Now that I have your attention, I’m about to have a serious conversation with you from a nursing perspective and the area of work I am in which is Women’s Health. In honor of International Women’s Day I thought this would be a good post to put out there today.
In North America, regular screening for cervical cancer in women is done on a proactive, preventative basis instead of on a reactive one. In Canada, depending on which province you live in, this type of screening can be anywhere from every year to every three years. In Ontario where I work, it’s every three years for women to have their regular pap test done. There are exceptions which I will get to shortly.
What is a pap test?
A pap test is a routine screening test done during a vaginal examination to check for abnormal cells on the cervix. A speculum is placed in the vagina and a sample of cervical cells is collected using a soft brush. The specimen is then sent to the laboratory to be examined under a microscope. When all cells are normal, the pap test result is normal. An abnormal pap test result means some of the cells on the cervix did not change normally and there is some abnormal growth in the cells of the surface layer of the cervix. This is called dysplasia. If these cells go undetected and continue to grow, they may develop into cervical cancer. This is the reason why regular screening is crucial for women.
What does an abnormal pap test mean?
It can mean one of six things.
ASCUS – (Atypical Squamous Cells of Undetermined Significance)
This means there are mild changes in the cervix and the test detected some abnormal cells. It may be caused by something as minor as an infection, irritation, inflammation or thinning of the vaginal tissue in perimenopause or menopause.
LSIL – (Low Grade Squamous Intraepithelial Lesion)
Again, mild changes detected with some abnormal cells. However, these changes are related to the Human Papilloma Virus (HPV)
ASC-H – (Atypical Squamous Cells, Cannot Exclude High Grade Intraepithelial Lesion)
Some abnormal cells cause by moderate to severe dysplasia.
AGC – (Atypical Glandular Cells)
Some abnormal cells of glandular type that may be arising from inside the cervical canal. Patients here require a surgery called a Cone Biopsy
HSIL – (High Grade Squamous Intraepithelial Lesions)
Moderate to severe dysplasia, precancerous lesions are present. Patients here require surgery called a LEEP
Adenocarcinoma – Cancer of the Cervix
When patients have an abnormal pap with their family doctor, they are referred to a Gynecologist who specializes in Colposcopy which is further testing of the abnormal cervical cells. I work with an amazing Obstetrician/Gynecologist, Dr. Constance Ling, MD, FRCSC
What is Colposcopy?
It is similar to the pap test except that once the pap is complete, vinegar 4% is sprayed onto the cervix to highlight any abnormalities that might be there. After waiting a minute the Dr. looks through the colposcope at the cervix. The colposcope looks like a microscope on wheels. If there is a need to take a biopsy, it is done at that time and sent to pathology for examination. Results can be any one of the six listed above and if necessary a future surgery can be booked to remove the abnormal cells and tissue. Patients are closely monitored every 6 – 9 months having their colposcopy done until they have two normal paps in a row. Once they reach this milestone they are discharged from the Gynecologist back to their family doctor once a year for their regular pap tests. This is the exception to the rule of being seen once every three years.
What Causes An Abnormal Pap?
It can be from anything mild like an irritation, infection or inflammation to most commonly the Human Papilloma Virus (HPV) which is a sexually transmitted disease that causes genital warts. This virus can live in the body and go undetected for years without symptoms unless the warts become visible or a woman has an abnormal pap result. Therefore, for those who are not in a committed relationship, it is important and recommended to use condoms as protection because you or the one you are with may have this virus and not even know it and could pass it on for life. Men are the carriers of HPV and it is said that 75% of the sexually active population will be exposed to this virus at some point in their lives. Even if you are married or in a committed relationship, you won’t know if you or your partner has this virus unless either of you have symptoms. Furthermore, there is no way to trace back to who or when you contracted HPV because it depends on the sexual history of every person your partner has been with prior to you. When your immune system is down the virus can become active in your body which can result in an abnormal pap test. By taking a daily multivitamin, not smoking and getting a vaccine called Gardasil 9, this can greatly help in clearing your paps back to normal again. Smoking feeds the HPV virus making it worse and chances of developing cancer are increased.
What is the Gardasil 9 Vaccine?
Gardasil 9 is an intramuscular injection that is given three times in the deltoid muscle over a period of 6 months. It keeps the HPV strain you have been exposed to quiet while protecting you from the other 8 that you haven’t been exposed to which greatly reduces the chances of cervical cancer from developing. Men can also receive this vaccine to protect themselves, prevent the virus from becoming active and causing genital warts or spreading it to other people. Young girls aged 11 and 12 are now being offered this vaccine for free in schools across Ontario before they become sexually active so they are protected ahead of the game. Boys are not yet included in this free offer, however it is widely available and recommended they get it too. After all, they are the carriers. By only vaccinating the girls, we are solving half the problem. Boys and adults need to pay for this vaccine and at pharmacies it costs around $200/injection x 3. Where I work we get it at cost from the drug company directly and we charge $160.00/injection x 3. Private health insurance plans often cover part of the cost however what is your health worth to you? Let’s stamp out HPV one vaccine at a time.
What is my advice on this?
Knowledge is power and talking about this subject is not taboo it’s essential. If you have kids, put on a brave face and talk to them about it, live a healthy lifestyle, have regular check-ups and pap tests with your Dr. get the Gardasil 9 vaccine and if you are not in a momogamous relationship, use condoms when you are sexually active to protect yourself and the one you’re with. You really don’t want to have this on your mind when you are with the one you love. By being proactive, taking care of yourself and knowing your sexual health, you can relax and enjoy the benefits.
Happy International Women’s Day!
~ Jennifer Juneau, RN
**P.S. – Please feel free to comment below and if you would rather send me questions in an email you can reach me at Jennifer.firstname.lastname@example.org