The Importance of a Pap Smear

Tue, Aug 30th 2011, 11:54 AM

In a country where a recent study shows 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 check list.  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.

Deidra Kemp, 35, is finally heading to a gynecologist in a few weeks for her first pap smear in eight years.  The mother of two says after going through one too many invasive tests while pregnant with her last son she felt she had had enough of doctor visits and her privacy being violated.

"I swore to myself that I would never go to see a doctor again in that capacity after the torture I went through to have my last son.  He is now eight and I probably wouldn't even be entertaining going to do a pap smear now if it wasn't for my sisters.  They are a lot better about doing these tests than I am and surprisingly they both found out they were rapidly developing [benign] growths in their wombs even though they regularly did check-ups.  Apparently our mother who died when we were very young had the same problem in her 30s as well.  So I am really worried and will be heading to see a doctor as soon as I can."

Dr. Patrick Whitfield, a general practitioner at Oxford Medical Center says pap smears are an absolute must for women who are sexually active.  It is a real risk that women like Kemp take by not having the 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 it's uncomfortable but it only lasts a few seconds.  This 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."

While research shows the HPV is considered a sexually transmitted infection (STI) as it is common in those sexually active and non-existent in those who are not, it is not as alarming as HIV or gonorrhea.  Physicians say unlike these illnesses HPV can often vanish on its own and 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," Dr Whitfield says.  "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 have a problem to see a physician.  Unmonitored or untreated HPV can lead to cancer and really damage your fertility levels if it spreads.

"There is no need for women to be dying of this 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 it done when it is so easy and quick."

Another myth that needs to be debunked is that one has to go to a specialist to get a pap smear.  Dr Whitfield says 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 23-year-old Anna Gibson [name changed] getting her first pap smear was both a relief and nightmare.  The college student says 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," says Anna.

"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, 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 which not only cleared me of HPV but also identified exactly what my recurring problem was. This test was more helpful and painless than I thought."

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," says 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," says Dr Whitfield. "We don't want women to take a chance with their lives since this is very preventable and very treatable."

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