Cervical cancer and pap smears at a gynae: Risks involved, symptoms, and what you can do to prevent it
When should you be booking that trip to the gynae? Should you be going for a pap smear if you're sexually active? What even is a pap smear? For reasons bewildering enough, a good degree of self-awareness and knowledge surrounding our own sexual health remains shrouded in the dark for most of us females. Cervical cancer is the 10th most common cancer affecting women in Singapore, yet most women tend to delay or avoid getting the necessary check-ups done due to a general sense of fear and uncertainty.
Cervical cancer is a cancer of the cervix — the opening of the womb — that is covered by a thin layer of tissue consisting of cells that can potentially morph into cancerous ones. Although it can take several years to fully develop, early cell changes can actually be detected via early screening for these abnormal occurrences. A more-than-common cause of the cancer type is when the cervix is infected by the human papilloma virus aka HPV. Whilst most women who are sexually active are actually prone to the infection, HPV itself does not mean one is auto susceptible to cervical cancer. As there are various types of HPV, only more 'high-risk types' like those of the cervix or vaginal area might persist, and possibly lead to cancerous cell formation. In other words, it's highly advisable that sexually active women in their late 20s, should go for the recommended screenings even if there is no pain or visible symptoms. The cancer type is common, but can be prevented if detected early enough for most females — as long as you do your due diligence of a regular pap smear test.
We ask Dr. Liana Koe, a professional gynaecologist with STO+G Practice based in Thomson Medical Centre, to weigh in further on some of the questions you might have before your first pap smear test.
What are the main symptoms of cervical cancer that I should look out for?
Cervical cancer can present itself with abnormal vaginal bleeding between your periods, after intercourse or after menopause. If you have abnormal vaginal discharge or pain, this might also be a cause of concern and should be checked out immediately.
However, to reiterate, the cancer type is often asymptomatic, even in their pre-cancer phase and hence, the regular screening is advised.
When is a good time to get my pap smear done?
Symptoms or no symptoms: all sexually active women (with male or female partners) aged 25-29 years are highly advised to get their pap smears done at least once every 3 years.
Those between ages 30-69 years can get their tests done once every 5 years, and after the age of 69, you can stop getting screened if your previous tests had turned out fine.
It's also best done a week after your periods but if you're suffering from persistently abnormal bleeding, the test can still be performed accurately.
What will happen during my first check-up to the gynae?
A regular cervical cancer screening consists of a pap smear test and for some women, a test for HPV infection as well. If it's a pap smear test, the sample will be tested for the presence of abnormal cells, and if it's a HPV test, the sample will be tested for the presence of 'high-risk' types of HPV.
The screening process itself is pretty quick and easy. A plastic device or speculum is gently inserted into the vagina to examine the cervix. Using a brush, cells will be obtained carefully from the cervix and automatically sent for testing.
If your gynaecologist believes it is required, a pelvic ultrasound scan might also be done to have a closer look at your uterus and ovaries. If you have never had any sexual activity before, this can be done through the tummy, but if you have, you will be advised to do it through the vagina for more accurate results.
Will it hurt a lot?
Although you may feel some discomfort, Dr. Koe would like to reassure her patients that it only takes a few seconds for the sample(s) to be collected!
What can I expect after the test?
Your results will come out within the first two weeks after the test. The test is ultimately to help detect any abnormalities that may lead to cancer. Your doctor will subsequently advise on the next suitable course of action depending on the risk factors involved.
What might be the other possible causes of the abovementioned symptoms?
Genital tract infections, benign genital tract growths, ovarian cysts, endometriosis and hormonal changes can all result in abnormal bleeding, vaginal discharge and/or pelvic pain. Seeing the gynaecologist will bring you a step closer to finding out the direct cause to put you at ease.
How can I reduce my chances of getting cervical cancer?
As high-risk HPV types are the main direct causes of cervical cancer, you are highly advised to get the HPV vaccine done. The newest vaccine available actually protects against 7 high-risk HPV types — the causes of actually 90% of cervical cancer.
It is most effective prior to the onset of any sexual activity — from ages 9-26 — but can still be considered even outside of these ages or recommendations.
Are there additional precautions I can or should take if I am sexually active?
Cervical cancer is not the only concern. The main precautions should be against sexually transmitted diseases and prevention of pregnancy; both of which, condoms are the way to go.
Finally, what is your main priority as a gynaecologist when a patient comes in for a screening?
My priority as a gynaecologist is to look after my patients holistically. Through a thorough history check and medical examination, my goal is to address all their concerns regarding general female health, fertility, and any other menstrual issues.
In addition to cervical cancer screening, not many women know about the HPV vaccines that are available to prevent cervical cancer, and my biggest advice to anyone considering either a pap smear or the vaccine, is to just get it done — as soon as possible.