A test no woman should skip

Mon, Oct 12th 2015, 12:49 PM

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 -- a procedure to test for cervical cancer in women -- should be routine on every woman's annual health checklist, but unfortunately many women wait years between tests or until a lingering problem arises, which is the worst time to finally get checked out, according to physicians.

Antoinette Simms (name changed) 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, undergoing cryosurgery (application of extreme cold to destroy abnormal or diseased tissue), 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 back to her once-a-year visits for her Pap smear. Looking back she says she's happy she was that diligent.

Detecting cervical cancer early with a Pap smear gives women a greater chance at a cure. Pap smears detect changes in the cervical cells that suggest cancer may develop in the future. Detecting the abnormal cells early with a Pap smear is the first step in halting the possible development of cervical cancer.

Dr. Patrick Whitfield, a general practitioner at Chesapeake Comprehensive Centre says Pap smears are an absolute must for women who are sexually active. He said women take a real risk by not having the annual exam, especially as problems that arise as a result of having done the test, 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. But 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," 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 possible 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. 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 [pap smears] done when it is so easy and quick," said the general practitioner.

Another myth that needs to be debunked is that one has to go to a specialist to have 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 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," 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 less 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 have a Pap smear done either, once you become a teenager you can have a Pap smear. 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 to 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 warned.

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 have her first Pap smear done. 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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