Cervical cancer is the most common cancer in the female reproductive tract and is the second most common cancer in women next to breast cancer. It is however a more deadly cancer since for every 4 Filipinas who survive breast cancer, only 2 or 3 will survive cervical cancer. In Asia, there are 266,000 new cases of cervical cancer diagnosed each year. Of these, 7225 new cases are from the Philippines alone, according to our 2005 National Cancer Institute statistics. The sad thing is that two-thirds of these cases are diagnosed at a late stage when they are beyond the operative stage such that 32.3% of them die in 1 year and 73% will die in 5 years.

In developed countries where medicine is socialized and where mass screening with Pap smears is mandated, the incidence of invasive cervical cancer has declined tremendously. This is because the disease is caught at a pre-cancerous or early stage where the disease can still be eradicated without major surgery.

WHAT IS THE PAP SMEAR?
The conventional Pap smear is most inexpensive screening test for cervical cancer. It involves taking a sample of cells from the cervix (which is the opening of the uterus) either with a brush, a spatula or a cotton swab, smearing this on a glass slide and fixing it with a solution so the Pathologist can look under the microscope for any cancerous cells or signs of infection. Conventional pap smear, however have a high failure rate, and is estimated from 50-80% accurate. A new method of Pap smear called the liquid based pap test has improved accuracy by about 54%.

Fig 1. How to perform a Pap smear.

With the liquid-based pap test, the cells taken from the cervix are rinsed in a small vial of special solution to preserve the cells. At the laboratory a machine is able to separate the blood and mucus from the cervical cells which are then tested for abnormalities. Research shows this new method of pap test significantly increases the ability of the doctor and laboratory to identify cervical abnormalities.

WHO SHOULD HAVE A PAP SMEAR AND HOW OFTEN?

In 2016 the American Cancer Society came out with the following guidelines for early detection of cervical cancer:

• All women should start having Pap smears from age 21-29 every three years. No HPV screening is necessary.
• From age 30-65, women are recommended to test for both the Pap smear and HPV test.. If the HPV test is negative, the Pap smear and HPV can be done every 5 years. However, for women who have certain risk factors such as diethylstilbestrol (DES) exposure before birth, HIV infection, or are immunocompromised due to, chemotherapy, chronic steroid use, or organ transplant should still continue to have annual Pap smears.
• Another option for women 30-65 years old is to have only Pap smear without HPV testing every three years
• For women over 30 years old with access to a center where the Human Papillomavirus is tested may opt for HPV testing. If found to be negative, they may be defer screening to every 5 years with either the conventional or liquid-based Pap test, plus the HPV DNA test.
• Women 65 years of age or older who have had regular screening for the last 10 years 3 or more normal Pap tests in a row and no abnormal Pap test results in the last 10 years may choose to stop having cervical cancer screening. Women with a history of cervical cancer, DES exposure before birth, HIV infection or a weakened immune system should continue to have screening as long as they are in good health.
• Women with a history of CIN2 or CIN3 should continue to have testing for at least 20 years after the abnormality was found.
• Women who have had a total hysterectomy (removal of the uterus and cervix) may also choose to stop having cervical cancer screening, unless the surgery was done for treatment for cervical cancer or for a  precancerous lesion. Women who have had a hysterectomy without removal of the cervix should continue to follow the guidelines.

It is always helpful to tell women to see their gynecologist for an annual check-up on their birth month so they don’t ever forget that on their birthday, their gift to themselves is their health. Having a regular check up can help you catch cervical cancer before it catches you.