Preventing Cervical Cancer: The Power of the PAP

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Arnice Trotter’s Pap smears were normal, but the 50–year–old St. Louis woman knew something was wrong "because of the terrible smell of the blood I constantly passed." She was diagnosed with an aggressive kind of cervical cancer on the day her first grandchild was born.

Cancer of the cervix–the part of a woman’s body that connects the uterus and the vagina, providing the pathway for menstruation, a conduit for sperm and a canal through which a baby is born — is the fifth most common cancer in African–American women and the tenth most common in their white counterparts. The disease may be linked to a strain of human papillomavirus (HPV), transmitted through sexual intercourse.

The virus itself does not cause cancer, but it increases a woman’s risk of contracting the disease when combined with other factors, including:

  • beginning intercourse at an early age (within a year of starting menstruation). The cervix of a young girl is more susceptible to HPV infection
  • having multiple sexual partners
  • having sex without a condom or other barrier protection that can block virus transmission
  • smoking — cigarette smoke contains chemicals that concentrate in cervical lining.

Every woman who has ever had sexual intercourse may have HPV, which increases her risk of developing cervical cancer. About 50 percent of all sexually active adults in the U.S. are infected with HPV, including men, though they don’t have the same susceptibility to cancer from it as women do. So how can an African–American woman protect herself from developing cervical cancer?

  • practice safer sex
  • have a monogamous relationship
  • limit the number of sexual partners
  • use a condom
  • have a yearly Pap smear

A Pap smear detects cervical cancer in its early stages, when it is the most treatable and curable, as in Trotter’s case. Since regular Pap smears became part of women’s health regimen, there has been a dramatic drop in the incidence of cervical cancer. The exception: Black women older than 65 who have not had a Pap smear in the past three years.

ACOG recommends all women have their first Pap smear, which tests for cervical cancer, beginning at age 21 or three years after first intercourse, whichever comes first. This should be repeated annually for women up to age 30. After age 30, if a woman has had three negative Pap smear results, she can reduce screening to every two to three years.

A Pap smear, a painless test where cervical cells are scraped, placed on a slide and examined under a microscope, is usually accompanied by a pelvic exam, which may pinpoint other physical problems.

If you have a pre–cancerous lesion, your doctor will probably use a procedure called a colposcopy, which magnifies the growth for better viewing. According to Alexander Burnett, MD, a gynecologic oncologist at Norris Cancer Center, University of Southern California, in mild cases, no treatment is needed, because the lesion usually clears up naturally.

In moderate or severe cases, one of these treatments may be done:

  • Cryosurgery – freezing abnormal cervical cells and sloughing them off. This inexpensive technique can be done in a physician’s office.
  • Loop excision (LEEP) – under local anesthesia, a fine wire loop with electrical energy flowing through it is used to remove abnormal tissue. This is the procedure of choice because it provides tissue for biopsy, heals faster than cryosurgery and makes it easier to watch for future changes to cervical tissue.

If you are diagnosed with cervical cancer, your doctor may suggest the following treatments:

  • removal of part of the cervix
  • surgery to excise uterus and cervix
  • radiation
  • combination of radiation and chemotherapy

When detected early, most cervical cancers can be treated without major surgery.

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