Pap Smear

What is a Pap Smear? A Pap Smear is a screening test for cancer of the cervix (the passageway between the vagina and the uterus). For women, a Pap Smear can also be used to screen for non-visible Human Papilloma Virus (HPV) infection. The Pap Smear is not a specific test for HPV, although sometimes the results suggest that HPV might be present.

Your clinician will determine whether you need a pelvic exam and Pap Smear, based on your age and medical history. You should have routine Pap Smears if you are 21 or older, or you became sexually active at least three years ago, even if you are younger than 21 or are not currently sexually active

A Pap Smear is a procedure performed by your clinician during which a sample of cells is taken from your cervix using a small brush or swab.

This procedure is usually painless, although some women may experience minor discomfort. Cells from the Pap Smear are then examined for any abnormal microscopic appearances, which can include changes caused by HPV infection. There are several different systems used to report the results of a Pap Smear. UHS uses a method called the Bethesda system.

HPV infection of the cells on the cervix can lead to changes in normal cell metabolism and the formation of precancerous cells, a process called dysplasia. A Pap Smear can detect these abnormal cells. Since there are no signs or symptoms of dysplasia, it is important to get a Pap Smear regularly if you are sexually active.

Human Papilloma Virus or HPV is the most common sexually transmitted disease (STD) among college students today. It is estimated that up to 50-60% of sexually active female college students are infected with HPV at some point during their college years. There are more than 100 different types of the virus. Some types of HPV cause warts on hands or feet, others cause genital warts and some can have no visible symptoms at all. When no visible symptoms of HPV are present, the infection is called subclinical.

Most people with HPV, especially those with a subclinical infection, do not know they have it. It is estimated that 70% of individuals with HPV may be unaware that they are infected because they do not develop visible warts or abnormalities on their Pap Smears.

HPV Vaccination is available for individuals from age nine and older that have not yet been exposed to HPV - it reduces the risk of pre-cancer changes by 70% and reduces the risk of external genital warts.  The vaccine is given intra-muscularly in three sessions over a six-months period.

Transmission HPV is usually contracted through vaginal and/or anal sex. It is possible, but unlikely, for it to be contracted through oral sexual contact. Direct skin-to-skin contact easily spreads the infection--the virus is not transmitted through blood or body fluids. Actual intercourse with penetration is not necessary to transfer this infection. Transmission can occur with same sex or opposite sex partners. Although the types of HPV that cause visible warts spread more easily, people infected with subclinical HPV, who show no signs of infection, are also contagious and can infect others. There is at least a 64% chance of contracting HPV with each act of unprotected sex with an infected partner.

What is the relationship between HPV and cancer? Several types of HPV that cause subclinical infection and dysplasia can develop into cervical cancer. However, cervical cancer is extremely rare among young adults because the immune response is effective in most cases. Early changes are found on Pap Smear results and can be treated before cancer develops. Regular Pap Smears combined with appropriate follow-up treatment can practically eliminate the risk of developing cancer.

Certain other factors may increase the risk of cervical cancer, the most common of which include: a history of many sexual partners (or a partner with such a history), a history of sexually transmitted diseases, sex before the age of 21, a weakened immune system, smoking, poor diet, or the presence of other infections. Using a condom during sexual activity may decrease the risk of cervical cancer.

Cervical cancer does not develop overnight. Precancerous and cancerous changes usually occur over a period of many years. Regular Pap Smears may be used to monitor HPV infections that seem likely to lead to cervical cancer.

If the Pap Smear is mildly abnormal, more frequent Pap Smears may be the only recommendation. If more severe dysplasia is found, or if there are several atypical Pap Smears, a colposcopy and biopsy will be recommended. If your biopsy confirms the presence of precancerous or cancerous cells, treatment may be appropriate. If cervical cancer is present and if left untreated, it may spread to other parts of the body and eventually cause death.

Treatment of subclinical HPV Some experts say that there is no proven benefit to treating subclinical HPV infection that is not precancerous. While removal of abnormal cells may reduce the amount of virus in your system, it may also cause scarring on the cervix. In the majority of cases, abnormal cells will disappear on their own without treatment. It is important, however, that health care providers watch carefully for precancerous changes on the cervix that may be found along with HPV infection.

Treatment of precancerous cells or dysplasia, which may lead to cancer, is very important. The goal of treatment is to prevent the development of an actual cancer or prevent its spread to deeper tissues. The clinician must often seek to remove not only the abnormal cells but some of the surrounding tissue as well.

Options for treatment include electrosurgery, traditional surgery, laser surgery or cryotherapy. It is important to discuss treatment options with a knowledgeable clinician to make an informed choice regarding your care and follow-up.

Prevention You can reduce your risk of contracting HPV by not having sex or genital contact with anyone or by limiting your number of sexual partners. People with many sexual partners have a greater risk of contracting HPV and other STDs. Condoms and latex dams will provide some protection but may not cover the entire affected area of the genitals, thus some contact with infected skin can still take place. On the other hand, condoms are very effective at preventing the spread of other STDs, including HPV, and should be used consistently with each sexual act.
 

Mammogram & Diagnostic Services
Mammogram is a low-level x-ray of the breasts that can detect cancer at its earliest stage. It can also show other changes in the breast that doctors believe may suggest cancer. At our Center For Comprehensive Women's Health we offer a full spectrum of services, including:
 

Screening Mammograms For those with no current breast problems. Screening mammograms can be scheduled with or without a physician referral. To offer easier access than ever, we have expanded the hours on Monday and Tuesday evenings at Mercy Hospital.   Diagnostic Mammograms For a follow-up from a screening or for those with a current breast problem. If a screening mammogram indicates a potential problem, your physician will want to schedule for a more sophisticated test.   Diagnostic Ultrasound Using sound waves to produce an image, today's advanced equipment can image all soft tissue organs in the body, as well as veins and arteries, in a safe and painless procedure. Mercy's Accredited Vascular Laboratory works closely with the Breast Health Resource & Lymphedema Center and Mercy's Mammography Centers to provide patients with the most complete array of care possible.

Why is Mammogram performed?

Mammogram is performed to screen healthy women for signs of breast cancer. It is also used to evaluate a woman who has symptoms of a breast disease, such as a lump, nipple discharge, breast pain, dimpling of the skin on the breast, or retraction of the nipple.

Screening mammograms are important for early breast cancer detection. The American Cancer Society recommends mammogram screening every year for all women age 40 and older. The National Cancer Institute recommends mammogram screening every 1 to 2 years for women age 40 and older. Experts recommend that certain women at high risk of breast cancer should also have a breast MRI along with their yearly mammogram. Ask your doctor if you need an MRI.

Guidelines from the American College of Physicians, however, debate whether women with a low risk for breast cancer should begin mammogram screening at age 40. The 2007 guidelines, instead, recommend that women in their 40s ask their doctor when they should begin having the test.

In addition to mammography, clinical breast exams (where the clinician palpates with the fingers) and breast self-examinations are important for breast cancer screening. Women age 20 and older should receive clinical breast exams every 3 years; women age 40 and older should receive clinical breast exams every year. The American Cancer Society recommends that all women age 20 and older perform monthly breast self-examination.

These are general recommendations for mammography, clinical breast exams, and breast self-exam. Women should discuss with their personal physician how often to receive breast cancer screening, including mammography and clinical breast exam. Recommendations vary depending on personal risk factors such a strong family history of breast cancer.