I was recently bemused by a gross interpretation of “cause
and effect” while advising a young Balinese couple with
some minor health problems. The questions that they had for
me were resolved quite quickly, so I thought I would take
the opportunity to discuss some preventative health measures
with them. When I started to talk about the PAP smear the
couple looked at each other quite disgusted at the mention
of this life saving procedure. The young man spoke in defense
of his wife sternly making the statement that she would never
have such a procedure performed. Curious at their fearful
reaction to my suggestion I questioned them on their knowledge
of the PAP smear. It soon became clear as to how this test
had been so misrepresented. An Aunty of the lady had a PAP
smear performed several years ago. Shortly after the PAP was
performed they told her she had cancer. Within 12 months of
the test she was dead. Indeed this unfortunate woman had a
progressed cervical cancer at the time of the smear, but in
the minds of these people the cause of the problem must have
been the test, as she had previously had no problems. The
tragedy of this story is that if this woman had been given
routine PAP smears from an early age (18 years old) the cancer
would have been detected early enough and the disease completely
cured.
Why should I have a PAP smear?
Cancer of the cervix (kanker leher rahim) is the second most
common cause of cancer-related disease and death among women
worldwide. The best way to prevent cervical cancer is by having
regular Papanicolaou (Pap) tests.
A Pap test can detect viral infections (such as human papillomavirus)
and other cancer-causing conditions. Early treatment of these
conditions can stop cervical cancer before it fully develops.
A woman can have cervical cancer and not know it because she
may not have any symptoms.
The occurrence of cervical cancer has decreased because of
Pap test screening. Many women (millions) are found to have
abnormal Pap tests each year. Most of them are early stage
and need reasonable observation by a doctor.
Risks factors for cancer of the cervix
Multiple sexual partners (or sexual partners who have had
multiple partners)
Starting sexual intercourse at an early age
Viral infection, such as human papillomavirus (HPV), human
immunodeficiency virus (HIV), or herpes simplex virus (HSV)
Weakened immune system
Previous cancer of the lower genital tract
Smoking
When & how often should you have a PAP smear?
Cervical cancer screening is recommended yearly starting at
age 18 years or when a woman becomes sexually active, if younger
than age 18.
Less frequent screening is done if you have a negative Pap
test 3 years in a row, or if you are not sexually active.
No upper age limit for screening exists, because the incidence
of cancer of the cervix increases with age. Most of these
cancers are diagnosed after age 50 years. Even after menopause,
a woman should continue to have regular Pap tests.
If you have had your uterus removed, yearly screening should
be performed if there is a history of abnormal Pap tests or
other lower genital tract cancer.
The best time to have a Pap test is when you are not menstruating.
If you feel more comfortable with a female doctor, you can
ask for one.
For 2 days before the test, avoid the following because these
might hide any abnormal cells.
Intercourse
Douches
Vaginal medications (except as directed by your doctor)
Vaginal contraceptives such as birth control foams, creams,
or jellies
Pap smear should be done as part of a pelvic exam and should
be accompanied by a breast exam performed by your doctor.
It should only take a few minutes to perform a Pap smear.
How is a PAP smear performed?
You will lie on the examination table on your back with your
knees up and bent and your feet in stirrups (rests). While
you are lying on an examination table, your doctor will use
a small metal or plastic instrument called a speculum to open
your vagina so that the walls of the vagina and cervix can
be seen clearly.
A sample of mucous and cells will be scraped from your cervix
(the part of your uterus that extends into your vagina) and
endocervix (the opening of your cervix) using a wooden scraper
or a small cervical brush or broom.
The sample of cells is applied evenly to a glass slide and
sprayed with a fixative. This sample is sent to the lab for
close and careful examination under a microscope.
During the test, you may feel a little discomfort. Most women
feel nothing at all or feel pressure. Staying relaxed will
help stop any discomfort. Breathe slowly and concentrate on
relaxing your stomach and legs.
A Pap test should not be painful. If you are experiencing
pain during the test, tell your doctor.
Some women experience a little bleeding after a smear test.
This is normal.
What if the results are abnormal?
You will receive a letter from your doctor with your test
results, or your doctor may only contact you if there is a
problem. A negative or normal test means that your cervix
looks healthy. All the cells are of a healthy size and shape.
A positive or abnormal test means that something unusual is
in your sample. Cells of a different size and shape were found.
An abnormal Pap test does not always mean you have cancer.
Cells sometimes appear abnormal but are not cancerous, but
you will have to return to the clinic for follow-up care.
Remember that abnormal conditions do not always become cancerous,
and some conditions are more of a threat than others.
A positive test can be caused by an infection of the cervix.
A yeast, trichomonas, chlamydial, or gonorrheal infection
can cause the cervical cells to appear inflamed. Afterthe
infection is treated, the Pap test usually returns to normal.
Human papillomavirus (HPV) can also cause a test to be positive.
This virus may exist on the cervix or in the vagina as well
as causing genital warts. Many types of HPV have been identified,
and some of them are associated with cervical cancer. If you
have HPV, you have a higher risk of developing cervical cancer.
Your sample may be positive because it shows changes that
may become cervical cancer.
If you have an abnormal Pap test, a repeat test should be
done every 4-6 months for 2 years until 3 consecutive negative
tests have been obtained.
If your Pap smear is positive because of an infection, the
underlying cause should be treated. The test should then be
repeated in 2-3 months, because cancer of the cervixcan be
hidden by an infection. A check-up with a doctor is a must.
Although the Pap test is the best method of preventing cancer
or detecting it early, it is not perfect. Because even the
best labs can miss some cell changes, you should have the
test performed yearly. If your Pap test is normal, you will
continue routine screening.
Early cervical pre-cancers or cancer often have no signs or
symptoms. Therefore, it is important for women to have regular
Pap tests. Symptoms usually appear when the cancer is further
along.
Report any of the following to your doctor right away:
Unusual vaginal discharge
Blood spots or light bleeding other than your normal period
Bleeding or pain during sex
These symptoms do not mean that you have cancer. They can
also be caused by other conditions, but a check-up with the
doctor is a must to find out.
Clearly an ounce of prevention is worth a life in the case
for the PAP smear. This test is readily available at clinics
and labs around Bali; there is even a mobile unit operated
by Yayasan Sehati Ph. 0361 – 263690. That’s all
until next edition, stay healthy, stay happy and stay young!
Kim Patra is a qualified Registered Nurse / Midwife, and
mother of three, who has been living and working in Bali for
past 15 years. She has assisted many traveller (... and others)
either as a flying medical escort or just a voice on the end
of the phone! Kim is happy to discuss any health concerns
that your may have. Her e-mail contact is info@chcbali.com
