Q. I'm 40 and have been getting Pap smears regularly for many years. I had a small amount of dysplasia 10 years ago but have not had anything wrong for a long time. Should I be getting more done? I've heard about something called a colposcopy. I also just heard about a vaccine against cervical cancer.
A. The possibility of a vaccine to prevent cervical cancer is very exciting. But first, some background.
Cervical cancer is the second most common cancer for women and is the most common cancer in younger women, 35 to 55 years old.
The cervix is the lower part of the uterus that opens into the vagina. It is covered with a layer of tissue called the epithelial layer, which contains plate-like cells called squamous cells. About 85 percent of cervical cancers develop in these cells.
The epithelial layer can become infected with many different microorganisms, which cause changes in the cells called dysplasia. The more dysplasia, the higher the risk of cancer.
But the infection of most interest is the human papillomavirus, which can be transmitted during intercourse. It has been shown to be the major, if not the only, cause of cervical cancer.
Symptoms may include spotting but rarely show up until later stages. Fortunately, routine tests, especially the Papanicolaou (Pap) test, can pick up as many as 90 percent of cervical cancers, often before symptoms are seen.
In a Pap test, cells are scraped from the lining of the cervix with a small, spatula-like device. The samples are sent to a pathologist, who looks for changes in the cells that suggest cancer or other abnormalities.
Because the procedure is safe, takes only a few seconds and is relatively inexpensive, it's recommended that women have this test once a year beginning after their first intercourse or at age 18, whichever comes first.
Sometimes colposcopy is recommended to more accurately pinpoint where to get cell samples. Colposcopy entails inserting a scope containing a magnifying lens into the vagina to check for signs of abnormal cells on the cervix.
If an area of the lining of the cervix looks abnormal, a small tissue sample is taken to be examined by a pathologist for the presence of cancerous cells. This biopsy can confirm or negate a cancer diagnosis.
A similar procedure, called endocervical curettage, may be used in conjunction with colposcopy to get tissue not so easily observable. But samples from the endocervix often are taken with a regular Pap smear as well. The tipped end of the spatula is inserted a small distance into the opening of the cervix, and cells are scraped from there.
Based on the information in your letter, I suggest that you write down questions and talk with the doctor who has been doing your Pap smears about what future schedule would best serve your needs.
A vaccine against HPV recently was reported to be very effective against infection. If additional studies continue to show that it is effective and safe, most cases of cervical cancer could be wiped out in the coming decades.
Write to Allen Douma in care of Tribune Media Services, 435 N. Michigan Ave., Suite 1400, Chicago, IL 60611; or contact him at DRFamily@aol.com. This column is not intended to take the place of consultation with a health-care provider.