Pap smear: the test *every* woman should make a priority

By Linda Van Le, M.D.

Gynecologic oncologist at UNC Hospitals in Chapel Hill, N.C., and UNC Rex in Raleigh, N.C. | Leonard D. Palumbo Distinguished Professor of Gynecologic Oncology at the Department of OB-GYN at UNC School of Medicine

The American Cancer Society predicts that in 2017 more than 4,000 women will die from cervical cancer. That statistic used to be much, much higher. In fact, the ACS also predicts that nearly 13,000 women will be diagnosed with cervical cancer this year. But, we’ve learned that with early detection, cervical cancer can be treated.

Dr. Linda Van Le, gynecologic oncologist at UNC-Chapel Hill

Getting screened is the most important thing you can do to prevent this disease. Here’s why:

What causes cervical cancer?

Cervical cancer is caused by HPV or the human papillomavirus. HPV is spread through sexual activity, and women have no idea they have acquired it or have passed it to a partner. HPV doesn’t always cause cervical cancer, but it can. HPV can infect cells on the cervix and cause changes that can grow into cancer. Precancerous cells usually won’t cause any symptoms or discomfort at all, which is why screening to detect those cervical changes are so important. If detected early enough, cervical cancer can be treated, often before it even really begins. A Pap smear and an HPV test at an annual gynecologic exam is the best way to prevent this gynecologic cancer.

What is a Pap test or Pap smear?

A Pap smear is a test that screens for cervical cancer. During a pelvic exam, the provider uses a speculum to view the cervix, which is at the top of the vagina and end of the uterus, and uses a brush to collect cells for testing. The test does not take long, and it is not usually painful, but it can be a bit uncomfortable. The cells are then tested to see if they are normal or abnormal. Results can take a week or two to come back. If the test returns abnormal results, further testing may be required.

How important is a Pap smear? What if you don’t have insurance?

Every woman should get Pap smears. Every single one. (It could save a life!)

Even women who think they cannot afford the test should make it a priority. For women who are uninsured, programs exist to provide help. Visit the National Breast and Cervical Cancer Early Detection Program website and use the interactive map to find the services in your area or call the local health department to find out their policies on payment. Many offer a sliding scale based on income.

Women in the Triangle area wishing to be seen at an UNC OB-GYN clinic and interested in finding about pricing can call and ask to speak to a financial counselor.

The phone number for the clinic is 984–974–2131 — we can help you find the right clinic and get you the information you need to get this very important screening.

Does an abnormal result mean cancer? What happens next?

Not necessarily. Abnormal results may occur for a few reasons other than precancerous cells or cancer cells on the cervix. Inflammation or infection would also interfere with results. If precancerous or cancer cells were detected, the next step is a colposcopy (a magnified view of the cervix) to better view the cervix or to collect tissue samples. Remember, if caught early, or caught before the abnormal cells begin to grow out of control, this can often be successfully treated.

When should women start getting Pap smears?

The best answer is to talk to your doctor and find that best time — especially if you are sexually active. In general, gynecologists recommend that regular Pap smears begin at age 21. Even women who have never had sexual intercourse should have a Pap smear to check their cervical cells. The test is performed during a pelvic exam, and if the results are normal, only needs to be repeated every three years until the age of 30. Over the age of 30, the test should take place every three to five years. Pap smears won’t detect sexually transmitted diseases or HIV — ask to be tested separately for those, and as often as you feel necessary.

So, Pap smears are a must. Is there anything else women can do to prevent cervical cancer?

Prevent yourself from becoming infected with HPV. There area few HPV vaccines on the market that can prevent becoming infected with the type of HPV that most often causes cancer. Learn more about this vaccine here, or ask your doctor. These vaccines are most effective when given at age 11 or 12.

Smoking is a risk factor for many cancers, and this is one of them, because smoking can make it hard for the immune system to fight HPV.

Dr. Linda Van Le is also a member of the UNC Lineberger Comprehensive Cancer Center. Learn more about UNC Lineberger and UNC OB-GYN.