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Pap smears: the lifesaving cancer test we love to hate

As we look back at our 80-year history, it’s one of the things we’re proudest of. By educating women about the importance of Pap testing and making the tests available and accessible to women regardless of their income, we have saved countless families the pain of losing mothers, daughters, wives and sisters to cervical cancer.
In the early 1900s, cervical cancer was the No. 1 cause of cancer deaths among women in the United States. Today, it’s 14th on the list of deadly cancers for women. That drop is thanks to widespread screening and other efforts to eradicate the disease. Cervical cancer is a highly preventable disease and, if caught early, highly treatable.
Planned Parenthood is a huge part of that success story. Last year, Planned Parenthood affiliates nationwide performed 274,145 Paps. In San Antonio and the Rio Grande Valley, we performed more than 2,000 Paps. Most of these were for low-income and uninsured women, many of whom report that Planned Parenthood is their only source of health care.
Unfortunately, cervical cancer is still a threat for women of color — the vast majority of our patients. The incidence of cervical cancer for Latina women in the United States is almost twice as high as non-Latina white women. Cervical cancer mortality along the Texas/Mexico border is about 30% higher than the rest of Texas. Women continue to suffer and die every year from this disease because they didn’t get the health care they needed, and women of color are disproportionately affected.
Planned Parenthood South Texas has the solution to cervical cancer and we will be relentless in our fight to eradicate this threat to women once and for all. With ever more advances in cervical cancer screening and better, more pervasive education about its importance, we look forward to a day when we don’t have to talk (very much) about cervical cancer at all. In the meantime, read on for a brief history of the Pap test.

Birth of the pap

Cervical cancer usually takes years to develop. During this time, the cells in the cervix change and grow rapidly. If precancerous cells are found and treated early, cervical cancer can be prevented. Otherwise, cervical cancer can be deadly.

In the late 1920s, Greek scientist Georgios Papanicolaou developed a simple test to detect cancer by inspecting cervical cells under a microscope to find abnormalities. Papanicolaou published a paper about his test, which was cheap and easy to perform, in 1943.

Soon, annual Pap smears — named for their inventor — became common for women, and the rate of cervical cancer in the U.S. was cut in half. The rate continued to drop for the next 50 years, thanks to providers like Planned Parenthood South Texas educating patients about the importance of the test and providing it for free or low-cost to women.

If a Pap test shows the presence of abnormalities, a clinician may decide to further tests are needed, or she may perform a colposcopy — a special exam to examine the cervix more closely. During this exam, the clinician looks for precancerous cells and typically takes cell samples for biopsies.

Abnormal cells can be treated with Loop Electrosurgical Excision Procedure (LEEP), in which a small electric wire loop is used to remove abnormal cervical cells before they can develop into cancer.

HPV in the spotlight

In the 1970s, a German researcher discovered that the human papillomavirus, or HPV, is tied to cervical cancer. In fact, two particular strains of the sexually transmitted infection are responsible for about 70 percent of cervical cancers. Other strains can cause other forms of cancer.

In the 1990s, Paps were supplemented with tests to detect the presence of HPV. Later, a DNA test was developed to identify the strains of HPV that can cause cancer.

Co-testing with HPV tests and Paps smears is more likely to find abnormal cells or cervical cancer than a Pap test alone.

At Planned Parenthood South Texas, we test cervical specimens for HPV in our lab. If positive, the lab will automatically genotype the specimen for the HPV types that are associated with cancer.

Of course, preventing infection with HPV — the most common sexually transmitted infection — is ideal. To that end, the HPV vaccine Gardasil was introduced in 2006.

Although Gardasil was first recommended for ages 9-26, a new version of the vaccine has been approved by the Food and Drug Administration for ages 9-45. It also protects against some strains of the virus that can cause vulvar, vaginal, and anal cancers.

Evolving guidelines

As cervical cancer screening became more sophisticated, health authorities began questioning whether women needed Paps so frequently. In the last 25 years, the guidelines have changed and will continue to evolve. Not all medical groups agree on guidelines, but in general, annual tests are no longer recommended.

Planned Parenthood South Texas screens patients for cervical cancer based on evidence-based guidelines. How often a patient should receive a Pap test depends on age, medical history, and the results of the patient’s last Pap or HPV test. Many patients can get tested every three to five years if their test results are normal.

Screening for cervical cancer by telemedicine may become common in the future to provide care for women who live in remote or rural areas without easy access to clinicians.

Disparities persist

Cervical cancer is highly preventable and, when found early, highly treatable. Yet thousands of women still die from this cancer every year in the U.S. And women of color are disproportionately affected.

Latinas have higher rates of cervical cancer than Anglos; black women have the highest rates of death from the disease. People of color often face barriers to routine screenings and follow-up health care, including lack of money, lack of insurance, and lack of available clinics. An estimated 80 percent of deaths from cervical cancer could be prevented by regular screening and treatment.

Planned Parenthood’s role

Planned Parenthood South Texas has a decades-long commitment to preventing cervical cancer, beginning with Pap smears.

Today, our Stop Cervical Cancer program comprises HPV vaccines, Pap and HPV testing, coloposcopies, biopsies, LEEP and, for women with invasive cancer, navigation to oncological care. Patients in need of cancer treatment are never turned away due to lack of funds.

Our Hable Con Tu Hermana outreach program in the Rio Grande Valley includes education about cervical health. Promotoras (state-certified community health workers) provide eligible women with vouchers to cover the cost of a clinical visit to Planned Parenthood, including cervical cancer screening.

No one should die from a preventable, treatable cancer. That’s why Planned Parenthood works every day to providing the education and high-quality care our patients need to prevent this terrible disease.