Pap test procedure facts

Jan 7 2009

January is Cervical Cancer Awareness Month and The University of Texas M. D. Anderson Cancer Center shares important information about the cervical cancer screening exam, the Pap test.

For many women, their annual Pap test is not something to look forward to; however, this test has the potential to make a huge difference in the lives of women everywhere. The Pap test detects cell changes, which may cause cervical cancer. If these cell changes are found and treated early, cervical cancer may be prevented.

Andrea Milbourne, M.D., associate professor in M. D. Anderson's Department of Gynecologic Oncology, explores six facts women should know about this important test.

1. Increased sexual activity equals increased need for a Pap test.

Increased sexual activity raises a woman's risk for acquiring the human papilloma virus (HPV). While HPV can be harmless, it also can cause cervical cancer by changing normal cells in the cervix.

"Because condoms do not provide 100 percent protection against HPV, women who are sexually active and not in a monogamous relationship need to be even more vigilant about following cervical cancer screening guidelines," Milbourne said.

2. The HPV vaccine is a supplement, not a replacement for the Pap test.

Getting the HPV vaccine, or encouraging young female family members to consider it, is a great first step toward cervical cancer prevention. That being said, the vaccine is in no way a substitute for the Pap test.

"The vaccine may give women a false sense of security," Milbourne said. "And because getting a Pap test is not what most women consider a favorite activity, getting the vaccine might cause them to procrastinate even more to make an appointment for their next Pap test."

Because the HPV vaccine does not protect against all types of HPV, or other sexually transmitted diseases, it cannot be the only method of cervical cancer prevention. Women also should remember that cervical cancer doesn't have many visible symptoms, which makes the Pap test significantly important in preventing cervical cancer.

3. Women should prepare for an upcoming Pap test.

Milbourne recommends a few tips to help women prepare for an upcoming test:

• Avoid douching or using vaginal medicines, spermicidal foams, creams or jellies 48 hours before the test.
• Do not have sexual intercourse 48 hours before the test.
• Reschedule a Pap test appointment if an unexpected heavy menstrual flow occurs on the day of the exam.

"Lubricants, spermicides, douching and sexual activity can interfere with the interpretation of Pap test results, potentially leading to incorrectly interpreted results or the need for repeat tests," Milbourne said.

4. A woman is never too old to get her Pap test.

Of all the benefits that might come with growing older, skipping a regular Pap test for a sexually active woman over age 65 is not one of them.

As female life expectancy gets longer, many women continue to enjoy sexually active lives throughout their sixties and into their seventies.

"For women over age 65, cervical cancer is rare, but it does happen," Milbourne said. "If you are over age 65, sexually active and not in a monogamous relationship, you should continue your annual Pap test, as you are still susceptible to HPV, which can cause cervical cancer."

5. Women can afford a Pap test.

"Without health insurance or access to affordable health care, a Pap test can be costly," Milbourne said. "For women who can not afford a Pap test, there may be places in your community where you can get one for free."

For information on where to get a free or low-cost Pap test, call the National Cancer Institute's Cancer Information Service at 1-800-4-CANCER. Pap tests also are sometimes covered by Medicaid and are covered every two years by Medicare or every year for certain women at higher risk. For more information, call 1-800-MEDICARE.

6. Before the Pap test, cervical cancer was a leading cause of death in American women.

The American Cancer Society estimates that about 3,870 women died from cervical cancer in the United States during 2008. This number is low compared to annual statistics for other more common cancer types, such as breast or lung cancer, but what most people do not know is that cervical cancer was once one of the most common causes of cancer death in American women.

As the Pap test became a standard test for American women, doctors were able to find abnormal changes in the cervix before cancer developed. Between 1955 and 1992, the cervical cancer death rate declined by 74 percent.

"While the cervical cancer death rate continues to decline in the United States, women in countries where Pap tests are not as readily available or affordable still face the challenges, shared by American women more than 50 years ago," Milbourne said.

Cervical cancer is the second largest cause of female cancer deaths worldwide, according to the World Health Organization, with 288,000 deaths each year. About 510,000 cases of cervical cancer are reported each year - nearly 80 percent are in developing countries.

For additional information, visit www.mdanderson.org/focused.

M. D. Anderson experts available for interview:

Andrea Milbourne, M.D., Associate Professor, Department of Gynecologic Oncology
Milbourne's interests include evaluating women with preinvasive disease of the lower genital track. She also is involved in providing counseling for women with non-gynecologic malignancies about contraception, preservation of fertility, and dealing with sexual and psychological issues during and after cancer treatment. Milbourne also treats pregnant patients with cancer. Milbourne is a collaborator in several research projects and currently is investigating fertility preservation during cancer treatments and novel approaches to cervical cancer screening. 

Helen E. Rhodes, M.D., Associate Professor, Department of Gynecologic Oncology
Rhodes' clinical focus includes providing comprehensive consultative gynecologic care for M. D. Anderson patients, regardless of their primary cancer diagnosis. She also provides evaluation and treatment for women with pre-malignant diseases of the female genital tract. Her surgical focus includes expanding the use of minimally invasive surgical techniques. Rhodes' research interests include investigating optical imaging techniques as diagnostic tools for the vulva, vagina, cervix and ovary. She also serves as the director of colposcopy and preinvasive diseases in the Department of Gynecologic Oncology.