Regular checks of the breast and cervix (the part of the uterus at the top of the vagina) are important to finding early signs of cancer. At one time women only went to their doctors if they themselves found a problem, such as a breast lump or unusual bleeding from the vagina. Unfortunately, by the time such symptoms appeared, the cancer could have already progressed past an easily treated stage. Some women are afraid to see their doctor while others just rarely go to one. Again, breast, cervix and other cancers might be found too late.
Screening for disease can also be done when a woman comes in with an unrelated medical problem. The difficulty with this infrequent (opportunistic) method is that some women may be screened more than they need to be, while others are not screened at all. Over the last few years, only half of Canadian women eligible for mammograms or Pap smears actually had them.
How can we improve this situation? We can do population-based screening instead. This basically means that all women in the target group, the women most likely to get that particular disease, are offered screening through invitations sent in the mail.
In the case of cervical cancer, all women between the ages of 18 and 69 years of age would be invited to have a Pap smear done. Any woman who has had sexual intercourse, even once, may potentially have been exposed to the virus connected with cervical cancer. Women over the age of 69 can continue to be screened if they have had an abnormal Pap smear in the past. Older women who have never had a Pap smear would also need to have the test done a few times to rule out cancer or pre-cancer changes. Even a woman who has had her uterus removed (a hysterectomy) may require a Pap smear. If the cervix was
left at the time of surgery, Pap smears are needed until the age of 69.
Women who have had infections, HIV or other cancers are considered more at risk of cervical cancer. They would continue to have Pap smears after age 69.
Most of the information we have about breast cancer suggests women between the ages of 50 and 69 should have mammograms. Since the risk of breast cancer increases with age, it is wise to continue having mammograms after age 69. However, screening is suggested mainly for those between 50 and 69. Yet in 2001, only half of women in this age range said they had done a screening mammogram in the previous two years. During the same year, only 44 per cent of the women who should have had a Pap smear actually had one done.
It is important to understand that cancer of the cervix can usually be prevented or treated if picked up early. Women who seldom or never have a Pap smear done are at the highest risk of developing this cancer.
Each time a Pap smear is done, a few cells are taken from the cervix and put on a slide. Over the years, with comparative Pap smear results, the doctor gets a pretty good idea of what is normal or abnormal for a particular woman. In most cases it takes a long time, usually over twenty years, for abnormal results to develop into cancer. Each annual Pap smear helps ensure no abnormal cells have developed.
Knowing more about both breast and cervical cancer can help in understanding why screening and early detection are so important.
Every woman can potentially get breast cancer, and the risk increases with age. Only a few women have strong family histories of breast cancer. For these women, testing is particularly important.
Depending on your age, be sure to have regular mammograms and a yearly breast examination done by your doctor. Some women also like to do their own monthly exam, depending on their family history and comfort level. It is essential to see your doctor immediately if you find something wrong when doing your own breast exam.
This special x-ray can find many breast cancers too small to feel. Mammograms use less radiation than a chest x-ray and are safe.
The answer depends on your age. If you are under the age of 40, your risk of breast cancer is low. But if you have two or more first-degree relatives (mother, sister, or daughter) with breast cancer, your doctor may recommend having mammograms done earlier. If this is the case for you, be sure to discuss mammograms with your doctor during a check-up.
If you are between the ages of 40 and 49, your doctor will likely recommend a mammogram. If you decide to go ahead, it is important to have one done every year until you turn 50. Between 50 and 69, women usually have mammograms done every two years unless more frequent screening has been suggested. Women over the age of 69 should know that it is still important to have mammograms, as the risk of breast cancer continues to rise. Since screening programs may not send you reminder notices, be sure to talk to your family doctor about it.
Talk to your family doctor about how to set up an appointment.
You will be asked to remove your clothes from the waist up and given a covering gown. X-rays of each breast are taken. Although having the breasts pressed down is uncomfortable, it only lasts a few seconds. Your doctor will receive a copy of the mammogram results. You may also receive a copy if you have been tested at a provincial site. Make sure to find out your results and plan a time for your next mammogram.
A BSE, or check of your own breasts, should be done around the same time each month. Women who are still menstruating should check themselves seven to ten days after a period. This is a good time for a BSE since the breast is quiet hormonally. Those women no longer having periods can check around the same time each month. Your doctor, health unit or The Canadian Cancer Society (www.cancer.ca) can give you a brochure showing how best to do a BSE.
Although some studies suggest BSE is not necessary for all women, you should decide whether it is important for you. Those with a strong family history of breast cancer are an exception. In this case it is essential to do regular breast self-exams, see the doctor for an annual exam, and have mammograms at the right times.
A Pap smear is a simple test to monitor changes in the cervix. Your doctor places a speculum in the vagina (birth canal) and carefully takes a few cells from the cervix with a soft brush. The cells are put on a slide and sent to a lab to be checked. A report is then sent to your doctor. Some doctors phone you with the results, while others only call if the test is abnormal. Regardless, it is a good idea for patients to follow up all their test results.
Make an appointment with your doctor at a time when you do not expect your period. (This is necessary as blood on the slide would prevent the technician from clearly seeing cells taken from the cervix.) Pap smear results are even clearer if you can avoid using birth control creams or jellies, douching or having sex for 24 hours before the exam. Your doctor will ask when you had your last period, and whether you have recently experienced problems with menstruation.
Remember, you run the greatest risk of developing cervical cancer when you do not have Pap smears to help find abnormal cells. Cancer of the cervix can usually be cured if found and treated early. Having a regular Pap test lets you take control of your health.
An abnormal Pap test means that cells taken from the cervix look different under the microscope. Changes may be mild, moderate or severe, and are usually caused by a virus on the cervix. This virus is called human papilloma virus (HPV). Women get it through sexual intercourse. Fortunately, most of the time cells return to normal after this infection, but in a few women they do not. Cells may become more abnormal and possibly even cancerous. It is essential to do regular follow up on both normal and abnormal Pap tests and have treatment as needed.
If your Pap test is abnormal, your doctor will redo the test in three to six months, depending on the result. If the result is more abnormal, or an abnormal test result has appeared for the second time, you will be sent for further tests. The next step involves a test called colposcopy. It is like doing a Pap smear using a microscope to better see changes. The colposcope stays outside of the body. A gynecologist, a specialist dealing with women's reproductive systems, performs the exam. A sample (or biopsy) of the abnormal cervix tissue will be taken.
Depending on the results, treatment will be prescribed. Follow-up colposcopies will be done until your biopsy results become normal. At that point, you return to your family doctor for regular check-ups.
HPV, a virus, is the main cause of abnormal Pap tests. Any woman can be exposed to it through sex or other intimate contact. Though most women's bodies fight off the virus, in some cases it can lead to changes in the cells of the cervix.
Women who have had sex at a young age, who have many sexual partners or a male partner with many partners, are more at risk. Smoking, problems with the body's ability to fight infection, and infection with other sexually transmitted diseases (STDs) also heighten the risk. Although there is no specific treatment for HPV, the cell changes it causes can be treated. In the future, young girls may be vaccinated against HPV to prevent it from causing cervical cancer.
Women who do not get regular Pap smears are the most likely to have unnoticed changes in the cervix that are not treated soon enough. Other women at risk are generally older, from rural areas, recent immigrants or Aboriginal, and have less education and lower income.
Women felt they had no time, or they or their doctor thought it was unnecessary. Others did not think they needed one after having had a hysterectomy. Some felt it was too embarrassing, or did not like doing it.
Still, Pap smears are an important part of safeguarding your health. One-third of the women with cervical cancer have never had a Pap test. Another third had not had one done in the previous three years. Take control of your health by having regular Pap tests and being aware of the risk factors that you can change.