changes are temporary and benign - they do not indicate cancer.
  3. The cervical cells may exhibit changes that could be identified as "pre-cancerous" conditions. The recommended follow-up would probably be another Pap smear in three to six months or a colposcopy. This is examination of the cervix using an instrument with magnifying lenses. A biopsy of tissue may be taken for additional examination, and the area may be treated with electrical heat, laser or cryosurgery to destroy the problem tissues.

Sometimes it is not immediately possible to tell if suspicious-looking cells are a benign change (not cancer) or a pre-malignant change (recurring or possibly cancer). However, an abnormal Pap smear result alerts your physician that a medical problem may exist and that further evaluation is needed. Less often, Pap smears show malignant cells. The recommended follow-up may include colposcopy, several forms of biopsy, or more complicated surgery. Follow-up on all abnormal findings and compliance with expert advice are critical.

Parts of content Information from are from: The National Cervical Cancer Campaign,  http://www.cervicalcancercampaign.org/home.htm
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