This is the last part of the Cancer preventive care series. You can read the series preamble here
PAP test may be the oldest of all the screenings first being discovered in the 1920s. It has evolved significantly over the last century. It is used to detect abnormal cells on the cervix which can lead to cervical cancer. It’s one of the first tests to have the guidelines change in the last 7 years and has the broadest age range now covering women 21-69 years old. About 5 years ago it was changed from being an annual test to being performed every 3 years and it was at that time that the program put the age down to 21 from 35 because researchers have found that the majority of cervical cancers are caused by Human Papilloma Virus or HPV.
The pap test is done by your doctor, gynecologist or nurse in the office. You should not have your period at the time of the test as the blood can obscure the cells. During the test a special brush is used to scrape cells off the surface of your cervix after your vagina has been opened with what is called a speculum. The cells are sent to the lab in a special solution and viewed by a pathologist.
The test is recommended to be repeated every three years and like the colon cancer FOBT, having it done regularly makes the test more reliable because the lab can compare results if necessary.
The biggest cause of cervical cancer is said to be HPV which is a sexually transmitted disease. Generally, for most HPV strains and when we’re young, the body can wash away or repair these cells like it gets rid of a cold. But as we age our bodies lose that capability and the cells continue to change. Some strains of HPV can actually cause the DNA changes leading cancer cells to form and avoid the body’s attempt to rid itself of the virus. These strains can be vaccinated against and you should speak to your doctor about the vaccine. Though HPV is thought to be the main cause of cervical cancer other risk factors for developing this type of cancer are smoking, a weak immune system and use of the birth control pill but not all the risks are known.
There is little you can do yourself to monitor for these abnormal cell formations. Symptoms include pain with intercourse and/or vaginal bleeding after intercourse, as well as bleeding or spotting between periods. Typically there are no symptoms until the bad cells actually start to invade the surrounding tissue.
Positive pap results can come back positive for ASCUS which stands for Atypical Squamous Cells of Undetermined Significance. This is one of those that the body is generally able to heal on its own so it will recommend a repeat pap in 6 months to make sure the body has done its part. Results can also show LGSIL or HGSIL which stand for Low Grad or High Grade Squamous Intraepithelial Lesion. This means there’s actually a lesion, or growth, on the cervix made up of these changed cells. These changed cells are considered precancerous and are referred to as dysplasia. Lastly, a pap could actually identify cancer cells.
If LGSIL, HGSIL or cancer cells are found on a pap the next step is an automatic referral to a gynecologist for a colposcopy. If the ASCUS doesn’t clear after 6 months then colposcopy is the next step. During a colposcopy the doctor begins the same way as a pap and, in fact, does a pap. Then he puts acetic acid (same as vinegar) on the cervix and views it through a scope which does not enter the body. Bad cells (which can be pre-cancerous or cancerous) react to the acid and turn color allowing the surgeon to see the affected area(s) and he uses a tool to take a sample of that area. It is done without anesthetic and it feels like a really bad pinch. Everything gets sent to the pathology lab for analysis.
Once the results come back from this biopsy, next steps can include monitoring with colposcopy every 6 months for a time or a LEEP/Cone procedure where they take a large chunk of tissue from the cervix hopefully removing all the bad cells. The pathology report will let you know what cells the lesion contained and whether the surgeon got it all. A last option, depending on your age, is a hysterectomy which may seem a bit extreme to some people but it eliminates the threat of recurrence.
The alternative to not having this test done is those cells change and continue to change forming cancer cells. Cancer cells like to invade surrounding tissue and by the time it’s found it may have spread up into the uterus and other reproductive organs and it may have metastasized. Cervical cancers typically metastasize to pretty much any organ in the body because the cervix is so close to the lymph nodes. It should take many years to reach this point and regular pap tests should catch cell changes early on. Unfortunately, abnormal cells do like to duplicate at a faster rate than healthy cells.
I ran into these cancer cells and it was scary but it was discovered early enough and it was treatable and curable. Catching it early enough gave me plenty of options to choose from for treatment. I chose hysterectomy because of my age. The more options available, the better chance at a full recovery and that is the best outcome.