Preserving fertility for women diagnosed with early stage cancers
Many women want to know
Because Every Woman Matters
For many women, the thought of getting a Pap smear can be quite a scary one. They face severe anxiety prior to a Pap test and surely many even cancel their scheduled Pap test appointments. Getting a Pap test may not be on your list of favorite activities to do, however, this 5 minutes procedure is the most essential and lifesaving test for women. The Right Information about Pap smear and its significance can help alleviate the fear of Pap smear and can help you move closer to adding a smear date to your calendar.
Cervical cancer is the number a leading cause of mortality in Indian Women. Early detection has better prognosis and outcome. However, there are several barriers to early detection of this disease in India. Poor knowledge about this disease and screening tests is one of the primary reasons for late presentation of the disease and resulting deaths. A survey revealed that at least 81% of women patients had poor knowledge about this disease. Also, there is some amount of social stigma surrounding this disease, as it is linked to sexual transmission through HPV virus. It is appalling that in contrast to western countries (68-84%) only 2.6-6.9% of women undergo pap test in India.
Pap smear test, first developed by Dr. Papanicolaou in 1943, has been one of the best screening tests for women. After the introduction of population-based screening programs using Pap smear test, it was observed that the annual incidence and prevalence of cervical cancer in many western countries decreased by 50-70%. One of the easiest ways to detect Cervical Cancer is through a Pap smear test. Women should be aware that clinical stage at presentation is a single most important variable in survival and prognosis. The later or more advanced the stage of the cancer is, the poorer the survival statistics is as indicated in Table 1. The five-year survival percentage decreases with increasing stage. Therefore, diagnosing cervical cancer in early stage gives the best chance for each woman.
What exactly happens during a Pap test?
During a Pap test, cervical cell sample is obtained from the cervix through the vagina. A special instrument called speculum is inserted into the vagina and samples are obtained by using a cotton swab a brush or a wooden stick. This is then sent to a lab to be studied under a microscope to detect abnormalities if any. This entire procedure takes less than 5 minutes. It is recommended that women have their pap test starting age 21 to 65 years. It is always a best practice for women to have an open talk with her doctor about when to start screening. Women above age 30 are often advised to start a HPV co-testing which includes testing for presence of HPV virus along with Pap test every 3 years. Besides detecting malignancies, a Pap test is also useful in noting cervical changes, inflammation, benign findings etc.
Understanding Pap Results: Understanding your test results is equally important as much as getting a Pap test done.
For women where HPV co-testing is recommended, results of HPV test and Pap test both are used to interpret the status as well as decide the future course of action. A Pap test result may be reported as either “Normal”, “Inconclusive” or “Abnormal”. It is important to discuss and understand the results, in order to decide if further evaluation, follow-up or treatment is required.
Normal Pap Test means no abnormal or cervical cancer cells were detected. Having a normal test result does not mean no follow-up screening is needed in future. The current guidelines recommend that a woman with normal Pap test will have to repeat the next Pap after 3 years.
Inconclusive Pap Test ( ASC-US: Atypical Squamous Cells of undetermined significance) means the cells do not appear normal in morphology, but do not show malignant characteristics either. In such cases, if a HPV co-test is positive, the Pap is asked to be repeated after 1 year. If a HPV co-testing is negative, then Pap may be repeated after 3 years. A colposcopy may be recommended if needed.
Abnormal Pap test indicates cytological changes induced by HPV. These changes can be low-grade or mild, moderate or severe. The latest classification divides the results based on cell type into squamous cell and glandular cell changes.
The low-grade lesions or the LSIL (Low grade squamous intraepithelial neoplasm) or CIN1 (Cervival Intraepithelial neoplasia) are abnormal cells that are mildly abnormal or that only one-third of the cells are abnormal (CIN1)
High-grade SIL (HSIL), CIN2, CIN3 are moderate to severe abnormal cells.
In the case of abnormal Pap test, a colposcopy may be additionally performed. In case if HSIL, CIN2, CIN3 immediate treatment may also be initiated. A colposcopy is a probe that helps look inside the cervix using a microscope.
Often this involves a biopsy to obtain sample of the cervix that may appear abnormal.
Because Every Woman Matters.....
Every woman should make a personal commitment to follow the recommended screening schedules and guidelines for Cervical Cancer Screening. All women in the age group of 21 to 65 must plan an annual visit for cervical examination, Pap test, HPV test as suitable. Warning signs of cervical cancer may include abnormal vaginal discharge and bleeding in between the periods, pain during sexual intercourse. Even if a Pap test is normal, but the appearance of these symptoms warrants a visit to the gynecologist. Adapting a healthy lifestyle is very important in maintaining a healthy immune system and preventing cervical cancer. Eating nutritious diet, cessation of smoking is very important. With a healthy immune system it is possible to fight-off HPV and prevent Cervical Cancer. Having HPV positive does not mean multiple sexual partners or a sign of promiscuity. It is common for sexually active people to acquire HPV in their lifetime and that it may be present long before it is detected. Women must not treat this as a tabooed subject and must be forthcoming in learning and educating themselves, to empower themselves and their daughters towards preventing Cervical Cancer.