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.
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?
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
Infected
By Unsterile Speculum
Hygiene
woes at Dallas County’s Parkland hospital led to OB/GYN alerts
Abnormal
Pap smears and HPV
Smoking and
Cervical Cancer
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!
Pap Test Coercion Getting More Attention