cervical cancer

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What Is a Pap Test Used For?

Thursday, March 20th, 2014

The term  “Pap test” or “Pap smear” is known by almost every woman in the United States.  However, over the past few years, its annual frequency has been questioned and the actual manner in which it is performed has been enhanced in many gynecologists’ offices. One of the components of a gynecologic exam that you have undoubtedly undergone is the Pap test (or Pap smear).  As stated in my health book for women and many times before on this blog, A Pap smear is NOT a pelvic exam.  The purpose of a pelvic (gynecologic exam) is to check all of your reproductive organs, which includes uterus, ovaries, vagina and vulva.  The Pap test is only to check for cellular changes in your cervix (the mouth of the womb) that may signal cancer or precancer. This is why regular appointments with your gynecologist are so important – because a precancerous condition can be treated before it becomes invasive cervical cancer, but the only way to detect a condition like this is with a Pap test.

Make no mistake – a Pap test can save your life. The chances of treating cervical cancer successfully are far, far higher when it is caught in its early stages. In most cases, precancerous cell changes can be treated before they ever become cancer at all. If you are wondering why you need a Pap test, or have been putting off making an appointment for your annual visit to the gynecologist, remember: a Pap smear is the absolute best way to prevent cervical cancer.

With that said, a Pap test is not recommended for women less than 21 years of age.  However, between the ages of 21 and 65, most women need an annual Pap test. Even though the American Cancer Society recommends Pap tests every three years, the American College of Obstetricians and Gynecologists recommends this screening test every year, because three years is a long time for cancer to grow and spread. Why wait three years when your cervical cancer could have been caught in its precancerous stage two years earlier?

Even if a woman has had a hysterectomy, she still needs a Pap test if her cervix is still in place, which is the case with certain types of hysterectomies (known as subtotal or supracervical hysterectomies). Either way, she still needs an annual pelvic exam; you can find more information on this in my book, Inside Information for Women.

To help ensure accurate Pap test results, you should not douche for a couple of days beforehand. That was a trick question, you should not be douching in the first place!!). Also avoid sex, vaginal creams or suppositories, deodorant sprays or powders in the vaginal area before a pelvic exam and Pap test.  Although some gynecologists prefer that the patient is not menstruating, a Pap test can be performed during your menses and they are not mutually exclusive.  If there are cancer cells present, they will be present whether you are menstruating or not.

What Does a Pap Test Involve?

The Pap test is done as part of the pelvic exam, and is very quick. The doctor places a bi-valved instrument called a speculum (hopefully warmed) in the patient’s vagina, which allows the cervix to be visualized.  The word “speculum” comes from the Latin “to see”. The doctor then uses a special brush (cytobrush) or swab (similar to a Q-tip) to collect cells from the cervix. These cells are placed on a slide and examined in the lab under a microscope. That is the traditional Pap smear.  Recently, liquid-based Pap tests have essentially replaced the conventional Pap smear.  In this test, after the cytobrush or the Q-tip has collected the cells from the cervix, it is submerged into a small vial of liquid preservative for transport to the laboratory, where it is then processed and smeared on the slide.  The presence of Human Papilloma Virus (HPV) can also be tested with this technology.  Some spotting is not unusual after a Pap test, but the test does not hurt. If the test shows a potential problem, your doctor will let you know that further testing is needed. Although this can be scary, remember that abnormal test results do not necessarily mean you have cancer.

Most insurance plans cover Pap tests as part of the gynecologic visit. However, if you are uninsured and not participating in the coverage afforded by the Patient Protection and Affordable Care Act, there are facilities that offer free or low-cost Pap tests

– Yvonne S. Thornton, M. D., M. P. H.

What You Need to Know about Cervical Cancer

Thursday, February 6th, 2014

Cervical cancer, just as the name implies, forms in the tissues of the cervix, which connects the vagina and the uterus. Generally slow growing, cervical cancer usually does not cause any symptoms. This makes it extremely important to get regular pelvic exams, during which screening tests are done that can find early-stage cervical cancers and even precancerous cells.

Any women can get cervical cancer, but it is typically found in women over 35. There are about 12,000 new cases diagnosed in the United States each year. Almost all cervical cancers are caused by HPV (human papilloma virus), the virus that causes genital warts.

Who Is at Risk?

There are several risk factors that increase a woman’s chances of developing cervical cancer. If you have none of these risk factors, your odds of getting it are very low. These risks include HPV infection (which you may not be aware of, another reason why those pelvic exams are so important); smoking or exposure to secondhand smoke; HIV infection, which can significantly weaken the immune system; certain medications which weaken immune system response; and multiple sexual partners.   

Can Cervical Cancer Be Prevented?

The good news is that cervical cancer is highly preventable. The first step for younger women and girls is to get vaccinated against HPV. Gardasil, a vaccine that prevents HPV infection, protects against the four types of HPV that are responsible for most cervical cancers as well as genital warts (70% and 90% respectively). The vaccine is administered via a series of three simple injections and has very few and mild side effects.

An annual visit to your gynecologist is another excellent way to be sure that, should cervical cancer be present, it is caught in its early and easily treatable stage. It is important for women to realize that even if they haven’t been sexually active recently, they are still at risk for cervical cancer if they have ever had sex. For this reason, continued screening is vital and saves numerous lives every year.

Keep in mind that anyone can lower their risk of various types of cancers by living a healthful lifestyle. Eating plenty of fruits and vegetables, getting enough exercise and enough sleep, and avoiding smoking and other dangerous chemicals are all effective ways to protect yourself and your family.

While cancer cannot always be prevented, it can often be found early and treated. If you haven’t seen your gynecologist recently and it’s closing in on a year (or has been longer than that), make an appointment today. Ignorance is not bliss when it comes to cancer – it’s often a death sentence.

– Yvonne S. Thornton, M. D., M. P. H.

You’ve Been Diagnosed with HPV. Now What?

Monday, December 10th, 2012

Have you gotten your HPV vaccination yet? If not, go get one now. HPV, or the human papillomavirus, is the single most common cause of cervical cancer in women. In many cases, women don’t even realize that they have HPV. For that reason, it’s important that every sexually active person is vaccinated because it is technically an STD (sexually transmitted disease) transmitted through intercourse. The HPV vaccination is simple, especially compared with the possible consequences of cancer treatment without it.  As stated in a prior blog in 2009, the benefits of being vaccinated against HPV far outweigh the small potential dangers.  If you are between 9 and 26, you should seriously consider getting the vaccination.

If you’ve been diagnosed with HPV, you’re probably wondering what happens next. It is too late to get vaccinated at this point, but it’s important that you understand how high your risk for getting cancer is. Though HPV (depending on its type) causes cancer in many instances, it is not to say that you’ll get it for certain. Many high-risk HPV infections simply go away on their own without leaving anything more than a few cell abnormalities. This spontaneous clearance of the virus usually occurs in women who are younger than 30 years of age.  It’s also important that you understand ways to decrease your risk once you’re diagnosed with HPV. Smoking and poor oral hygiene have both been linked to increase cancer risk following an HPV diagnosis, so it’s important that you take proper preventative measures.

In some ways, your HPV diagnosis is a perfect way for your doctors to more closely monitor your risk of developing cervical cancer. Many women who have cervical cancer can go years without even knowing that the cells are developing. It is a silent progression from a precancerous lesion to full-blown cervical cancer.  After your HPV diagnosis, doctors will know to check for cervical and anal cancer regularly. If they notice a tumor, they can take action quickly, which is the best way for you to beat it. It can take up to twenty years for cancer cells to develop after an initial HPV infection, so regular screening is necessary. Even if a tumor forms, you still have very good chance that it is not even cancerous.

You might be devastated when you first learn that you’ve contracted HPV. However, depending your age, it may resolve or it may persist.  If it does persist, then it certainly increases your risk for cervical cancer.  However, it does not necessarily mean that you will get it for sure. Stay on top of your regular screenings and stay positive.

Read more about HPV and cervical cancer in my newly updated health book, INSIDE INFORMATION FOR WOMEN.

– Yvonne S. Thornton, M. D., M. P. H.


It’s Called an Annual for a Reason

Thursday, August 2nd, 2012

It’s not news to OB/GYNs that women don’t exactly look forward to their annual exam.  We understand that it may feel more like a chore than a checkup when you’ve been told you have to do it every year.  Some experts though, have new recommendations, saying most women don’t need yearly cervical cancer screenings.  Before you start celebrating though, you may want to consider the many long-term benefits annuals have on your health.  As I have mentioned many, many times on this blog, ”A PAP SMEAR IS NOT A PELVIC EXAM.”

The new recommendations by the U. S. Preventive Services Task Force and the American Cancer Society were released March 15, 2012.   They recommend:

  • Women between ages 21 and 65 without risk factors (such as DES exposure or immunodeficiency) should undergo cytologic screening (a Pap smear) every 3 years.
  • Those aged 30 to 65 wishing to extend the screening interval could undergo screening with both cytologic exam and human papillomavirus (HPV) testing every 5 years.
  • Women younger than 21 should not be screened.
  • Women older than 65 who have been adequately screened previously should not be screened.

 The above recommendations may cause women to shirk going to their OB/GYNs for that dreaded pelvic examination because they are not having an annual Pap smear.

However, as we age, there’s no doubt our bodies change.  For the most part, those changes are normal.  Sometimes though, medical issues can develop.  Every time you go to an annual exam, you are getting checked to make sure everything is in healthy working order.  If you catch issues before they get too big, treatment and even cures can be more effective.  With the rise in so many types of cancer, you’ll want a professional checking to make sure there are no signs of tumors.  That is why pelvic exams, mammograms and cervical screenings are so important.  If you were to wait two or three years, it may be too late.  My health book, Inside Information for Women will explain all the aspects of a pelvic exam and an annual gynecologic examination.

You also have the chance during your visit with an OB/GYN to discuss your health and how it’s affecting your life, or how your life is affecting your health as the case may be, and that can bring up symptoms that you didn’t even realize were connected.  It can also provide you with valuable advice that will help you take care of your body.  With all the change people go through in a single year, it’s nice to know that someone with knowledge and compassion is there to make sure you remain in good health for many years to come.

The fact is women are such multi-taskers trained to take care of everyone that we forget to take care of ourselves. The point is, if we don’t take care of ourselves, we won’t be there to take care of others. Don’t have time for your annual checkup? It’s time that you find the time.


– Yvonne S. Thornton, M. D., M. P. H.

HPV infections usually resolve on their own

Thursday, October 27th, 2011

It’s become common practice among some OB-GYNs to test for HPV, the human papilloma virus, due to the association of some strains of this sexually transmitted infection (STI) with cervical cancer.

But testing of women under the age of 30 is inadvisable. Because, although at least half of all sexually active men and women will get genital HPV at some point in their lives, the immune system will fight off and remove most of these infections from the body with no treatment. Seventy percent are gone within a year and 90 percent within two years.

It’s that 10 percent of cases we have to watch for. Some of those will lead to precancerous lesions in the cervix which, if left untreated, can develop into cervical cancer. But this process takes from 15 to 20 years. So, testing women under 30 for HPV leads to false positives, more testing, and perhaps invasive procedures in women who are at little or no risk of developing cervical cancer from HPV.

The American College of Obstetricians and Gynecologists (ACOG) therefore recommends that women under 30 not be tested for this STI, and I agree. If a woman under 30 has one of the high risk types of HPV, and if it persists, there will be ample time to find it and treat it. If she has one of the lower risk strains, it will probably be gone with no intervention within a year or two.

– Yvonne S. Thornton, MD, MPH

There’s much more to an annual pelvic exam than a Pap smear

Tuesday, October 25th, 2011

You might have read that the U.S. Preventive Services Task Force now recommends that most women have Pap smears just once every three years instead of once per year.

Does that mean you can skip the OB-GYN appointment until 2014?

No, no, no, and no.

You must have a pelvic exam every year. Pelvic examinations save lives. A Pap smear, which can help identify cervical cancer, is just one part of that examination. Your OB-GYN does much more during your annual. She also looks for any evidence of ovarian cancer, vaginal cancer, myoma (fibroids) and other abnormalities of the reproductive tract.

And while it’s true that cervical cancer is typically a slow-growing cancer that takes an average 10 years to spread, sometimes these cancers “don’t read the books” and spread in a shorter period of time.

In my new health book, INSIDE INFORMATION FOR WOMEN, I tell you in greater detail what to expect when you have a gynecologic examination.

Don’t take risks with your health. Your “annual” is called that for a reason. Make sure you see your OB-GYN for your pelvic examination every year.

– Yvonne S. Thornton, MD, MPH