Cervical cancer testing

Tamika L. Felder was an ambitious freelance television producer in Washington, D.C. She maintained a healthy diet and was diligent about getting medical checkups, including a yearly Pap test to screen for cervical cancer. Because her test results were always normal, Felder began to take them, and her gynecological health, for granted. So when a job change left Felder temporarily without health insurance, she was unconcerned. "I knew I needed to go to the gynecologist, but since I wasn't sexually active at the time, I thought I could let it slide for a while," she says.

But Felder's "temporary" insurance lapse stretched to two years without a medical checkup. When she finally saw a gynecologist for a routine exam and Pap test, she was diagnosed with an aggressive form of cervical cancer. A week before her twenty-sixth birthday, Felder had to undergo a radical hysterectomy.

THE PAP TEST CONTROVERSY

Cervical cancer is one of the most curable forms of cancer. In fact, for the general population, the five-year survival rate for the disease is 71 percent. But African-American women are more than twice as likely to die of cervical cancer as White women because far too many of us, for various reasons, don't get regular Pap tests. That's why some question the recent decision by the American Cancer Society (ACS) to relax their guidelines for how often women should get cervical-cancer screening. In effect, these new recommendations could prove to be deadly for Black women.

These new guidelines suggest that women age 30 or older who have had three consecutive normal Pap results be screened only every two to three years, and that Pap tests be done annually only if the traditional Pap evaluation method is used. If a newer, more accurate liquid-based test is used, the ACS suggests a woman be screened only every two years. Ironically, Felder fell into the latter category, because her previous tests had been normal. Yet waiting two years nearly claimed her life.

The ACS says the new guidelines were developed, in part, to reduce the number of unnecessary procedures performed on women with abnormal but inconclusive Pap results. But some doctors worry that the revised policy will cause women, particularly African-Americans, to put off getting tested--which could have alarming consequences. "The danger with the new guidelines is that they appear to be more lenient about cervical-cancer screening," warns Robert Bristow, M.D., a gynecologist-oncologist and assistant professor at Johns Hopkins Medical Institutions in Baltimore. "Women who should be getting a Pap smear every two to three years may think they're no longer that important and delay being tested for five or seven years."

Hilda Hutcherson, M.D., an ESSENCE columnist and assistant professor of OB-GYN at Columbia Presbyterian Medical Center in New York City, goes a step further and rejects the new guidelines outright. "I continue to tell women to get cervical-cancer screening every year," Hutcherson says.

Proponents of the new guidelines say that they are just that--guidelines--not hard-and-fast rules. "Doctors should assess each patient individually as to how often she needs a Pap smear based on her cervical-cancer risk, age, medical history, number of sexual partners and the screening tests used," says Paula Hillard, M.D., a gynecologist who served on the ACS task force that developed the guidelines.

Today, at age 28 and cancer-free, Tamika Felder has devoted herself to educating women about cervical cancer through lectures and a self-published E-newsletter. Not surprisingly, Felder also thinks women should have yearly Pap tests. "I always wanted to have a huge family," Felder says. "Now all I can do is wonder if having a Pap test earlier could have saved my chance to have kids."

Making Sense of Pap results

Doctors use these terms to describe cervical-cancer-screening results:

Negative There are no signs of cancer, precancerous changes or other significant abnormalities present.

ASC Atypical squamous cells. This reading indicates that abnormal cells are present but are not precancerous. Your doctor will run a test for human papillomavirus (HPV) and, depending on previous Pap results and the presence of other risk factors, perform a cone biopsy (the removal of a cone-shaped tissue sample from the cervix) or a colposcopy (the examination of the vagina and cervix through a lighted microscope).

SIL Low-grade, high-grade squamous intraepithelial lesion. Often called dysplasia, a low-grade SIL shows an early precursor to cervical cancer that frequently goes away without treatment. A high-grade SIL diagnosis, which suggests the presence of a high-grade cervical precancer, requires treatment to prevent cancer from developing. Your doctor will do a colposcopy following this result.

AGC Atypical glandular cells. This is an abnormality that may be associated with precancers or adenocarcinoma (a malignant tumor originating in glandular tissue). Your doctor will probably recommend a colposcopy.

THE CERVICAL CANCER 'BUG'

Human papillomavirus (HPV) is one of the most common sexually transmitted diseases in the United States. An estimated 5.5 million new cases occur each year in this country, and approximately 20 million Americans are currently infected, according to the Centers for Disease Control and Prevention. Unlike many other STDs, this virus does not need to be in bodily fluids to be transmitted--it can be passed through skin-to-skin contact, so condoms offer little protection. HPV can cause genital warts, flesh-colored growths that can appear on the vulva, in and around the vagina, cervix and anus, or on the penis, scrotum and around the anus in men. In addition, the virus can go away on its own, or stay with you indefinitely and pass unnoticed from person to person. More alarming, doctors now know that certain types of HPV cause more than 90 percent of all cervical cancers, though the mechanism is unclear. Yet many women are unaware of the link between HPV and cervical cancer. In one national survey, 70 percent of women didn't know what caused cervical cancer, and 76 percent had never heard of the virus.

HPV Test

A test for the human papillomavirus (HPV) was recently approved for widespread use by the Food and Drug Administration (FDA). The test can identify 13 strains of HPV that are responsible for most cervical cancers.

Q Who should get the HPV test?

A The FDA recommends the test for women over age 30. While teenagers and women in their 20s are more likely to get HPV because they tend to have more sexual partners, the virus usually clears up on its own. But this is less likely to happen for women over 30.

Q How often should I be tested?

A Women who opt to be tested should have it done every three years and at the same time as the Pap test.

Q What does a positive result mean?

A It means you've been exposed to HPV, but it doesn't automatically mean that you have cancer. Debbie Saslow of the American Cancer Society (ACS) says HPV is very common. In fact, ACS projects that three of every four people will get an HPV infection during their lifetime. Only relatively few strains of the virus can lead to cervical cancer; it's the persistent ones that cause concern. Testing positive once isn't necessarily alarming, says Saslow. "But testing positive two or three times in a row means a somewhat increased risk of cervical changes that have the potential to become cancer down the road."

Q Should I still get a Pap test too?

A Yes. The HPV test is not designed to take the place of the Pap test, but rather to be used in combination with it.

Q Is there any danger if women in their 20s get tested?

A There is potential for harm, says Kenneth Noller, M.D., chairman of the OB-GYN department at the Tuffs-New England Medical Center in Boston. Frequent testing of younger women could lead doctors to prescribe unnecessary treatments that could cause scarring or infertility later on.--Nicole Saunders

PROTECT YOURSELF

Researchers are developing an HPV vaccine. While early results have been encouraging, it will be at least another five to seven years before it will hit the market. Until then, here's what you can do to protect yourself:

PRACTICE ABSTINENCE.

STAY MONOGAMOUS. If abstinence is not an option for you, have sex with only one partner who has sex with only you.

DON'T RELY ON CONDOMS. HPV is spread by direct skin-to-skin contact during vaginal, oral and anal sex, and condoms don't cover all genital skin. And forget over-the-counter protection. Spermicidal foams, creams, and jellies won't protect against HPV and genital warts.

BUTT OUT. Studies have shown that women who smoke are at increased risk of developing dysplasia (a precancerous condition) or full-blown cervical cancer if they have a "high-risk" HPV strain.

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