The Test That Women Does Do

Symbolic of the poor state of cervical cancer, this ribbon is made of a burst rubber band on a backdrop of a cheap paper towel!

Cancer of the cervix begins with great benevolence.

It gives us a chance to spot it long before it becomes a fully-fledged cancer.

Yet until the Pap smear becomes a routine part of our lives we are giving our chance at derailing cervical cancer early a slap in the face.

Too many of us just aren’t sure what a Pap smear is.

One perky, young UWI graduate, teaching at an all girls secondary school asked me if the Pap smear had something to do with her ovaries!

Another well-spoken woman, already at least 40, couldn’t remember the words ‘Pap smear.’ She referred to “The Test That Women Does Do,” specifically “the one” that Family Planning people do at health events.

Very simply, the Pap smear simply scrapes some cells off the cervix surface. (alliteration not intended!) In layman’s terms the cervix is known as ‘the neck of the womb’. This part of the womb is easily accessed as it hangs into the vagina – so the nurse or doctor can both reach and see it once the vaginal passage is held open with a speculum under good lighting.

(A speculum is a simple flattish but rounded instrument smaller in diameter than an erect penis. For the Pap smear it’s lubricated with gel and at this point I emphasize that the speculum’s only crime is that it is often a bit cold! The dread it conjures in ladies’ minds is most unjustified!)

The cells scraped off for testing are then fixed on a slide and sent for microscopic evaluation by a cytologist or pathologist.

Though cancer cells, infections and even the presence of the human papilloma virus may be indicated when the test report is prepared, these are not the reasons you go for a Pap smear.

You go because cervical cancer develops slowly enough to be caught and arrested while the cells are still transitioning through varying degrees of dysplasia. Dysplastic cells are abnormal cells which don’t yet have the full characteristics or behavior of cancer cells.

Women who postpone their Pap smears indefinitely or who choose to believe that going every five years is okay, run the risk of missing the window of opportunity to arrest transitioning cells, long before they become frankly cancerous.

The nurse or GP will typically refer abnormal Pap smear results to a gynaecologist.

In these earlier stages, the gynaecologist advises on the right protocol for your case often based on a further more sensitive test: colposcopy.

Some mild changes that a Pap smear might reveal, especially with younger women and teenagers, are often self-reversing and need only be monitored, but always ensure that your gynaecologist gives you clear follow up advice and answers all your questions.

So now you’re saying, “Oh thank God! If I go for regular Pap smears the chance of treating and removing any unwelcome changes very early is much higher!”

So how regularly should you go? Recent US guidelines suggest that all sexually active women over 21 should have Pap smears. How often? Some practitioners will say for women under 30 every two years is enough. Others prefer that you get tested every year till you have a record of three normal consecutive smears, after which testing frequency will depend on your individualized risk.

The professional advice given considers risk factors such as chlamydia infection, the presence of HPV virus, cigarette smoking and having several partners.

Especially if you are under 30 though, the possibility of cancer seems so remote and distant that it’s easy to procrastinate and make excuses.

Remember, cancer does not happen overnight. While most women with cervical cancer are not under 30, the early changes that lead to closer evaluation and life saving removal of dyspastic tissue can be found in women still in their 20’s and early 30’s.

The risk of cancerous changes in the cervix are higher for women who smoke cigarettes, started sexual activity very young or had many partners.

But all women who are sexually active (or used to be) should reduce their risk by having routine Pap smears.

So no matter how monogamous or inexperienced you’ve been, take the precautions. Don’t equate lower risk with zero risk!

One way to overcome any fear and awkwardness is to go with a girlfriend or relative who had a positive Pap smear experience.

Once you’re relaxed and your practitioner has the basic skill required, a Pap smear is at worst, mildly uncomfortable.

On the other hand, if your practitioner is rough, rude or just makes you uncomfortable then you need to get some advice from your girlfriends about who else you can go to.

You have the right to keep a trusted friend, relative or female nurse present for your Pap smear.

If your local health centre does not offer the service every week to large numbers of clients your Member of Parliament needs to know that the government service is inadequate and putting lives at risk.

Costs of private care can be prohibitive. A visit and Pap smear can easily cost $450.00 at the gynaecologist. You may need to budget and plan for it just as you might do for school fees, a vacation or a new car.

For those on the UWI campus though, the service may be available at UWI’s Health Service Unit.

And if not, is there a good reason? Is it that campus girls are known to prefer having their pap smears done off-campus? And for the young researchers among you as well as the campus activists, has this question ever been studied?

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This article was first published in The Campus Chronicle’s last edition. It has been edited slightly before re-publication on this blog. The Campus Chronicle was a short lived newspaper and this article was published in its last edition in November 2011.

The Campus Chronicle was published with the readership of Trinidad and Tobago’s tertiary education students in mind.