Screening for Cervical Cancer
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The purpose of screening is early diagnosis and treatment. Screening tests are usually administered to people without current symptoms, but who may be at high risk for certain diseases or conditions.
The number of new cases and deaths due to cervical cancer is decreasing each year. Experts agree that this is due to early detection and treatment. Early detection and treatment are possible due to the widespread availability and use of cervical cancer screening methods—the pelvic exam and Pap test.
Pelvic exam —This test is performed in a doctor’s office. You will change into a dressing gown and lie back on the examination table. There will be stirrups at the end of the table where you can rest your feet. The doctor may complete other aspects of a physical exam first, including examining your thyroid gland, heart, lungs, breasts, and abdomen. As part of the pelvic exam, your external genitalia will be examined for signs of infection or redness. Next, the doctor will slide a speculum into your vagina. The speculum allows the vagina to be opened slightly. This should not hurt or pinch, but may be uncomfortable. You also may feel a bit nervous or anxious. Try to take slow, deep breaths to help yourself relax.
At this point, the doctor will perform a ]]>Pap test]]> (see below for a description of this procedure). The doctor may also perform additional tests at this time to check for sexually transmitted diseases, such as chlamydia or gonorrhea. After the doctor is done, the speculum will be removed. The doctor will then place two gloved fingers into your vagina while pressing on your lower abdomen. This identifies the size, shape, and position of your uterus, fallopian tubes, and ovaries. The doctor may then place one finger in your vagina and one finger in your rectum to examine the tissues separating those organs.
You should not feel pain during the exam, but you may experience a pressure discomfort. If you are experiencing pain, tell your doctor. You may have a trace of vaginal bleeding afterwards from irritation of your cervix.
Pap test —The Pap test is performed during the pelvic exam. Once the doctor has inserted the speculum into your vagina, your cervix will be visible. The doctor will use a flat stick or a soft brush to collect a sample of cells from the outer cervix and its canal. These cells are placed on a slide or suspended in an aqueous solution and sent to a laboratory for evaluation. Your doctor should have the results of your Pap test in 1-3 weeks. If any abnormalities are found, your doctor will call you and discuss follow-up care.
Prior to your scheduled pelvic exam and Pap test, it is important to keep in mind the following things:
- Do not schedule the Pap test during your menstrual period. If possible, schedule it two weeks after the first day of your period.
- Do not use vaginal creams, medications, or douches for 72 hours before the test.
- Do not use contraceptives, such as spermicidal foams, creams, or jellies, for 72 hours before the test.
- Do not have intercourse for 24 hours before the test.
The Pap test is the oldest effective screening test for cervical cancer and remains a mainstay in early detection. It is important to get tested regularly, as determined by the needs of your health. Women with increased risk factors, such as ]]>HPV]]> or previous abnormal tests, need tests more often than others. Discuss with your physician how often you should be tested. If you are uninsured or if your insurance will not cover the frequency of examinations your physician recommends, contact your local cancer society to see what resources are available to assist you.
The American Medical Association recommends the following guidelines for cervical cancer screening:
- Annual Pap test and pelvic examination starting at age 18.
- Annual Pap test and pelvic examination at onset of sexuality activity, if earlier than age 18.
- After 3 or more normal annual Pap tests, the Pap test may be performed less frequently at your doctor's discretion.
American Academy of Family Physicians website. Available at: http://www.aafp.org/online/en/home.html .
American Cancer Society website. Available at: http://www.cancer.org/docroot/home/index.asp .
American Medical Association website. Available at: http://www.ama-assn.org/ .
National Cancer Institute website. Available at: http://www.cancer.gov/ .
Last reviewed February 2009 by ]]> Ganson Purcell Jr., MD, FACOG, FACPE ]]>
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