Truth
About Pap Smears
The Pap smear test was developed by and named
after Dr. George Papanicolao in 1928 for the purpose of early
identification of cervical cancer. The goal of pap smears is
to identify high-grade precancerous cervical lesions and early-stage
asymptomatic invasive cervical cancer. While it is true that
pap smears have helped to reduce many cervical cancer cases,
too many unnecessary pap smears are done. More is known about
cervical cancer today.
Many women were led to believe that cervical cancer was very
common and that any woman was at risk for cervical cancer for
many years. Also, many women were not informed that 99% of cervical
cancer cases were caused by human papillomavirus (HPV), a sexually
transmitted infection. HPV is contracted through skin-to-skin
contact during sex — vaginal, anal, or even oral sex.
It is not passed through the semen, but is harbored within the
cells of the entire genital region. The truth is cervical cancer
is rare. HPV infections often clear without leading
to cervical cancer. Many women were encouraged to have
yearly pap smears regardless of their risk factors. Since cervical
cancer is in essence a sexually transmitted disease (STD) caused
by HPV, a woman can estimate her personal risk.
Dr. Joel Sherman in his article, “Informed
consent is missing from Pap smears and cervical cancer screening”
argues that AIDS is more dangerous than cervical cancer. He
shared his concern about HIV in the below statement:
“For comparison’s sake, HIV (AIDS)
is an even more dangerous STD with a five times greater incidence
than cervical cancer. Yet no one ever suggests that everyone
be tested for HIV, and there are laws in many states restricting
testing. Testing is suggested only for those at risk, but this
tactic is never used for cervical cancer.”
Women are often pushed into having Pap smears,
but rarely told that they might not need them or asked if they
want them. Informed consent for Pap smears is often missing.
Every woman should be informed of risk factors for cervical
cancer, pros and cons of cervical cancer screenings, high incidence
of abnormalities that resolve spontaneously, and complications
from HPV Treatments such as biopsies and colposcopies.
A number of doctors still demand that woman has
a pap smear / pelvic exam before prescribing birth control pills.
"Hormonal oral contraception can be prescribed safely without
a pelvic examination, according to guidelines from the World
Health Organization and the American College of Obstetricians
and Gynecologists. While weight, blood pressure, and health
history are required before prescription of hormonal contraception,
screening for sexually transmitted infections and cancer are
not necessary to evaluate patients for initiation of oral contraceptive
use for birth control." (Source: Pelvic exam necessary for contraception Rx?)
Sometimes, women will go to their doctor for
other reasons such as ear problem or sore throat and get a lecture
that they need a pap smear. Check out Pap
Test Coercion Getting More Attention. Some women feel obligated
to submit to a pap smear at those appointments.
The guidelines for pap smears are too general. The guidelines
do not take into consideration that not all women have the same
risk levels and risk factors for cervical cancer. One area of
concern is that a woman who has never been exposed to HPV generally
does not need a pap smear. Also, the guidelines are not good
for high-risk women who may need pap smears more often. Check
out some guidelines in the United States and Canada:
1.) Canadian
Medical Association Journal - Cervical Cancer Screening
Recommendations
2.) American
Cancer Society - Cervical Cancer Screening
Recommendations
Every doctor’s office should have pamphlets
about pros and cons about Pap smears and risk levels and risk
factors that increase a woman’s chances of cervical cancer
for women to help them assess their risk levels for cervical
cancer. It would be very helpful to have a list of risk levels
and risk factors like the list below.
Risk Levels and Factors for Cervical
Cancer:
Zero to very low risk level:
- *A true virgin woman who has never engaged
in any kind of sexual activity including heavy petting, oral
sex, anal sex, and skin to genital contact.
- *A woman who has never engaged in any
type of sexual activity with anyone except for one sexual
partner who also never engaged in any type of sexual activity
with anyone else.
*Other factors that could
slightly increase the chance of cervical cancer in this group
are:
1.) Based on some studies,
smoking could possibly cause cervical cancer without HPV infection.
2.) Mother took DES (also known as diethylstilbestrol)
during pregnancy with you between 1938 - 1971
to prevent miscarriage and premature delivery. It is estimated
that only 1 in 1,000 women who were exposed to DES in the
womb will develop cervical cancer. (Source: Cervical
Cancer And DES Exposure)
3.) Mother had HPV infection when she gave
birth to you (only applies to vaginal birth). The risk of
HPV transmission to the baby during childbirth is very low.
Even if babies do get the HPV virus, their bodies usually
clear the virus on their own. (Source: HPV
and Pregnancy).
4.) You had a Pap smear with an unsterile
speculum. (Sources: Infected
By Unsterile Speculum and Hygiene
woes at Dallas County’s Parkland hospital led to OB/GYN
alerts)
Low risk level:
- *A woman who has never had HPV infection
and is in a long-term mutually monogamous relationship with
a man who is not infected with HPV.
*Check out other factors
that could slightly increase your chances of cervical cancer
in the zero to very low risk level group.
High risk level:
- A woman who has had multiple sexual partners.
- A woman in a relationship with a man who had multiple sexual
partners.
- A rape victim.
- A smoker who has HPV infection.
- A woman who is infected with HIV or other STDS such as
Chlamydia.
- HPV infected woman with a weakened immune system.
Women infected with HIV that causes AIDS are at an extremely
high risk for developing cervical cancer. Check out this article:
HIV-Infected
Women Have Higher Risk of Incident Invasive Cervical Cancer.
Keep in mind that HPV has the ability to hide, or to pop up
when we are least expecting it. The virus will often flare up
whether or not external symptoms manifest when women are under
emotional stress or their immune system is weakened. Sometimes,
the virus can lie dormant for decades. It is possible for HPV
infection to reactivate years later.
The HPV test should be offered to women who have been exposed
to HPV since the HPV test detects precancerous lesions better
than pap smears. Check out HPV
test may be better than Pap smears to detect early cervical
cancer: Study. There are many reports of Pap smears not
detecting abnormal cells until it's too late and the cancer
is advanced. The HPV DNA test, on the other hand, tests for
the actual virus, which makes it much more effective as a test
for cervical cancer.
For women who need pap smears and HPV DNA tests, we strongly
recommend that they only allow a female doctor or mid-level
provider (midwife, physician’s assistant, or nurse practitioner)
to do a pap smear on them. It is always very risky for a woman
to allow a male doctor do a pap smear on her because he could
easily sexually abuse her. Check out why
women should avoid male doctors for female health issues.
Also, it would be prudent for you to ask your doctor if she
can use a disposable speculum for your pap smear instead of
a metal speculum that is reused to reduce your chances of getting
HPV or other STDs from speculum that may have not been sterilized
properly. Make sure your doctor washes her hands and uses brand
new gloves before doing your pap smear.
In conclusion, all women should be offered informed
consent about pap smears and decide for themselves whether or
not to screen/what age to begin screening. Providers’
offices should have pamphlets that fully explain both the pros
and cons of pap smears and risk levels. Then each individual
woman should decide for herself. Doctors should never
require a woman to have a pap smear for a prescription or physical
exams.
Medical Disclaimer: The information on this
web site is for educational purposes only. It is not intended
in any manner as professional medical advice. You should consult
a healthcare provider to determine the appropriateness of the
information on this article for your own situation, or if you
have questions or issues regarding a medical condition.
Other Related Articles:
Why
HPV Vaccine Should Be Avoided?
Are
Pap Smears Necessary For Virgin Women?
What
You Should Know About All-Female OB/Gyn Practices?
Why
Women Should Avoid Male Doctors For Intimate Examinations?
Female
Patient Modesty
Sources:
Informed
consent is missing from Pap smears and cervical cancer screening
By Dr. Joel Sherman
Are
Pap Smears Necessary For Virgin Women?
Cervical
Cancer and DES Exposure
HPV
and Pregnancy
Infected
By Unsterile Speculum
Hygiene
woes at Dallas County’s Parkland hospital led to OB/GYN
alerts
Abnormal
Pap smears and HPV
Smoking
Boosts Cervical Cancer Risk
Smoking
and Cervical Cancer
Stop
Smoking and Reduce Your Cervical Cancer Risk
Informed
Consent for Pap Tests/Pelvic Exams Still Not Offered to Women
How Often Do You
Need a Pap Smear? A Pelvic Exam? The Low Down on What’s
Down Below!
Holding
Birth Control Hostage
Pap
Test Coercion Getting More Attention
Medical Disclaimer: The information
on this web site is for educational purposes only. It is not
intended in any manner as professional medical advice. You should
consult a healthcare provider to determine the appropriateness
of the information on articles about medical procedures for
your own situation, or if you have questions or issues regarding
a medical condition. |
