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March 28th, 2009

8:04 PM

One thing we can learn from Jade Goody

Is the importance of going for regular Pap tests. December Quinn/Stacia Kane made an excellent blog entry about this.

I didn't sit for the exam to get the necessary paper qualification, but I did learn how to read Pap smear slides during my post-graduate days. I hadn't read a Pap smear slide in years but I think I can still remember correctly what that is is all about, heh.

A Pap smear slide is just that - a slide smeared with a swab taken from your cervix. After the slide is dipped in a series of dyes and fixatives, a cytologist or trained cytotechnician (usually a cytotechnician in this part of the world - the cytologist usually gets involved only to confirm abnormal cases detected by the cytotechnician) will take a look at your slide under the microscope and scan the slide, which contains thousands of cells in a well-done smear, for any sign of abnormality in the cells. The person will ask himself or herself these questions: Are the nuclei too big compared to the volume of cytoplasm? Do the nuclei show features that are not normal? More often than not, many Pap smear slides are normal. However, a careful and well-trained cytotechnician will notice even if a single cell looks abnormal enough to warrant further check-up and male note of this in the report. One cell is all it takes to sound the alarm.

"ASCUS" or "ACUS" means "atypical (squamous) cells of uncertain significance". Sometimes you may see "AGUS" in the report, which means "atypical glandular cells of uncertain significance". Squamous and glandular cells are names of types of cells - let your doctor worry about the differences between the two types of cells. For you, ASCUS and AGUS simply mean the cytotechician noticed that there were some cells that look unusual, but not unusual to the point that there is genuine cause for alarm. This is usually more of a "Hmm... curious, worth investigating further just to be sure!" kind of concern rather than "Sound the alarm! Alert the hospitals!" kind of alarm. Usually, that is. Sometimes there are exceptions. When it comes to Pap tests, generalizations can only get you so far. A careful cytotechnologist evaluates every slide on a case by case basis.

The ASCUS phenomenon could be caused by anything from imperfections arising from the swap-taking to the slide staining procedure, but because we are all very careful here, this means that the presence of these cells warrant a further Pap test a few months down to road to ensure that there is really nothing wrong with you. Remember, a Pap smear slide contains only a small sample of the cells in your cervix - perhaps the doctor missed sampling the parts with unusual/potentially dangerous cells.

If you are infected by HPV, the Pap smear slide of yours will show cells with distinctive abnormal features (jagged and shrunken nuclei, perinuclear halo, discoloration, for example). HPV could be transmitted due to sexual activity, but there is a school of thought which suggests that every woman has the HPV gene in her DNA and this gene can be triggered by various factors to become active. Don't think that you don't need to go for regular Pap tests if you are not sexually active.

"Dysplasia" is... well, this is actually just one word used to describe a wide array of cellular abnormalities. There are degrees of dysplasia, from mild to severe. Some people use a classification system where dysplasia is ranked from Classes I  to III. Classes IV and V are really bad news as they are reserved for full-blown cancer cases. The Bathesda system, widely used in the US, specifies another way of classification. There are many different arguments about how we should quantify the degree of dysplasia, and I don't think there is ever a consensus for the perfect classification system for dysplasia. The Bathesda system is the one currently in fashion, but I know as many cytologists who feel that the system is too wordy and subjective as those who believe that this system is better than previous ones.

But for the layman, "dysplasia" simply means that there is definitely something wrong in the smear that warrants a follow-up biopsy examination. There is no "uncertain significance" here like in those ASCUS and AGUS cases. The abnormal cells are not cancer cells, but they show signs of having the possibility to turn into cancer cells if the situation is left unchecked. This is why if your Pap smear report says that you have dysplasia, your doctor will ask you to undergo a biopsy examination, where a small sample of tissue from your cervix will be sent to a pathology lab for further evaluation.

Don't think that there should be some outward sign that you have dysplasia. In fact, there is no outward symptom for HPV infection either.

If you are confirmed to have either dysplasia or HPV infection, your doctor will advise you accordingly on what kind of treatment you should seek.

So you see, taking a Pap smear test is important because if there is anything funny taking place in your cervix or vagina, the Pap test has a high chance of letting you know of this.

I had come across Pap smear slides with full-blown carcinoma, usually of women who held off taking regular Pap tests until they couldn't ignore the foul-smelling discharge from their vagina or the growth that is showing, and by that stage, it is usually too late to save them. I would see their removed Wertheim's hysterectomy specimen being sent to the laboratory a few weeks later, when my trained histopathologist colleague would report that the cancer cells had spread into the omental fatty tissue surrounding the uterus as well into the lymph nodes and the woman in question would not have much time left. You see, by the time you exhibit physical symptoms that suggest you may have cancer, there is a high chance that it is too late to save you. Early detection is the key, and we women should be counting ourselves blessed that we actually have a way to detect cervical abnormalities at their early stages.

In Malaysia, many women feel embarrassed to subject their private parts to physical examination. In fact, when people always ask me, it is for this reason that I don't say that women should take Pap test when they are sexually active because some women would believe that taking Pap tests would be tantamount to announcing to the world that they are having sex. Instead, I tell them to start going for regular Pap tests when they hit 18, which should be a good age to start as most young ladies are sexually active at that age. But if you are already having sex when you are, I don't know, 13, 14, 15, or 16 and you care for your health, you should start making arrangements to have regular Pap tests. Pap tests are actually free or heavily subsidized if you go to the nearest government-run family planning center, so it is not as if Pap tests are not for you if you can't afford going to a private clinic.

Look at Jade Goody - she didn't know she had cervical cancer until it was too late.

PS: For men who engage in anal sex (ie you are the "bottom" in the relationship), you can actually go for anal Pap test, where a swab is taken from your anus and rectum. This method can help detect HPV infection and cellular abormalities..

2 comment(s).

Posted by Karen Ranney:

I don't make a point of telling people this, but maybe I should. I was treated for cervical cancer at the age of 27, diagnosed through a routine pap smear. I went the whole route, biopsy, surgery, etc.

I had no symptoms. None. I had no clue there was something wrong.

I went through with the surgery to take everything that could be taken out of me, and for years I went through routine testing to ensure there were no further signs of cancer.

Also, for years, I reminded all my friends - and sometimes, perfect strangers - to have a pap test. I've stopped doing this, but maybe I should start again.

I can remember the night my doctor entered my room (I had a full-blown surgical conical biopsy) and told me that it was cancer. I was alone, staring out at a snowy night in Chicago. Yet the terror of that moment fades in significance to the realization that he could have easily said to me, "Karen, you have cancer, and there's nothing we can do."
March 29th, 2009 @ 7:32 AM

Posted by Stacia Kane:

Mrs. G., thank you so much for pointing out that yes, you should have the Pap done whether you are sexually active or not. I'm ashamed that I left that out of my post; I was focusing so heavily on the outrageousness of denying women Paps until they reach 25, and on the general recommendation that they start when a woman becomes sexually active, that I completely neglected to say that whether you are or not it's important to be tested.

Tomorrow I'm going to edit the post to reflect that and comment on it in a new post.

Thanks! :-)
March 30th, 2009 @ 6:09 AM