Health: The Pap Test – What, Where and Why
What, Where, and Why.
A Pap test or Pap smear is one of many procedures a doctor or nurse will perform when a woman has a regular health check-up. It can detect unhealthy changes in the cells of the cervix, which can sometimes lead to cervical cancer, the second most common type of cancer among women aged 20 to 49, after breast cancer. According to Cancer Care Ontario (CCO), cases of death from this disease have gone down by over sixty percent in the last 30 years, mostly due to screening using regular Pap tests, however, about twenty-five percent of Ontario women are not screened regularly, and among them a big number are newcomers to Canada.
Doctor Verna Mai, Provincial Lead of Public Health for CCO, observes that many women new to Canada are unfamiliar with the health care system, or have language barriers that prevent them from asking their doctors about the Pap test. “Depending on the country that some women come from, they may not have had access to Pap testing in the past, so they arrive to Canada not knowing they should be having it,” she says. “Doctors need to remind people about it, and women also need to bring up the topic, before they get their test done.”
Some women may be frightened by the test, especially if they don’t know how the Canadian system works. If this is the case, Dr. Mai recommends that they start by finding a family doctor, and making the test a regular part of their medical check-ups. “New immigrants need to know that it might be a challenge to find the right family doctor, but it is something they are entitled to do, and once you have one everything is so much easier, because you can ask any question about the test.” she explains.
Women who feel the test may be too uncomfortable, should keep in mind that the survival rate of cervical cancer is higher than ninety percent when it is caught early. “It is only a minute or two of discomfort, but then you know that you have made sure that nothing is wrong with your cervix, and that you are in charge of your health”, Dr. Mai stresses. “If you find something abnormal through screening it means that you found it early, but if you wait until you have some bleeding or pain, by that time it may mean that you have cervical cancer at an advanced stage.”
For this reason, the Ontario Cervical Screening Program recommends that all women who have ever been sexually active have regular Pap tests until age 70. If the tests results are normal for three years in a row, then it is advised to continue with the screenings every three years. “the Pap test will find abnormalities, but it doesn’t find everything, and because it is not perfect, only after three annual tests you probably have a good sample of cells to know that you’re not missing anything obvious, and then you could go every three years,” Dr. Mai explains. “The most worrisome situation is when women don’t go for many years, because all studies show that women who have never had a Pap test are at the greatest risk.”
What to Expect
A Pap test is done at the doctor’s office or at a community clinic. Two good sources to find a reliable provider are The Association of Local Public Health Agencies (www.alphaweb.org/ont_health_units.asp), and the Ontario Women’s Health Network (www.owhn.on.ca/dir_online.htm). The Pap test should be done between menstrual periods, and it is recommended to wait 24 hours after the last sexual intercourse, and 48 hours after applying foams or medicines in the vagina, before having it. An internal exam should follow it, during which the doctor or nurse checks the vagina, uterus, and ovaries. It is normal to experience some mild spotting of blood after the test. There are three possible results: normal or negative, abnormal, or cancer of the cervix. Most times, they will be normal, and another test won’t be necessary before one to three years, but each person should consult about the frequency recommended for them. The patient will hear back from the health provider only if there is an abnormality.
An abnormal Pap test may simply mean that there are changes in the cervical cells, or that there is a treatable infection. In most cases, abnormal cells change back to normal on their own. In other cases, they may become pre-cancerous cells if they are not found on time and treated.
Cervical cancer usually takes a long time to develop, and there are no early signs and symptoms. The Pap test can find most abnormal cells before they turn into cancer, but it is just as important to obtain follow-up care. Doctor Mai is emphatic when she says “the Pap test is only the beginning of the screening process and if you have something that needs follow-up, you won’t find answers until you go for the next appointment. The test is not a treatment; it is a way to identify abnormalities that need to be further investigated, and treated if necessary.”
If the results show severe cell changes, specialized treatment should be sought. For more serious cell changes, the patient is referred to a specialist who looks more carefully at the cervix with a colposcope. The doctor may take a small piece of tissue from the cervix for a biopsy, which is the only way to know for sure if the abnormal cells are cancer.
The HPV Vaccine
The Human Papillomavirus (HPV) is one of the most common sexually transmitted infections, and it has been identified as the major cause of cervical cancer. A vaccine, called Gardasil, that prevents certain types of HPV has been approved for use in Canada. It protects against infection with two high risk types of HPV (16 and 18) that cause approximately seventy percent of cervical cancers. The National Advisory Committee on Immunization recommends the vaccine for girls between 9 and 13 years of age, before the beginning of sexual activity, and for young women between the ages of 14 and 26, even if they are sexually active. However, since the vaccine does not protect against all types of HPV, vaccinated women should continue to have regular Pap tests.
To obtain more information about prevention and treatment of cervical cancer go to the websites of the Canadian Cancer Society (www.cancer.ca) or Cancer Care Ontario (www.cancercare.on.ca)