Cervical Cancer and the Pap Test
Cervical cancer is the most common form of cancer among women in India. Almost one third of all cancers seen in women in India are cervical cancers. 2-3% of all women over the age of 40 will develop some form of cervical cancer. Although the average age at diagnosis is 45, cases at 20-30 years have been noted.
Who is at risk?
Women who were married at an early age.
Women who have had multiple pregnancies.
Women with a history of having sexually transmitted disease.
Women who have multiple sexual partners.
Women whose partners have had multiple sexual partners or who have had sexually
Women from low socioeconomic status (due to poor hygiene).
Women undergoing treatment involving suppression of the immune system from steroids, other diseases or HIV Symptoms Abnormal vaginal bleeding between periods, after intercourse or after menopause Persistent white, brown or blood stained, foul smelling vaginal discharge
Loss of appetite
Unexplained weight loss
Involuntary loss of urine or fecal matter
The cervix is the neck of the uterus, which protrudes into the vagina providing a canal between the two. Malignant cell changes in the cervix usually take many years to develop. Now, treatment for cervical cancer requires minimal surgery if caught early, leaving fertility intact. If the disease is advanced, a total hysterectomy, removal of the uterus and cervix is needed making it impossible to have children. Fortunately, cervical cancer is easily detected with a Pap smear test. The test is named after the Greek American doctor, George Papanicolaou, who invented it. During a pelvic examination, the doctor first examines the vagina. Then with the blunt tip of a depression stick or a cotton swab, two or three sample scrapings are taken, one from the outer cuff of the cervix, one from the area just inside the cervical canal and a possible third from the vaginal wall. The cells are smeared onto a slide and sent to a laboratory for microscopic examination to reveal precancerous changes, called dysplasia. Slides are classified as follows:
Class I Negative, normal smear with no abnormal cells.
Class II Early dysplasia, slightly atypical. This includes all minor cell changes including inflammation and infection.
Class III Suspicious, mild to moderate dysplasia, cancer precursor, cervical intraepithelial neoplasia (CIN). These are then rated as CIN 1 or 2 according to the proportion of abnormal cells present as well as the degree of change.
They may or may not be precancerous.
Class IV Highly suspicious, severe dysplasia. CIN 3, carcinoma in-situ (cancer of the surface of the cervix).
Cannot definitely be called positive for cancer, may or may not be malignant.
Class V Positive for cancer, suggests need for further diagnostic testing.
As is evident from the above classification, an abnormal slide does not necessarily mean cancer. Quite a few women do have mild, moderate and even severe dysplasia but don't develop cancer because the condition is successfully treated. This may take the form of treatment of an infection with antibiotics. Further diagnosis may be indicated by looking for lesions and tissue biopsy, followed by removal of the lesion if necessary.
The whole procedure is quick and painless and provides the best protection against advanced cervical cancer. Studies show that the test reveals abnormal cell changes as much as eight years before a full fledged cancer develops. The test can detect 90% of potential cancers early enough to ensure a 100% cure.
In the West, death rate from cancer of the cervix and uterus has dropped more than 70% since the 1940s when the test was first introduced. The Pap test is the most widely used and effective tool available to doctors for cancer prevention, but it can only be effective if it is given a chance to be used. In India the full potential of the test is yet to be realized since women do not get themselves screened every year. Most women do not think it necessary to visit a gynecologist on a regular basis.
For women over 40, the visit becomes even less frequent. In a survey done by CARF, it was found that most women have last visited their gynecologist when they were last pregnant. This is one reason why older women fall victim to cervical cancer.
Pap tests are recommended every year for all healthy women over the age of 20 and those under 20 who are sexually active. Note: A Pap smear does not always detect cancer of the endometrium (wall of the uterus) and ovaries. Always consult a doctor about any abnormal bleeding or pain.