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!

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.

The Giant Misunderstanding About the Purpose of Cancer Screening – And Some Screening Guidelines

Thinking of screening tests as preventative rather than diagnostic is an important cultural change that needs to be introduced into our health beliefs.

The idea that screening tests are diagnostic is misleading. Most screening tests require further testing to tell you more about what any abnormal screening results mean.

Statements like, “I ‘fraid to do a mammogram, yes. I don’t want to find out I have breast cancer,”

Or

 “If my PSA high what I going to do? I don’t want to take no surgery! I ‘fraid dat! Suppose I can’t get no erection when they done with me! If I have to dead let me enjoy myself and I will dead when I ready!” reflect our beliefs that screening tests are meant to diagnose or help us ‘find out if we have cancer.’

Since accepting a diagnosis of cancer requires a highly disruptive mental shift, many of us avoid screening in order to stay within our comfort zone.

However, if regular screenings were recognized as a tool to reduce negative outcomes then scheduling screenings routinely and with much less fear and anxiety could become the norm.

– excerpted from the as yet unpublished article, Cancer Screening, What You Don’t Know Can Hurt You

Anyway here are some guidelines that you include in your plans for 2012. I usually schedule my Pap smear within the first two months of every year. Having routines for check ups makes planning easier.

Screening tests are supposed to pick up early cancer in persons who have no symptoms. Sometimes they pick up pre-cancerous lesions, giving you and your doctor the ability to remove early lesions before they become cancerous. Why miss such an opportunity?

Recommendations

PROSTATE CANCER: begin annual PSA testing at age 40 and keep all your results in one place. The PSA test is a blood test. The PSA is more useful than the Digital Rectal Examination (examining the prostate through the rectum with a gloved finger) but some doctors prefer to have both on record. If anything changes it’s useful to have records to compare new results with.

TESTICULAR CANCER: screening not recommended. Visit your doctor if any changes noted to the testicles and scrotum.

BREAST CANCER: breast self-exams help with breast awareness but from the age of 20 have the breasts examined by a physician or trained nurse every 3 years. (clinical breast exams). From the age of 40, take a mammogram every year. Some parts of the world begin mammogram screening at age 50 but this is not recommended in the Caribbean. Mammograms are more likely to require additional information from ultrasound scans for women under the age of 50.

Thermography is believed by some to be a safer and better way of screening for breast cancer. However mainstream health organizations do not recommend thermography, stating that there is not enough evidence yet to do so.

CERVICAL CANCER: routine screening for this cancer, more than any other, has the most potential benefit as routine screening will allow a very high percentage of cases to be detected in their pre-cancerous or even early and curable stages.

Screening entails regular Pap smears from age 21 or three years after becoming sexually active. Screening continues to be necessary for women who are no longer sexually active till advised by their doctor that they can discontinue. Some hysterectomies do not involve removing the cervix and women need to be clear as to how their surgeries were performed since if the cervix remains (as in a subtotal hysterectomy), they still need their Pap smears.

Health care workers advise women based on their individual risk profile how often their smear needs to be repeated.

 

COLORECTAL CANCER: at least by age 50 have a stool test done annually, (faecal sample sent to the lab to look for traces of microscopic bleeding) plus sigmoidoscopy every 3-5 years (a lighted flexible tube or scope in the rectum). Some professional medical packages include colonoscopy every 5 years. If your mother, father, brother or sister had colonic polyps or colo-rectal cancer younger than age 60 then consult with your doctor about the right age for you to begin screening. It has been recommended that African- Americans begin screening by age 45.

LUNG CANCER: screening is not recommended at this time. CT screening is being discussed by experts. Some believe that the expense and harm will outweigh the benefits and that too few lives will be saved or extended to justify the burden of cost. Symptoms such as coughing of blood, chronic cough, shortness of breath or chest pain should be referred to your doctor and could be caused by many various conditions.