“I really HATE this part” said my first patient this morning as she reluctantly positioned her feet in the stirrups. “I just don’t know how you do your job” she remarked and shook her head a little disturbed, I think, that I would have willingly chosen such a strange line of work.
To be honest, I don’t particularly enjoy doing pap smears, and I also hate getting them as much as anyone. But I do very much enjoy helping women avoid cancer.
Despite the efforts of me and my gyno colleagues, 13,000 women are still diagnosed with cervical cancer each year in the United States, and a third of them will die from the disease. Another 500,000 will be diagnosed with precancerous lesions requiring anxiety-provoking biopsies and painful surgical procedures.
The good news is, with our modern understanding of the way cervical cancer grows, there are steps you can take to help prevent the disease.
Don’t Have Sex
Cervical cancer is caused by the sexually transmitted virus HPV (human papilloma virus) that around 75% of women will contract in their lifetimes. Most women’s immune system will fight off the virus within a couple years and they never even know they have it, but in other women the virus will begin to cause precancerous changes to the cervix that, if left untreated, can develop into cancer.
Many of my patients get understandably freaked out over the thought of having a sexually transmitted virus. I try to reassure them that the virus is currently so prevalent that statistically any woman who’s had more than one partner (or if her partner has ever had another partner) has been exposed.
While celibacy and monogamy are excellent strategies to prevent cervical cancer, they are not the most practical option for most women. So, let’s move on to other strategies.
Because cervical cancer is caused by a virus, we’ve been able to develop a vaccine to help prevent it. To be most effective, the vaccine needs to be given before any HPV exposure. It is currently recommended for boys and girls starting at age 11, with catch up vaccination up to age 26. The HPV vaccine is a phenomenal breakthrough – we have a shot that doesn’t just cure cancer: IT PREVENTS CANCER.
As a person who daily deals with patients who lives are seriously affected by HPV, I am very frustrated by all the negative press and rumor-mongering about the vaccine. With over 50 million doses given, the safety of the vaccine is well established, and there is no evidence of long term negative side effects from the vaccine. I am giving the vaccine to my children and I would encourage you to do the same.
Get tested for HPV
Despite all our amazing scientific breakthroughs, the pap smear remains our best weapon in preventing cervical cancer. A sampling of cells is obtained from the cervix usually with a small plastic brush, which causes that wonderful cramping sensation you feel during your exam. The cells are then examined under the microscope to look for precancerous changes. With the more recent discovery of HPV as the cause of cervical cancer, we have now added HPV co-testing to pap smears starting at age 30 which has significantly improved the quality of the pap as a screening tool for cancer. If there is no HPV present then we know the likelihood of cancer in the next few years is extremely low and the patient may be eligible for less frequent pap smears.
The problem with this new, more individualized approach, is that when patients hear “less frequent pap smears” it sometimes translates in their subconscious to “not at all”. Also, it is extremely important that you continue to get an annual exam each year to screen for ovarian cancer and discuss other preventive health issues with your provider.
If you have a history of abnormal paps or have a lowered immune system then you will likely still need a pap smear each year.
Luckily cervical cancer is relatively rare in the US, but it should be nonexistent. Of the women diagnosed with cervical cancer in the United States, 50% have not had a pap smear in over 10 years. So if you haven’t had a pap smear recently, I would encourage you to get your feet in the stirrups stat! If you are under age 26, talk to your provider about getting the HPV vaccine while you are there. While a shot in the butt and cold slimy speculum are no fun, neither is cervical cancer.