The word “cancer” generally puts fear into the heart of anyone being told they have the diagnosis, but many cancers can be cured without extensive treatment if they’re caught early.
Cervical cancer falls into this category, and early detection requires a simple PAP smear. This tool has been used for many decades and remains the test of choice for catching early stage cervical cancer or pre-cancerous conditions. The procedure, done in a doctor’s office in a couple of minutes, involves having a few cells gently scraped off of the surface of the cervix. The cells are then sent to a pathologist for examination.
The guidelines for how often women should have a PAP smear change from time to time as new research is reported. Based on the latest from the American Society for Colposcopy and Cervical Pathology and the American College of Obstetrics and Gynecology, women are advised to get their first PAP exam at age 21. “Patients used to get them as early as 12 or 13,” says Cortez gynecologist Daniel Bohle, MD. If the first PAP around age 21 is normal, Bohle says, women should repeat the test every two to three years throughout their 20s.
“After age 30, there are a couple of options,” says Bohle. “If a woman has a PAP that includes screening for HPV and both are negative, she can wait five years before having the tests again.” HPV, or human papilloma virus, causes genital warts and is associated with cervical cancer and is the most common sexually transmitted infection. “Eighty-five percent of people who have sexual intercourse have probably been exposed to HPV.”
Receiving news that a PAP is “abnormal” causes women to worry, but in most cases, it’s not cause for alarm. Sometimes cells show minor changes and the only follow-up required is a repeat screening, as most infections resolve on their own within two years. If cell changes are significant, a colposcopy and possibly a biopsy may be needed, both of which are done in a doctor’s office. If cancer cells are present, an office-based procedure called LEEP is performed. Here, the doctor shaves out the area of the cervix where malignant precancerous cells are located. This is done using local anesthesia.
There are 50 to 60 million PAP smears performed in the U.S. every year. About 3.5 million are abnormal, and there are between 12,000 and 13,000 reported cases of cervical cancer each year. “This is a very preventable cancer,” says Bohle. “I’m still surprised to see patients who have never had a PAP smear.” The PAP exam is important because cervical cancer is not symptomatic in the early stages. “Some women will have bleeding after intercourse, but the cancer is often late-stage by then,” says Bohle.
Because cervical cancer is related to HPV, it’s important for both girls and boys to receive the three-dose vaccine about age 11 or 12.
“We’re not doing a good job of this in the U.S.”, says Bohle. “Only about one-third of women have gotten the vaccine. In England and Australia, about three-quarters of women have had the vaccine, and they’ve seen a tremendous decrease in precancerous cervical changes.”
A PAP smear is not the same thing as a pelvic examination, and many women confuse the two. Even if a PAP and/or HPV screening is not needed (and most doctors don’t recommend them for woman after age 65), women should still undergo a physical examination every one to two years, including a pelvic exam.
Another gynecological condition, uterine cancer, is actually more common than cervical cancer, but the survival rate is better because women have symptoms that prompt them to seek attention earlier. “Post-menopausal bleeding is the most common symptom,” says Bohle. The treatment for uterine cancer is usually hysterectomy (removal of the uterus and ovaries). Risk factors for developing uterine cancer include cigarette smoking, being overweight, and a history of irregular periods.
By far the most serious of all gynecological maladies is ovarian cancer.
“It’s so unpredictable,” says Bohle. Death rates from ovarian cancer are extremely high because by the time it’s discovered the disease is usually fairly advanced. Symptoms include bloating, an increase in abdominal size with associated weight gain, and indigestion. “A lot of people have no pain at all,” says Bohle. Most ovarian cancers spread from the surface of the ovary into the abdominal area. Treatment is a complete hysterectomy, and the removal of any visible tumors in the abdomen, followed by chemotherapy.
The main risk factors for ovarian cancer are being positive for the inherited BRCA mutation or having a first-degree relative (mother, sister) who has had ovarian cancer. Women who are at high risk can be screened with a blood test called CA-125, but this is only somewhat effective because ovarian cancer advances so quickly. “Unfortunately, most women die within two years of being diagnosed with advanced disease. Every few years we hear of promising tests or screen for ovarian cancer, but so far none have panned out.”
Women who experience bloating or other symptoms associated with ovarian cancer should make an appointment to see a doctor, but they should not panic. A simple ultrasound procedure may quickly rule out serious disease and put a woman’s mind at ease. When in doubt, see a doctor.
Southwest Health Notes is a public service feature provided by Southwest Memorial Hospital in Cortez. The information provided herein is not intended as patient-specific medical advice or as a substitute for consultation with your personal health-care provider.