Preventing Cervical Cancer If every woman were tested every year, the Pap Test could potentially eradicate cervical cancer. For many women, the test itself has become synonymous with the yearly check-up. Yet there are too many women who are not tested regularly; and a disturbingly large number of new cases of cervical cancer occur in women who have never had a Pap test. In countries where the test has been widely used, it has been credited with a dramatic decline in cervical cancer--up to 70 percent. But after a steady decline, a slight increase in new cases was reported in the United States during the early 1990’s. About 15,000 women will be diagnosed with cervical cancer each year. Roughly one-third will die. The Pap test is a screening test that can detect cancer and pre-cancer of the cervix, the lower portion of the uterus which opens at the top of the vagina. Named after Dr. George Papanicolaou who developed it over 50 years ago, the test is meant to detect abnormalities before obvious symptoms are present. Perhaps the most significant element of the test is its ability to detect pre-cancerous changes of the cervix. In a Pap test, a sample of surface cells is scraped from the area around the cervical opening. The resulting “smear” is sent to a laboratory for microscopic examination. Because the cervix can be directly examined and sampled during a gynecological exam, a great deal has been learned about the natural history of cervical cancer. Virtually all tumors begin as early pre-cancers, called dysplasia, which develop on the surface of the cervix and progress from mild to severe grades over several months to a few years. The most advanced grades of dysplasia are likely to progress to cervical cancer. Even the earliest grades of dysplasia can be detected by a Pap test. Treatment for dysplasia is simple and can be very successful. The progression to cancer can be stopped and the surface of the cervix restored to a normal condition. There are some limitations to the Pap test, however. Primarily, it is not sufficiently sensitive to detect all abnormalities with a single test, resulting in an estimated 20 percent false negative rate. The good news is that abnormalities missed in one test have an 80 percent chance of being detected in the next test. Three negative tests in a row provide excellent assurance that no abnormality has been missed. Newer alternatives, such as PapNet, AutoNet and ThinPrep, promise to increase sample quality and interpretation. PapNet and AutoNet use computers to “rescreen” conventional Pap smears, identifying slides that are likely to contain abnormal cells. The slides can then be reviewed for abnormalities missed by the first technologist. ThinPrep is a new technology for processing the cells retrieved from the cervix during a pelvic exam. Rather than being smeared onto a slide, the cells are suspended in a fixative solution and collected on a filter. Regardless of the method or technology used to process cervical cells, being screened on a regular basis is key. Abnormal results require further investigation. Since the Pap test is a screening tool, it may indicate an abnormality, but does not provide a final diagnosis. Common vaginal and cervical infections can prevent a reliable reading. In these cases, the infection is treated and the Pap test repeated. Another category, “atypical, undetermined significance,” requires re-testing in three to six months. Up to 10 percent of the 50 million Pap smears performed each year show signs of slightly abnormal cells. These minor cell abnormalities rarely progress to cervical cancer. If dysplasia is suggested, however, then a further diagnostic procedure, called colposcopy, is required. The cervix is examined under magnification, allowing an area of dysplasia to be viewed and biopsied. If dysplasia is found, treatment usually entails a simple office procedure. Women should have a complete gynecological exam with a Pap test when they become sexually active, or at age eighteen, and then yearly thereafter. In addition, women should be aware of risk factors, including: sexual intercourse at an early age, multiple sex partners, infections such as human papilloma virus (genital warts), cigarette smoking, and a prior history of dysplasia. In reality, no test can completely eradicate cervical cancer, but regular screening is a protection that should be part of every woman’s health care plan. With proper treatment and carefully planned follow-up, women can be confident of dysplasia cure and the prevention of cervical cancer.
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