Michael Abrahams: Have no fear, do your Pap smear
April is Cancer Awareness Month, so I would like to take this opportunity to make a public cervix announcement to all women who have a cervix and have ever been sexually active: Please do your Pap smears.
Before going any further, for those who are unsure, the cervix is the lowermost part of the uterus (womb). It protrudes into and is attached to the upper end of the vagina. The cervix possesses a canal through which blood and the lining of the uterus are shed during menstruation (the period), and it is also this canal that dilates during labour to allow babies to be expelled from the uterus.
In addition, sperm have to pass through the cervical canal to enter the uterus and then the fallopian tubes for fertilisation to occur. The cervix, therefore, experiences a lot of traffic during a woman's lifetime, and proper functioning is essential if successful reproduction is to occur.
Approximately 99 per cent of cervical cancer cases are caused by a virus known as HPV, the human papillomavirus. This virus is the commonest sexually transmitted organism and most sexually active persons will acquire it at some point in their lives. However, of the more than 100 types of this virus, only a few are cancer-causing.
Women who initiate sex at an early age or have had multiple partners are at highest risk, leading many people to wrongly assume that only 'promiscuous' women will get the disease. The truth, however, is that from a woman has ever engaged in sexual intercourse, she is at risk. As a matter of fact, if a woman has had only one male partner, but he has had multiple partners, her risk is also increased.
Unfortunately, cancer of the cervix remains a major health concern. Approximately 530,000 new cases develop each year and 270,000 women die from the disease annually, with more than 85 per cent of cases originating in developing countries.
Despite these alarming statistics, cervical cancer is easily preventable, and the most important tool used in cervical cancer prevention is the Pap smear, named after the doctor who devised it, Dr Georgios Papanikolaou. During the test, an instrument called a speculum is inserted into the vagina in order to facilitate the collection of cells from the cervix.
The Pap smear is not performed to see if a woman has cervical cancer. It is performed to detect abnormal changes that can predate cancer by several years, allowing timely and effective intervention. As a matter of fact, it takes an average of about 11 years for a cervix to transform from normal to cancerous, giving ample time for intervention.
Most women who develop cervical cancer have either never had a Pap smear or had not got one during the five years preceding the diagnosis. This simple observation validates the efficacy of the test. As a matter of fact, the incidence of, and mortality from, cervical cancer decrease in countries with organised screening programmes, with the reductions being proportional to the intensity of the screening. In Iceland, for example, the mortality rate decreased by 80 per cent, and in several other countries, following the institution of organized screening, the incidence has fallen to less than 10 per 100,000 and the cancer is no longer found among the top 10 cancers in their women. By contrast, in Jamaica, it is the second commonest cancer in our women and its incidence is close to 30 per 100,000.
Regarding intervention, if a Pap smear indicates that action needs to be taken, the treatment is simple and effective. A procedure called colposcopy is performed, the abnormal area, if present, is identified and then ablated or removed. This is more than 95 per cent effective in preventing the development of cancer. If treatment fails and severe abnormalities persist, a hysterectomy (removal of the uterus) is close to 100 per cent effective in removing affected tissue, preserving sexual function.
Testing should begin no later than 21 years of age in women who begin sexual activity. By that time and should continue until at least age 65 years, with screening intervals of no more than three years. So if a woman does an annual Pap smear, it is almost a certainl that she will never develop cervical cancer. Yes, the test is that effective.
Michael Abrahams is a gynaecologist and obstetrician, comedian and poet. Email feedback to email@example.com and firstname.lastname@example.org