Regular Pap Smears: A Matter Of Life And Death

Pap smear—the term alone is enough to make a woman cringe, isn’t it? While they’re not painful they certainly can be a little uncomfortable and awkward. But is that worth putting them off? After this article you will know once and for all why it’s never okay to put off a pap smear.

What And Why?

A Pap smear, for those who don’t know, is a gynecological exam in which a doctor will use a speculum to open up the vaginal canal for a look at the cervix. Swabs are then used to take samples of the cervix to check for abnormalities and changes that could indicate infection and cancer. During a pap test some doctors also opt to take a swab to test for HPV (Human Papillomavirus) which is a very common STD that is behind 90 percent of cervical cancer cases. Pap smears are recommended for all women who are sexually active and women over the age of 18. (Some say 17 and others say 21).

As said before, a pap smear doesn’t hurt but being in that somewhat awkward position can be a tad uncomfortable and even embarrassing. This little bit of discomfort has led women to put off scheduling their Pap smears or avoiding them all together, but this can prove a very costly mistake.

It’s All In The Timing

Before you put off your next Pap smear you need to understand what putting it off can actually mean for your health and for your life. It’s easy to erase the Pap appointment from your calendar or to play the out-of-sight-out-of-mind game, but that won’t erase the reality which is that you’re putting your life at risk.

Pap smears more than anything else are a cancer screening tool. As with all cancers, the earlier you can find cervical or vaginal cancer the better. The Pap test can detect pre-cancerous changes which give you the chance to stop an otherwise inevitable cancer and save your life. The precancerous changes I am referring to is dysplasia which can range from mild to serious. The next step is cervical cancer. Dysplasia is cell changes that can lead to cancer if left untreated. So the sooner you detect these changes the sooner you can get the treatment, preventing the growth of cancerous cells.

A Silent Killer

Many women are under the gross misconception that they would know if something was wrong with them and especially something as serious as cervical cancer. It’s that kind of thinking that will get you killed because cervical cancer, just like many other gynecological cancers, will not cause symptoms until the cancer is in its advanced stages.

A lesson for you: dysplasia produces absolutely no symptoms. Cervical cancer may in some women cause mild bleeding or pain during or after intercourse, or a foul smelling discharge, but for the most part it can get to its advanced stages silently. And I don’t need to tell you that it is often a death sentence when cancer gets to its advanced stages. The saddest part of this is also the most promising: cervical cancer can be prevented if only women realize the importance of regular Pap smears.

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I think it's shocking that women don't get honest information about cervical cancer or screening - just alarmist articles that exaggerate and scare women. The fact is cervical cancer is rare and was in natural decline before screening started - it affected just 15 women in 100,000 before screening started in Australia. There are no randomized controlled trials for pap testing, so we'll never know for sure whether anyone is helped, but if they are the numbers are very small. In Australia 0.65% is the lifetime risk of cervical cancer (so thyroid cancer is more common) and after you take out false negative cases and consider the impact of other factors that are having an impact on incidence rates - fewer than 0.45% could be helped with this test. (other factors: hysterectomies, better condoms and hygiene, fewer women smoking and less STD) The hidden downside: the test is unreliable and produces lots of false positives - 77% is the lifetime risk of referral after an "abnormal" pap test in Australia - (DeMay puts the referral rate for the States at 95% lifetime risk due to over-screening and inappropriate screening) - that usually means a colposcopy and some sort of biopsy. Almost all are false positives and these biopsies and over-treatment can damage the cervix and cause issues - cervical stenosis, cervical incompetence - infertility, miscarriages, high risk pregnancies, premature babies, more c-sections and psych issues. Women under 30 don't benefit from pap tests, but have the highest risk for false positives. Many countries protect young women and don't offer testing until women are 30. Also, at 30 it seems women could simply have a HPV test and if negative for high risk HPV and in a monogamous relationship (or no longer sexually active) could forget testing - she could revisit the subject if her risk profile changes in the future. It seems these women are only tested to cover the possibility of her risk profile changing and screening is about populations, not individuals. (see article by Davy and Shorne) Women are having far too many pap tests and that risks their health - Finland has the lowest rates of cc in the world and sends the fewest women for biopsies - they offer 5 yearly testing from age 30 to 60.(5 to 7 in total) Some low risk women need to be very careful with testing - they accept risk with this test for no benefit - women who've had full hysterectomies for benign conditions, virgins, women in lifetime mutually monogamous relationships etc As a low risk woman, my risk of this rare cancer is near zero, the risks were too high for me - I have always declined pap testing. I understand American doctors will refuse women the Pill without pap testing - that is coercion IMO, and women should never allow it - make a formal complaint. Cancer screening has nothing to do with birth control and denying a woman BC can have very serious consequences - far greater than a woman declining an unreliable screening test for a rare cancer. No medical groups recommend pap tests for BC. Also, routine pelvic and breast exams are not recommended for asymptomatic women, they are of poor clinical value and risk your health. There is more honesty appearing these days, but articles that oversell pap tests don't help - women are entitled to the truth and to make the best decision of their level of risk - we're all entitled to protect ourselves from harm. See" Cervical cancer screening" in "Australian Doctor" July 2006 by Assoc Prof Margaret Davy and Dr Shorne. (re: women under 30 don't benefit from testing and re: HPV testing) Dr Robert Hatcher - google his name plus pelvic exams and birth control to find his article. A blood pressure test and your medical history are clinical requirements for the Pill. "Questioning the value of the routine pelvic exam" by your Dr Carolyn Westhoff "Women after birth control get unneeded pelvic exams" WSJ (both online) Dr Richard DeMay, "Should we abandon pap smear testing" (on line) Dr Joel Sherman's medical privacy blog under women's privacy issues - in the side bar, see research by Dr Angela Raffle from the BMJ, "1000 women need regular smears for 35 years to save one woman from cervical cancer"...Commentary: "Why I'll never have another smear test" by Anna Saybourn in the "Guardian" - online
10 years ago