Can You Trust Your Pap Smear?
Pap Smear Myths and Misconceptions:
You only need a Pap smear if you're sexually active. Not true. Even though most cervical cancer is associated with HPV, which is a sexually transmitted infection, there are reports of women who have never had sexual intercourse who have had cervical cancer. We don't have an explanation for this . . .yet.
You don't need a Pap smear if you've passed menopause. Not true. In fact, one in 4 cervical cancers develops in women over 65. Since Medicare began covering Pap smears in 1990, the incidence of invasive and noninvasive cervical cancer in covered women has decreased significantly.
You don't need a Pap smear if you've had a hysterectomy. Not true. Pap smears are also useful in picking up abnormal changes in the cells of the vaginal wall.
You should douche before having a Pap smear. The opposite is true! Douching may remove some of the cells your doctor is trying to collect on the smear. In fact, there are very few medical reasons for douching at all.
If you get a call to come in for a repeat Pap test, it's got to be bad news. Not true. Many times, the sample obtained from the traditional Pap smear is simply "inadequate"; not enough cells were obtained. This is annoying and inconvenient for doctors and patients, but the "better safe than sorry" advice applies here. One of the newer technologies, the ThinPrep® Pap test system aims to reduce the number of repeat tests needed by capturing and preserving the entire cervical sample in a container of preservative. This way, another smear can be prepared from the same sample if necessary, rather than having the patient return. Another technology is currently in development that will be able to collect a sample from the entire cervix.
Pap smear results are not that reliable; cervical cancers are commonly overlooked. Not true. In fact, if a woman gets her Pap smear annually, the chance of an abnormality being missed over five years is less than one-one hundredth of a percent.
Dr. Donnica's Top 5 Tips For Getting the Most Reliable Pap Results:
Schedule your Pap test at least 5 days after the last day of your period. The ideal time is in the second half of your cycle.
Don't have sex or use tampons, vaginal creams or foams 48 hours before your
test. If you do have intercourse, use a condom.
Don't douche! Not only is there probably no need to, douching can wash away some evidence of abnormalities.
Ask your doctor (or office staff) if the lab your Pap smear is going to is fully accredited and meets recent new standards.
Ask your doctor about the new cervical testing technologies (HPV testing, ThinPrep®, AutoPap®, and PapNet®) and whether you should be getting them.
If you are overdue for your Pap smear, schedule it today!
Ask your mom, sister, daughters, loved ones, and close friends if they have had their Pap smears as scheduled.
If you have a teenager, talking about the birds and the bees includes talking about proper health maintenance and routine Pap smears. If your sexually active teen or 18+ year old daughter hasn't had her Pap smear yet, offer to make the appointment and/or go with her.
Practice safe sex.
Shortcomings of the Pap smear:
Not nearly enough women get their Pap smears regularly
The Pap smear does not detect HPV (see below), now believed to be associated with most cervical cancers.
For most women, Pap smears are normal. But for the small group of women who might have abnormal cells, the Pap smear is far from perfect. A single pap can be falsely negative in one in five tests! Human error in the sampling and the screening process provide the biggest hurdles. About half of these false negative results come from inadequate sampling: the doctor may not get enough of the right cells; the cells may stick to the swab or not get onto the slide; the slide may not be fixated properly and the cells may be damaged as a result. The other half of false negatives are due to a failure of the laboratory technician to identify abnormal cells present on the slide or to interpret them correctly. This is very challenging. In fact, the screening process can be compared to trying to find the proverbial needle in a haystack, although that might actually be easier: a cytotechnologist has to examine 200,000 to 500,000 individual cells under a microscope to find as few as 20 abnormal ones. Simple problems such as eyestrain and fatigue of the examiner (who may examine up to 100 slides per day) may yield big problems for the patient.
These shortcomings are the basis for the development of the new cervical
screening technologies discussed next.
In 1997, a Gallup survey commissioned by the College of American Pathologists found that although nearly 9 out of 10 women surveyed knew they should have a Pap test every year, nearly 4 out of 10 of these women failed to do so in the previous year. Why?