In a country where studies have shown a significant predisposition for young Bahamian women to develop breast cancer, women old and young, with or without a family history of the disease, are keen to have their annual mammogram.
With so much attention being paid to breast cancer prevention, it is easy to forget an equally important test that no woman should miss -- an annual Pap smear.
A Pap smear should be routine on every woman's annual health checklist. But unfortunately many women wait years between tests or until a lingering problem arises, and this is the worst time to finally get checked out, say physicians.
Antoinette Simms (name changed), mid-40s said she has had her annual Pap smear done by her doctor for years, and is happy she did so. It was through her diligence in having her annual Pap smear that she said doctors discovered pre-cancerous cells in her cervix during her late 20s. She tackled the problem early by undergoing cryosurgery (application of extreme cold to destroy abnormal or diseased tissue); she saw her doctor every six months for two years following the surgery to ensure that the abnormal cells did not reappear or did not result in cervical cancer. She was given a clean bill of health and today has reverted to her once-a-year visits for her Pap smear. Looking back she's happy she was that diligent.
Dr. Patrick Whitfield, a general practitioner at Oxford Medical Center says Pap smears are an absolute must for women who are sexually active. He said that it is a real risk that women like Simms take by not having the annual exam, especially since problems that arise can be monitored early and dealt with if necessary, he said.
"A Pap smear, which is basically just a swabbing of the cervix to get a sample of the cell development, is simple, easy and virtually painless. For some women the test is uncomfortable, but it only lasts a few seconds. It is a very important test because its primary function is to uncover the presence and development of the Human Papilloma Virus (HPV), which can develop into cancer of the cervix, which is something people don't need to be dying from nowadays," said Dr. Whitfield.
HPV is considered a sexually transmitted infection (STI), as it is common in those sexually active and non-existent in those who are not, but for some people it is not as alarming as HIV or gonorrhea. Physicians say unlike HIV or gonorrhea, HPV and its future development into cancer can be detected years prior to it happening.
"Many women may feel afraid to get a Pap smear because of what they may find, but they really shouldn't be," said the doctor. "If you keep on top of your health in the early stages of an HPV infection you are more likely to never contract cancer since you can monitor it properly and treat it as you go along. The problem arises when you don't take this test regularly and wait until you do have a problem to see a physician. Unmonitored or untreated, HPV can lead to cancer and really damage your fertility levels if it spreads."
Betty Smith (name changed), 31, a mother of two had her first Pap smear done in six years. The last time she had a Pap smear she was pregnant with her first child. In her lifetime she has only had two Pap smears. She said it was not because she was afraid of what would be found, but that she had not been educated to the fact that she had to have the test done on an annual exam. When she had her second child, she said she was not given a Pap smear.
"Before I had my son I didn't know anything about a Pap smears. I may or may not have been told I needed to have it done once a year, but I didn't go because I didn't know I had to have it once a year," she said.
Just three weeks ago Smith had her second Pap smear. She was having medical issues and decided to have a physical (which is free of charge to her under her company's insurance plan and in which a free Pap smear is included) but which she just never did.
Smith said she wasn't scared to have the Pap smear done and it wasn't painful. She did say she was relieved when doctors gave her a clean bill of health. She plans to have her annual Pap smear from here on out.
"There is no need for women to be dying of this HPV illness in our country and in fact I have heard of very few, if any, cases in the last decade due to advancements in technology and vaccinations as well as more awareness of the test. Even so it is a mystery to me why so many women avoid getting [Pap smears] done when it is so easy and quick," said Dr. Whitfield.
Another myth that needs to be debunked is that one has to go to a specialist to get a Pap smear. Dr. Whitfield said that contrary to popular belief, a family physician or a general practitioner can perform the exam as long as there are no specific problems that a gynecologist may be more equipped to treat.
For Sandra Lewis [name changed], 23, getting her first Pap smear was both a relief and a nightmare. The college student said she put off getting her first Pap smear for a few months until a recurring health problem forced her to visit her physician.
"It was terrifying -- the thought of doing a Pap smear that is. I had a recurring yeast infection for which there was no known cause. Since it was more of an annoyance than something endangering, I didn't feel I needed the pap smear as urgently as my doctor recommended, due to my ongoing problem," said Lewis.
"It took a really bad outbreak to get me into my doctor's office first thing one Monday morning and I was terrified. Not so much of the outbreak but of the Pap smear, which I knew I would have to do right then and there. I admit it was very uncomfortable but the key is to relax, as my doctor kept telling me. As soon as I did that the exam was over before I knew it. Two weeks later I got favorable results that not only cleared me of HPV but also identified exactly what my recurring problem was. The test was more helpful and painless than I thought," she said.
Cancer of the cervix is not a common cause of death in Bahamian women because of access to regular Pap smear exams. However, it is a leading cause of death in women living in countries that do not have Pap smear programs.
"Unlike other STIs you can actually prevent getting certain strains of HPV. You don't have to wait until you are a certain age to do it either, once you become a teenager. Most investigators agree that routine immunization in females should begin at approximately age 12 years. Since the vaccine has been widely available only for a few years, catch-up vaccinations are currently recommended in previously unvaccinated females beginning at age 13 years and ranging to an upper limit of age 18-26 years. This vaccination can also be done for males, as there are studies that show they can suffer from ailments due to HPV as well," said Dr. Whitfield.
Even with a vaccination a routine Pap smear is still required as there are many strains of HPV, Dr. Whitfield warns.
Although major tests like Pap smears were previously reserved for older women, it is now recommended that within a year of a young woman becoming sexually active she should get her first Pap smear. This is especially true as risk factors for contracting HPV increase due to more women having sex at a young age, having multiple sexual partners, having a promiscuous male partner and history of sexually transmitted diseases.
"You should also be wary of contracting HPV because it is also associated with other health issues, such as anal cancer, genital warts as well as common skin warts of the hands and feet. Many times HPV doesn't prove to be harmful to many women, but a small percentage do develop complications such as aggressive cancers in the reproductive region or other parts of the body. We don't want women to take a chance with their lives since this is very preventable and very treatable," said Dr. Whitfield.

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