The answer to cervical cancer

Why women should continue getting Pap tests, even after menopause

Author: Patricia Palmer Hurd
Posted: Tuesday, January 01, 2008
Cervical cancer. The quiet little cancer. The one that doesn’t get a great deal of attention, and yet will still take the lives of 3,670 women this year. Women of all ages are at risk, but half of those diagnosed are between the ages of 35 and 55, with the average age of diagnosis of 47 years.

Ania Szpakowski of Scarsdale is one of those women touched by cervical cancer. The 57-year-old put everything else before her health: her family, her friends, her busy job traveling all over the world as a global division representative for a large insurance company. There never seemed a free moment to schedule a doctor’s appointment.

“I felt fine, no symptoms, completely healthy. So I didn’t think it was necessary to have an annual exam and Pap test,” Ania says.

Ania is not alone in this. Between 60-80 percent of women with newly diagnosed invasive cervical cancer have not had a Pap test in the past five years.

In April 2007, Ania was flying home from a business trip, and started experiencing heavy vaginal bleeding. “I remember my friends and myself joking about it,” says Ania, “because I was post-menopausal – my last period having been over a year and half ago.

“I thought perhaps my period had come back,” Ania explains. “I have since found out that once a woman has completely gone through menopause, any bleeding should be checked out.”

The bleeding lasted more than a week, so Ania scheduled a doctor’s appointment. She didn’t think it was anything to worry about; her only symptom was the bleeding, and she didn’t have any pain at all.

An examination and Pap smear revealed that Ania had Stage II cervical cancer. She spent the following six weeks undergoing chemotherapy, external radiation, and then internal radium implants. Finally, her life would be back to normal again.

And then the unthinkable happened. While undergoing cervical cancer treatment, the doctors discovered that Ania had breast cancer in her left breast. Ania took a deep breath, had a lumpectomy, and found herself battling two cancers. She was advised that these two cancers were not connected; however, her risk factor was that she had a history of smoking.

“I feel very glad that I caught my cervical cancer in time,” Ania says. “I now feel strong and healthy again, and am diligent about follow-up care.”

“My advice to all women is to get annual exams and Pap tests,” claims Ania. “This is one cancer that is symptom free until it’s too late.”

Cervical cancer is a preventable, treatable disease if detected early, yet some women fail to get tested, often women over 60. Many older women believe they no longer need Pap smears, thinking they are not at risk for cervical cancer because of their age, or because they are not as sexually active, or perhaps because they have had a hysterectomy. In reality, these women need Pap tests because their risk may actually be higher.

Because slightly more than 20 percent of women with cervical cancer are diagnosed after 65, it’s vital that women continue to have regular Pap tests at least until age 70, and possibly longer depending on their risk factors. Experts say it’s critical that postmenopausal women continue getting regular Pap tests if they still have a cervix. In fact, even if a woman’s cervix was removed during a hysterectomy, if she had a suspicious Pap test prior to surgery, she should continue having Pap tests.

According to George Hagopian, MD, a gynecological oncologist from Mount Sinai Medical Center in New York City who is also affiliated with St. Luke’s Cornwall Hospital in Newburgh, many women simply stop getting Pap tests after the birth of their last child. “By the time I see them,” Dr. Hagopian says, “they have cervical cancer. Many women aren’t aware that cervical cancer can, indeed, be a rough disease.”

The benefits of the Pap test are clear: the death rate of cervical cancer has declined by
74 percent since the Pap test was introduced in the 1950s.

Tom Morrissey, MD, of Vassar Brothers Medical Center in Poughkeepsie, claims that of the 1½ million abnormal Pap tests that occur each year, the cases that were detected early will have a 97-99 percent chance of survival.

“It’s vital to detect cervical cancer in Stage 1, before it has spread to any vital organs,” Dr. Morrissey says. “The one single test that can determine that is the Pap test,” Dr. Morrissey says. “You can lower your chances of getting pre-cancers of the cervix by reducing your exposure to HPV [human papillomavirus, a sexually transmitted disease],” claims Dr. Morrissey. “It’s vital that women are mindful of this.”

Cervical cancer tends to grow slowly. It can remain in an early stage, confined to the cervical covering, for 2 to 10 years, not usually causing any symptoms. Once cancer moves beyond this layer, it invades nearby tissue, including the main body of the uterus, the vagina, bladder and rectum.

Symptoms of more advanced disease include bleeding or spotting between periods, bleeding after sex, periods that last longer and are heavier than usual, bleeding after menopause, more vaginal discharge than normal, pain in the lower back or pelvis, and pain during intercourse. Because these symptoms may also be caused by other health problems, an exam and Pap test are necessary to make an accurate diagnosis. The goal of screening for cervical cancer is to find cervical cell changes and early cervical cancers before they cause symptoms.

A woman can reduce her risk of cervical cancer by getting a regular annual gynecological exam and Pap test, limiting the number of sexual partners she has, quitting smoking, using condoms, and following up on an abnormal Pap smear.

After the diagnosis: how cervical cancer is treated
“The stage of cervical cancer is the most important factor in determining treatment,” says Dr. Hagopian.

In Stage 0, treatment options are cryosurgery, laser surgery, LEEP procedure, and conization, with a 99-100 percent survival rate after five years. In Stage 1, treatment will be a radical hysterectomy, which involves the removal of the uterus, the cervix, the upper part of the vagina, and supporting tissues. With hysterectomy, patients have an 85-95 percent survival rate.

In Stages II-IV, considered advanced cervical cancer, a combination of chemotherapy with cisplatin and internal and external radiation is recommended. Stage II has a 65-70 percent survival rate, and Stage III and early Stage IV, a 40-50 percent survival rate.

“I’m very excited about the National Cancer Institute’s recommendation of using a PET scan, CAT scan, and MRI prior to surgery in patients that we suspect have advanced cervical cancer,” says Dr. Hagopian. “These diagnostic studies provide us with a full clinical picture before we determine treatment.”

Dr. Hagopian performs utilizes Da Vinci Robotic surgery for cervical cancer, as well as other gynecological conditions. This allows greater precision, is less invasive, and minimizes the pain for the patient, increasing the likelihood of a faster recovery.

Cervical cancer is one of the most preventable types of cancer. With regular Pap smears, cervical cancer can be prevented in just about all cases. The Pap test is the simplest and best tool to detect cervical cancer in its earliest stage.

“No excuses, get tested annually. It can save your life,” urges Ania Szpakowski.

The American Cancer Society recommends that women ages 30-69 should have a Pap test every two to three years if they’ve had three normal Pap smears in a row, but preferably annually. Women ages 70 and older may stop having Pap smears if they’ve had normal results three tests in a row and they’ve had normal Pap smears over the past 10 years. January is cervical cancer screening month, so make your appointment today!

Patricia Palmer Hurd is a Orange County freelance writer specializing in health-related issues.

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