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What
is a Pap Smear and Why is it Performed?
Cervical cancer screening began in the United States in
the late 1940s after Dr. George Papaniclaou developed the Pap smear. A Pap smear (also called a Pap test) is
a screening test used to examine cells from the cervix and the vagina. (The cervix is the
portion of the uterus that protrudes into the vagina). Cervical and vaginal cells are
studied to determine whether there is evidence of cancer or pre-cancerous changes. If
abnormal cells are found, they are classified according to their degree of abnormality.
Most abnormal Pap smears are caused by cervical infections or inflammation which can
usually be successfully treated before leading to cancer.
Abnormal Pap smear findings may
indicate:
- Infection (including the human
papillomavirus, HPV)
- Swelling or inflammation
- Pre-cancerous cell changes
- Cervical cancer
Pap smear is perceived by the medical
community as a reliable screening tool to help detect cervical cancer, along with regular
pelvic exams. However, Pap smears cannot typically detect other types of cancers, such as ovarian or uterine cancers, or sexually-transmitted diseases
(STD), with the exception of the human papillomavirus (HPV).
Who Should Receive a Pap Smear?
The American Cancer Society recommends
that all women begin receiving yearly Pap smears and pelvic examinations at age 18 or when
they become sexually active, whichever occurs earlier. Some physicians will not perform a
Pap smear each year if a woman has had three negative Pap smears in the course of three
years. However, a yearly pelvic exam should be continued even if Pap smears are not given
each year.
Regular or more frequent Pap smears may
be performed on women who have had hysterectomies (surgery to remove the uterus, including
the cervix), especially if the hysterectomy was performed because pre-cancerous and
cancerous cells were found in the cervix. In women who have had hysterectomies, the
tissues of the vagina are analyzed for changes that may indicate cancer.
In addition, women who have a weakened
immune system (from AIDS, chemotherapy or drug treatments, or organ transplants) are
considered at higher risk for cervical cancer and may require Pap smears more frequently
than once a year.
What are the Latest Statistics on Pap Smears and
Cervical Cancer?
Approximately 50 million Pap smears are
performed each year in the United States. The death rate from cervical cancer has declined
dramatically since 1955 (74% from 1955 to 1992) largely from the increased use of the Pap
smear. When detected early, the five-year survival rate for cervical cancer is
approximately 91%. If cervical cancer is detected before it has invaded any surrounding
tissues, the five-year survival rate is nearly 100%.
Even with the increased use of the Pap
smear, between 60% and 80% of American women who are newly diagnosed with cervical cancer
have not had a Pap smear within the last five years, if ever. According to recent studies,
elderly, African-American, and low-income women are the least likely to have annual Pap
smears.
The American Cancer Society estimates
that in 2001, 12,900 new cases of invasive cervical cancer will be diagnosed and
approximately 4,400 women will die from the disease. Researchers estimate that
non-invasive cervical cancer is nearly four times as likely as invasive cervical cancer.
What is the Human Papillomavirus (HPV)?
The human papillomavirus (HPV) is a
common sexually transmitted disease that affects both men and women. There are over 80 different strains of HPV, and
the most do not pose any health risks. However, some of the strains of HPV cause
genital warts in men and women and can cause cellular changes that may lead to cervical
cancer in women. A major risk factor for cervical cancer is the HPV. It is estimated that
one million new cases of HPV occur each year, and 20% to 40% of sexually active women have
HPV.
It is essential that all women over age
18 have annual Pap smears since the test accurately detects approximately 90% of all
cervical cancers. HPV is most commonly discovered by abnormal Pap smears results and is
most likely to spread when genital warts are visible. HPV does not typically interfere
with pregnancy or childbirth.
Research has shown that condoms do not
always prevent the spread of HPV because the virus can be transmitted by skin contact of
any HPV-infected area (such as the genitals). Limiting the number of sexual partners and
not having sexual intercourse with a person who has had several sexual partners can help
prevent HPV. There is currently no cure for HPV.
According to the American Cancer
Society, removing genital warts and abnormal cell growths caused by HPV can help reduce
the risk of cervical cancer from HPV. Treatments to remove genital warts include: laser
surgery, convention surgery, cold cautery (freezing the tissue), hot cautery (burning the
warts off with an electric instrument), or directly applying podophyllin or
trichloroacetic acid. In addition, the U.S. Food and Drug Administration (FDA) has
recently approved a drug called imiquimod cream to treat genital and perianal warts.
Click here to learn about HPV testing.
How Should a Woman Prepare for a Pap
Smear?
Women should not schedule a Pap smear
while they are menstruating because the presence of blood cells may interfere with the
test results. However, if a woman is experiencing abnormal vaginal bleeding, a Pap smear
may help determine the cause. Many physicians recommend not using douches, tampons, or
vaginal medications for at least 24 to 48 hours prior to having a Pap smear. According to
the American Cancer Society, the ideal time for a woman to have a Pap smear is five days
after her menstrual period has ended.
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