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Thursday, March 31, 2016

Pap smear: Early detection saves life

I am not a public health expert nor a specialist, the reason for me to write this article is because I am concerned that people (died and )might die of the preventable cause.

So it is cervical cancer that I am going to throw a little light and the ways to prevent it. Cervical cancer affects the cervix of uterus in the female reproductive system. In Bhutan, cervical cancer is the most common cancer diagnosed in women. More than half are diagnosed in late stages, leading to high mortality.  The morbidity and mortality associated with this cancer has impact not only on the life of these women, but also on their families.

Fig. 1.shows cervix affected by cancer
(Source: Google images)

A woman with cervical cancer lives with bleeding, foul smelling discharge, leaking urine/feces or severe pain for many months. She dies when she is still socio-economically productive leaving behind children who are small or dependent. Besides, the government spends a lot of money getting these patients treated in centers outside Bhutan. Cervical cancer is still the most common cancer referred for radiation. This is a cancer that is not only curable if diagnosed early, but is also preventable if detected early, with availability of good screening program.  

Risk Factors
ü  Early age at marriage is one of the most important risk factors.

ü  Multiple sexual partners increase the risk of exposure to HPV infection.

ü  Low socio-economy and low education: Women of low socio-economy are more likely to either not enroll in school or drop out early leading to early marriage and have more children. Due to low literacy, they are also less likely to participate in screening due to ignorance and lack of awareness.

ü  Smoking: Nicotine and by products of smoking are thought to increase a woman’s relative risk for cervical cancer because their concentration in the cervical mucus decreases the immune capability of the cervical tissue.

ü  Immuno-suppression: Immuno-suppression due to any reason leads onto persistence of HPV infection with more likelihood of developing cellular atypia. HIV positive women are at higher risk of developing cervical cancer. Cervical cancer is one of the AIDS defining cancers.

ü  Lack of screening program: Lack of an effective screening program also acts as a risk factor. Women who regularly undergo screening and adhere to follow up and treatment are unlikely to get cancer compared to those who never do it.

Symptoms of cervical cancer;
·       Abnormal vaginal bleeding;
·       Excessive or foul smelling vaginal discharge;
·       There may be urinary frequency and backache;
·       In advanced cases, there may be:
o   Pain in the pelvic region or lower limbs;
o   Swelling of lower limbs;
o   Renal failure in late stages;
o   Passage of urine and feces from  vagina;
Cervical cancer may remain silent for many years till it is well advanced.  Pap smear can help in early diagnosis and treatment.

Fig.2 shows the stages of cervical cancer(source;google images)

Cervical cancer can be prevented by vaccination against HPV (currently HPV vaccination is provided to girls in class VI ) and early detection through pap smear screening.

Pap smear is a proven method for cervical cancer screening. Pap smear studies the cells leading to identification of women with abnormalities in the cervix. In Bhutan, Pap smear screening services are available in BHUs and Hospitals. However, despite the free screening services, incidence and mortality due to cervical cancer did not change significantly over the past years. One of the reasons for this could be lack of awareness among women on this service. Even if women are aware, some do not avail the service. Some of the reasons I often hear is “I feel shy”. ‘I am scared it might be painful’. ‘I have no time’

If you are shy; just know that cervical cancer is even more painful than your shyness. It only takes 3 to 5 minutes to get a Pap test and it’s not a very painful procedure.

When should women get Pap smear done? 
·       Pap smear should be done 7 to 10 days after menstruation stops;
·       In women with amenorrhoea or in menopause or who had hysterectomy, it can be done any time;
·       In women who have delivered or had an abortion/miscarriage, it should be done after three months.

In Bhutan, target population for Pap smear is all women between 25 to 65 years of age regardless of HPV vaccination status. All women who are or were sexually exposed should participate in screening or do Pap smear

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