Dear Dr Mitchell,
I am 29, not sexually active at present, but I already have a child. I did my last pap smear sometime after the birth of my child four years ago. I have had sex just a few times since, and I have no problems with infections or pain, or anything that has been serious enough to visit a gynaecologist. Do I have to still worry about getting pap smears done every year? I find that things like doctors' visits take time, and I have a very busy schedule.
The pap smear or cervical smear is an extremely important test for women to do regularly even if they are not currently sexually active. The usual recommendation that is followed in Jamaica is for all women 21 years and older who are sexually active to do a pap smear every year. If, however, sexual activity is started before age 21 years, then a pap smear should be done three years after starting sexual activity. In addition, all women 30 years and older should have a pap smear irrespective of whether one is sexually active or not. At the age of 70 years, if all pap smears have been normal over the past 10 years, then yearly pap smears may be discontinued. If, however, a woman over 70 years, remains sexually active and falls in one of the high-risk categories, then regular pap smears are definitely needed.
In some developed countries where there is ready access to health care and a comprehensive screening system is in place, pap smears are done every two to three years instead of every year. However, in these countries the incidence of cervical cancer is low compared to developing countries where the incidence and death from the disease is high. Women who delay doing pap smears up to five years are at greatest risk of presenting with cervical cancer. The pap smear may be totally normal and may miss cervical cancer in some women who have the disease (false negative pap), however. In countries where the incidence is high -- especially in the Caribbean, Sub-Saharan Africa and Latin America -- it is important that frequent screening continues.
Cervical cancer is a sexually transmitted disease caused by the Human Papilloma Virus (HPV). This HPV can be detected by doing a swab of the secretions from the cervix at the same time the pap smear is done. This helps in reducing the number of false negative pap smears. If one of the high risk HPV types is detected, then a closer follow-up is needed even if the pap smear is normal and this allows for earlier detection of possible precancerous changes or even cancer of the cervix.
The good news is that cervical cancer can be prevented by vaccination. The four main HPV types that cause cervical cancer worldwide are the HPV types 16, 18, 45, and 31. These account for over 80 per cent of all cases of cervical cancer. Vaccination should start from as early as 10 years before exposure to the HPV and sexual intercourse. The response to vaccination is best seen in children since they mount an excellent antibody response which is important to destroy the HPV before it can get into the tissues to cause precancerous changes and then cancer of the cervix. Vaccination of older sexually active women has been shown to be effective and beneficial and women up to the age of 55 years have been known to show a good response to the vaccine CERVARIX.
The HPV also causes cancer of the mouth, throat, anus, vulva, and vagina. Vaccination will also help to reduce the number of women who will develop these cancers. The vaccine can be taken even if you have had the HPV in the past. Most women will naturally clear the infection on their own within six to 18 months and the vaccine will then protect them in the event that re-exposure to the virus occurs. Essentially, all women from 10 years to 55 years will benefit from vaccination. Vaccination does not cover against all types of the virus though it covers the majority, and so pap smears should still be done to pick up those few cases that can occur due to other less common HPV types.
Cervical cancer is the second most common cancer in women, second only to breast cancer. It is well worth spending the time to get your pap smear and breast examination done once per year or as often as your doctor has advised you. You have a child to live for so it is extremely important to take the best care of yourself, the time spent will be well worth it in the long run. Consult your doctor about the HPV vaccine at your next visit for your pap smear. The programme involves giving three vaccines over a six-month period. Best wishes.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@ jamaicaobserver.com; mail c/o All Woman, the Jamaica Observer, 40-421/2 Beechwood Ave, Kingston 5; or fax to 968-2025. See responses to your questions in All Woman. We regret we cannot provide personal responses.