In this week's column, rather than answer a question, I want to pose one based on a paper that was presented at the recent 54th Annual Clinical Meeting of The American College of Obstetricians and Gynecologists. When I read the abstract I was astounded and felt I should address the cause of my consternation.
A questionnaire was given (in English and Spanish) to over 350 patients in a family health center in New Jersey by doctors Raksha Joshi and Joseph Jaeger. They wanted to assess the patients' knowledge regarding their Pap test. Here are the questions from the survey — see if you know the answers. And, if like many of the respondents, you don't know the answer, read on.
- The Pap test can show that you have a Gonorrhea or Chlamydia infection. True or false?
- The Pap test is done in the ER if you go in for vaginal discharge. True or false?
- If the doctor tells you that your Pap isn't normal, you definitely have cancer. True or false?
- If your Pap isn't normal then you need a hysterectomy. True or false?
- If you have treatment for an abnormal Pap test then you can never have children. True or false?
- Cancer of the cervix is closely related to HPV (human papillomavirus) infection. True or false?
- The Pap test is done to detect cancer of the uterus, cervix, ovary and colon. True or false?
Here are the correct answers: All are false except for question number 6.
If you made some mistakes, know that you are in very good company. When the doctors looked at the answers they found that both the English- and Spanish-speaking patients had correct responses only 35 to 60 percent of the time. What's amazing is that for just about every question, over 40 percent of the respondents were wrong. As a matter of fact, 50 percent or more of the people got questions 3 and 5 wrong.
To clear up this apparent widespread confusion over Pap tests, I want to go over each question and provide the correct facts:
- Regular Pap tests are not used to test for a Gonorrhea or Chlamydia infection. On occasion, specific cultures can be done from the fluid of a liquid Pap, but this test has to be specifically ordered and will add to the cost of the test. You can't assume a regular Pap has “cleared you” for either of these STDs.
- When you go to the ER and complain about a discharge (and frankly, that's the wrong place to go for this compaint) the doctor may check for STDs, bacteria and yeast, but routinely does not perform a Pap test. Most ER physicians will assume that a woman gets her routine Pap done by her primary provider or gynecologist.
- An “abnormal” Pap may signify that there are only minor changes in the cells, something called atypia (more specifically, atypical squamous cells of undetermined significance or ASCUS). In the absence of a positive test for human papillomavirus, this finding could have very little significance. So don’t assume the worst. Discuss every abnormal result with your physician; follow-up will be contingent on the degree and type of abnormality.
- Even if precancerous changes are found in the cervix, a hysterectomy is not usually necessary. Treatments to remove the abnormal portion of the cervix include freezing, laser or removal with a special electrical loop (LEEP).
- Most treatments for abnormal Pap tests are designed to protect your future ability to have children. Depending on the degree of treatment, cervical scarring can occur and, in rare instances, affect fertilization, labor, and delivery. There are several fertility therapies that overcome or bypass cervical problems, so sterility need not be a major complication of necessary and appropriate treatment for an abnormal Pap test. rightfalsefalse0truetrue25
- Yes, over 99 percent of the time cancer of the cervix is due to a human papillomavirus (HPV) infection, which is sexually transmitted. Seventy percent of sexually active young adults are exposed to and/or have 1 of 30 types of HPV. The types that are considered to be high risk are more likely to cause changes in the cervical cells’ DNA and subsequent mutations leading to cancer. But the virus needs to be there for a long time before this occurs. The good news is that most women have an immune system that fights off this virus and it usually disappears within two years unless reinfection occurs.
- The Pap can only detect cancer of the cervix. It doesn't “look for” cancer of the uterine body or lining, the ovaries or the colon.
Dr. Reichman’s Bottom Line: Know why you're getting the Pap, what it can show and what it can't show. Your Pap smear is a crucial test for the prevention and detection of cervical cancer and should be done on a timely basis.
Dr. Judith Reichman, the “Today” show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You will find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," which is now available in paperback. It is published by William Morrow, a division of HarperCollins.