Embrace the Pap Test; Cervical Cancer Is No Game

Latinas and low-income women suffer from it at a higher rate.

By Elizabeth Hsing-Huei Chou, EGP Staff Writer

Asking your boss for time off work, waiting for the nurse to call your name, getting poked in funny places by a doctor you barely know – all this to find out how much you have to pay. Going to the doctor’s office is no relaxing walk in the park.

But neither is cervical cancer. So, before waving off the hassle of getting tested or vaccinated, think for a moment about what it means to put off seeing a doctor.

Yes, ladies, cervical cancer is a cancer of the “you know what,” down there. And it is life-threatening. Last year in the United States more than 4,000 out of 12,000 women with cervical cancer died from it.

This is also a sexually transmitted cancer, which might make you turn red to think about it, but it is caused by a virus that half the population carries at one time or another. That makes you wonder, doesn’t it?

There is no shame in it, whether you are 15-years old or 55-years old.

So what does all this depressing news have to do with you? You may think you are one of those people who will turn out fine or that you are not sexually promiscuous, or you are thinking you’ll wait until you have money to pay for those big health bills.

But early stages of cervical cancer have no symptoms. If you have not had a pap test in years or ever, and you don’t plan on taking one anytime soon, then the only surefire way to find out might be when your doctor recommends chemotherapy or surgery. What will your life and health bills look like then?

As a radiation oncologist at White Memorial Hospital, Dr. Ana Grace only sees patients after they have been diagnosed with cervical cancer, and she says some women, “unfortunately, come into the emergency room bleeding” before finding out.

There is quite a bit of positive news, though, including the fact that getting tested can be relatively simple and low-cost, if not free.

According to Dr. Grace, if you catch cervical cancer early, when it is still “pre-invasive,” it is “completely curable” and takes no more trouble than a few visits to the doctor’s office.

Doctors recommend getting a pap test every two or three years to detect the early signs of cervical cancer, or getting vaccinated if you are between the ages of 9 and 26 to prevent it completely.

There are also many places to get a pap test for free or at a lowered cost, usually around $15 if it isn’t free, at a clinic or a health fair, said Dr. Grace. Vaccines are also provided for free to those up to the age of 18.

If the doctor finds those early signs of cancer, you may still have to go through some uncomfortable procedures to remove the cancerous cells by freezing them, Dr. Grace said, but you are ready to go back to living your life the same day.

As a cervical cancer survivor, 55-year old Maria Magdalena is considered lucky, but before becoming a “survivor” she went through the very unpleasant experience of having all of her reproductive organs removed as a result of her cancer.

The first alarming signs of her cancer came when she had non-stop bleeding in her cervix area for 29 days. She went to the doctor to find out what was wrong, but was shuffled around from doctor to doctor.

Magdalena did not actually find out she was suffering from cancer until a year and a half later, when she took a pap test after she missed taking them for over a year.

“When they told me ‘you have cancerous cells,’ I felt the earth shake, not because I was scared, but because so many things go through your head, and all the plans I had in three days, I could no longer do,” she said. “You feel like the rug has been pulled out from under you. It feels horrible.”

When Magdalena thinks about telling others her story, she says “nobody can experience something through someone else’s head, until it happens to you.”

She says “we need to have an open mind to prevention,” including with vaccines, which when given to children could carry a stigma.

“I have heard that to allow this vaccine to be administered is like opening the door for young women to have sex before it’s time – as we say in our culture. But I think that it comes down to one’s home, the roots that we have instilled in our children,” she said.

Just as important as giving children a “good moral” upbringing is giving them “health advice,” Magdalena says.

Medical professionals concerned that this stigma is keeping women and girls from getting tested or vaccinated are also saying there should be no shame attached to cervical cancer. About fifty percent of people, including men, carry the human papillomavirus, HPV, that causes it, says Dr. Grace.

The more modest or the more cash-strapped you are, the more doctors are concerned. In fact, Los Angeles County is looking at cervical cancer as a serious health problem for those who don’t get tested or vaccinated.

Many of them are immigrant or low-income women, according to numbers collected by the County. “Hispanic women are the ones being diagnosed at a later stage and often times they’re the ones that have not gotten a pap smear within the past three years,” said Dr. Diana Ramos of the Los Angeles County Health Department.

Cervical cancer seems to affect Latinas the most in Los Angeles County, with 14.3 out of every 100,000 women suffering from it. Asian and Pacific Islander women come in second, with 9.3 per 100,000 women.

But level of income has an even bigger correlation with the number of people suffering from cervical cancer – 20 out of 100,000 at the lowest income level get cervical cancer.

Whether there is a social stigma or a lack of insurance or money to pay for health bills, all of this pales in comparison to finding out too late that you have cancer, said Dr. Grace.

“As a society we need to be embracing pap tests and preventative measures to keep our mothers and daughters alive,” she said.

Dr. Grace and Dr. Ramos provided some numbers to call if you want to find out about local places to get tested or vaccinated, even if you don’t have insurance or you don’t think your insurance will cover the test.

Dr. Grace recommended the state’s cancer health hotline Every Woman Counts at 1-800-511-2300 to find out places to get tested. Dr. Ramos recommended calling the Los Angeles County Health Department at 1-800-793-8090 to find out about where to get a free pap test.

Gloria Angelina Castillo contributed to this story.

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January 27, 2011  Copyright © 2012 Eastern Group Publications, Inc.


7 Responses to “Embrace the Pap Test; Cervical Cancer Is No Game”

  1. Petra on January 27th, 2011 10:40 pm

    I always hated going to get a pap but now i have a cousin who is only 39 with cervical cancer and its too late…she is in hospice with only weeks to live. I see her aalmost every other day and it hurts sooo much to see her suffer and knowing she has two little boys who are going to have to live their whole life without mama…

  2. Elizabeth (Aust) on January 28th, 2011 11:49 pm

    Screening is also a gamble, there is no guarantee a pap test would have helped your cousin, Petra – this test is very unreliable and somewhere between a third and one half of the small number of women who get cervical cancer have had a recent normal smear or a series of them (false negatives) – sadly, it also produces large numbers of false positives which cause worry, fear and means that 77% of Australian women who test get referred for colposcopy and usually some sort of biopsy for nothing…some are left with cervical damage that can cause infertility, miscarriages, cervical stenosis, pre-term labour/premature babies etc…
    Almost all referrals are false positives – lifetime risk from this rare cancer is 0.65%…
    Only 0.45% of women are helped by smears, so it’s important to examine your risk profile. As a low risk woman, I passed on pap tests almost 30 years ago – far too much risk for me.
    It’s about time a reliable non-invasive alternative were released – I fear vested interests keep this test going – too many people making too much money from all of this harmful and unnecessary over-treatment and biopsies. (and the women left with health issues following unnecessary procedures like LEEP and cone biopsies) The CSA blood test was patented in 2003, but has not been released – it’s supposed to be very reliable – I fear women will have to fight if they want something better than this inaccurate test.
    It is always sad to hear of rare and tragic cases, but testing can also risk your health – make it an informed decision.
    See: Dr Joel Sherman’s medical privacy forum under women’s privacy issues and in the side bar you’ll find my references – see Angela Raffle’s research, Richard DeMay, Laura Koutsky etc

  3. Anonymous on August 16th, 2011 3:41 am

    Stop with the fearmongering! I will never embrace the @#$#2 pap test. It is degrading and painful for me. I am extremely low risk for CC. Why is it still used when a much more reliable and less humiliating test, the CSA has been patented? If doctors were truely concerned about women’s health the CSA blood test would be the new norm instead of the outdated, barbaric pap test. It’s all about the money. Doctors sacrifice women for their own financial gain. Damn, I hate doctors! Answer this question you evil doctors, why isn’t the CSA test available? Men wouldn’t put up with a yearly violation of their private parts. The medical community is so damned misogynistic!!!

  4. Elizabeth (Aust) on September 28th, 2011 4:08 am

    I read that only 5% of women have HPV by age 40, so I don’t understand why we don’t triage women using the HPV blood test and then we could identify those women “at risk” – if they want to test, so be it….but testing all women, the other 95% who are not at risk of cc is crazy – it risks their health from false positives. HPV negative women could be advised to have another HPV test if they take a new partner, which might change their HPV status. This mass testing just causes enormous harm to the more than 99% who’d never have an issue with this cancer. In Australia 77% are referred at some stage for biopsies, that’s horrifying for a rare cancer that occurs in less than 1% of women. (0.65%)
    Women should demand access to the HPV blood test and some respect for informed consent – the pap test suits doctors – the over-treatment is very lucrative and this expensive program is in place with lots of vested interests – they don’t care about harming and worrying women, just feeding their best interests.
    It’s not good enough…in fact it’s scandalous!

  5. Not taking it on March 12th, 2012 9:33 am

    Oh, silly media and your scare tactics. You’re promoting an utter scandal that women just buy into. I find this entire article to be perfectly suited for a tabloid magazine. There’s so much to ridicule, but allow me to correct three misleading points.

    1. This is a bit more than just an inconvenient trip to the doctor. This is about women exposing themselves in humiliating, degrading ways. I have heard a few firsthand accounts of women being outright insulted and treated like crap by these so-called “doctors”. Nurses barging in the room while women are naked with no regard to their privacy, gloves breaking because of long fake nails, expressing feeling pain just to hear “suck it up”. No, this isn’t just a trip to the doctor’s office. This is mentally damaging and can be physically harmful.

    2. A vaccine prevents cervical cancer completely? You obviously aren’t informed. Did you know Gardasil claims to protect against only four strains of HPV.. but there are more than 100? Did you know over 100 girls have died from the vaccine in the US alone? Did you know there is research pointing to the fact that Gardasil may INCREASE these young girls’ chances of getting cancer? http://www.canadiangardasilawarenessnetwork.com/

    3. I feel pretty terrible for that woman who was told she had cancerous cells. It must be the worst feeling in the world. But what if I told you countless women were receiving false positives because the pap smear is actually an unreliable test? How many women have suffered months of pain, fear, and anxiety waiting for their second test? How many have had unnecessary procedures like LEEPs and hysterectomies because of these false and misleading tests? Check this out: http://researchnews.osu.edu/archive/thinprep.htm

    Don’t fall for trap, ladies. Womanhood is not a disease.

  6. Flabbergasted on April 20th, 2012 8:39 am

    This article is utter nonsense.

    HPV not PAP should be the initial screen. PAP is secondary for those found HPV positive (or otherwise symptomatic). Why? HPV causes most dyplasia and it is far more sensitive and specific than PAP which suffers from huge error rates. Indeed it is these error rates that lead to too frequent testing (annual) which produces a false positive problem (i.e. your lifetime odds of false positive referral for biopsy approaches 85%).

    This is flat-out unacceptable but women don’t ever hear the full story.

    1. You’re told you need a PAP for birth control script. Not true. Never was true. Unrelated. Just a way to force compliance without consent.

    2. You’re told that PAP brought down cervical cancer incidence. Very likely untrue since incidence was in rapid decline BEFORE PAP ever rolled out. Much more likely that reduced smoking rates and increased aspirin consumption did the trick.

    3. You’re told PAP is accurate (or not told how inaccurate it is). If you had a clean PAP and think you’re bulletproof think again. False negative rates are as high as 30% and false positives are in the 5-10% band.

    4. You’re not told that this hunt for dysplasia (funny cells) that we’re on at the cost of hundreds of billions annually is a fools errand. Every human system has dysplasia and we don’t know which will progress. We do know almost all resolves on its own.

    5. You’re told your bits and pieces are complex and out to get you (deadly cervical cancer). Truth be told, men’s prostates are a much bigger issue and cervical cancer is very uncommon and very slow growing.

    6. You’re told there is not a better way. Well, HPV testing can be done in your home (vaginal swab). Self-collection of cervical cells for PAP has been demonstrated. Stirrups are not required. Etc. Etc.

    Look, PAP has been a way to coerce women for decades now. That’s why it took ACOG 22 years longer than the ACS to come out with the 3 year…

  7. Flabbergasted on April 20th, 2012 8:53 am

    PAP testing is a bad joke.
    1. HPV should be the front-line screen not PAP (PAP okay for HPV positive or symptomatic). The problem is that HPV specimen collection can be done in the home making it ill-suited for coercing office visits (compliance). HPV testing is far more sensitive and specific.
    2. PAP has a huge false negative error rate. To compensate, US healthcare tests too frequently. This creates a different problem. With false positive rates in the 5-10% band, lifetime risk of being referred for a biopsy approaches 1 when PAPs are administered annually. With the possible exception of Germany, all other countries recommend PAPs in the 3-5 year frequency range.
    3. PAP is credited by your doctors for the decline in cervical cancer incidence. But the incidence of cervical cancer was in free-fall before PAP rolled out. Much more likely, decreased smoking rates and increased aspirin consumption (plus intense exercise for women) is the cause of the decline.
    4. Cervical cancer is uncommon and slow-growing. It’s reasonable to think that cervical and colon cancer screening frequencies with ultimately converge in the 5-7 year band.
    5. If you look at mens healthcare, you might be struck at the difference in approach. Prostate cancer incidence is very high. It does kill (credited with 30K lives per year) and yet there is no screening recommendation. Why? PSA is directional and Digital Rectal Exams are notoriously inaccurate (note: fingers don’t “see” cancer very well, something to keep in mind as asymptomatic women ponder the necessity of pelvic exams). So until the medical technology improves, not much point. If we were honest about PAP, you’d hear something similar (and, ironically, medical technology has improved for cervical cancer screening, in the form of HPV testing).
    6. But because patients and providers are indoctrinated and the system doesn’t share all the facts with patients in particular, this travesty continues under…

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