Fear of the Smear

As an obstetrician/gynecologist, I can tell you that oy vey iz mir is the prevailing thought many women have when they are facing a visit to their health care provider for a routine Pap smear to check for cervical cancer.

Fear of a painful experience, embarrassment and “I feel fine” are the most common deterrents to scheduling an annual gynecological exam. I can assure you, however, that while it may be briefly uncomfortable or a strange experience for some women, the Pap smear is a simple and quick procedure that saves lives.

National Cervical Cancer Awareness Month is coming up in January and provides  a great reminder to schedule that life-saving Pap smear. The American College of Obstetrics and Gynecology (ACOG) guidelines recommend that all women have a Pap smear starting at age 21, and that means everyone. No exceptions.

Let me tell you about Miriam, a lovely 27-year-old mom of three who had a Pap smear during her last pregnancy, four years ago. The lab result revealed mild abnormal changes and a papillomavirus (HPV) infection in her cervix. Unfortunately, Miriam did not return for a follow-up visit as I requested. Six months ago, she called and complained of irregular bleeding and a bad vaginal odor. A new Pap smear indicated that she had cervical cancer, thankfully confined to a small area. She was treated successfully and now will be followed closely.

Joan, a 67-year-old artist was not as fortunate. She experienced abnormal vaginal bleeding and was subsequently diagnosed with cervical cancer. Her prognosis is less optimistic.

What causes cervical cancer? Almost always it is a persistent infection with high-risk HPV, the most common sexually transmitted infection in the US. HPV can be a low-risk type or a high-risk type. There are 12 high-risk types that are implicated in cervical cancer. A Pap smear will identify these various strains.

There is no cure for HPV, but the body’s immune system usually eradicates the virus. Unfortunately, this does not happen with everyone. Most men who get HPV – and men can get it, from female partners – have no symptoms and their infection usually goes away, though before it does, it can lead to genital warts or even cancer.

About five years ago, a young lady named Teresa came to see me. She had just begun her freshman year of college. As is typical, I took a sexual history during her gynecological checkup. Teresa said she did not have a boyfriend at the time, but she had several close male friends with whom she would “hook up.” That fact, coupled with the impulsiveness of youth and peer pressure, can lead to devastating outcomes, such as future fertility problems.

The consequences of HPV infection are by no means limited to the young. Older women and men, who mistakenly believe they cannot get sexually transmitted diseases like HPV, face the same risk of contracting cancer.

The HPV vaccine is highly recommended for everyone between the ages of nine and 45. The vaccine protects against the types of HPV that cause most cervical cancers. With timely screening for HPV infection, cervical cancer is preventable and curable.

Just as the polio vaccine has been instrumental in largely eradicating polio in the US, we can hope for the same result with cervical cancer if there is universal use of the HPV vaccine. It’s important to be aware that as research into cervical cancer evolves, there will be new information and new guidelines. The best gift you can give to your loved ones is to take care of yourself and, by extension, them.

Israel’s Hadassah Medical Organization (HMO), owned by Hadassah, The Women’s Zionist Organization of America, is a leading medical research and treatment center for many diseases – including cervical cancer.  In 2021, HMO opened a ynecological oncology center for all types of gynecological diseases, offering treatments that minimize trauma to the body, preserve fertility and facilitate the fastest possible recovery.

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Dr. Gwen Cooper Simon is a member of the Hadassah Physicians Council.