When Mahrukh Ali*, a 30-year-old mother of three recently visited her gynaecologist for a post-delivery check-up, she was positive that she already knew all primary healthcare measures the doctors would prescribe. But when the gynaecologist mentioned Mahrukh needed a pap smear as part of the hospital’s post-operation protocol, Mahrukh was left bewildered. “I actually felt quite sheepish because even after undergoing three C-sections, I had no idea what a pap smear was,” admits Mahrukh. “Due to my ignorance, I had missed out on such an important precautionary measure that is necessary for women’s health!”
Unfortunately, Mahrukh is but one example of thousands of women — in Pakistan and around the world — who remain oblivious to the pap smear. Medically known as the Papanicolaou test, a pap smear is used to examine the female cervix for the incidence of cervical cancer. The procedure samples cervical cells and checks them for any abnormalities indicative of cancer or pre-cancerous conditions. Introduced in the 1940s — a time during which cervical cancer was one of the leading causes of female deaths — pap smears have been adopted globally as the standard screening test for women, particularly after they give birth.
Although medical advancements have improved the options available to those suffering from cervical cancer, the disease remains a growing concern, accounting for about 12% of all cancer cases internationally. The situation is even bleaker here in Pakistan where almost 20 women fall victim to cervical cancer daily, making it one of the top 10 countries with the highest female mortality rates (due to cancer). According to a recent research conducted by Globocan, a project initiated by the World Health Organisation (WHO) for cancer research, the prevalence of cervical cancer has risen from nine out of every 100,000 women in 2002 to 19.5 in 2008.
For a cancer type that is easily avertable, these numbers are deplorable. Experts cite the lack of pap smears as one of the main reasons for this as the test is widely available in Pakistan but rarely used. “Even though I know how important it is, I haven’t been able to take out time from my daily routine and have myself checked,” says homemaker Saba Karim*. “Between family and home, it gets very difficult to do anything else. I guess this is a social problem Pakistani women face — they aren’t too proactive about their health.”
Stressing upon the importance of a pap smear, Dr Para Butt, a gynaecologist at the Royal Institute of Medicine (RIMS) suggests that a woman should have herself tested immediately after she becomes sexually active and follow it up with a screening every three to five years. “Amongst the first few basic questions I ask new patients is whether they have had a pap smear and most of them don’t even know what it is,” shares Dr Butt. “WHO has made it mandatory for women to get tested every three years but convincing them to go for it is a gargantuan task!” Dr Butt attributes this to lack of awareness and understanding of the process, along with a reluctance to spend on a screening when there haven’t been any symptoms.
Fortunately, the procedure isn’t too lengthy or painful, contrary to popular belief. “I was very anxious when my doctor prescribed a pap smear to me but the test wasn’t as uncomfortable as I thought. There was also no pain at all,” says Rehana Danish* who has herself tested regularly in order to keep tabs on her health. While explaining the process, Dr Butt elucidates that the patient is made to lie down comfortably while the doctor visualises their cervix and scrapes some cells off the uterus using a soft spatula. The cells are then placed on a glass slide which is sent to the lab for testing. The entire process lasts roughly five minutes, minus the waiting time for the test results.
Other than detecting cervical cancer before it pap smears also ensure that any potential cancers are treated without the patient needing a hysterectomy (removal of the uterus). “For women who haven’t had children or wish to have more children, a timely pap smear can make sure cervical cancer is eliminated at the right time and through minimally invasive measures,” explains Dr Zeenat Eva Khan, a gynaecologist at the National Medical Centre. Dr Khan goes on to admonish Pakistani women for not visiting doctors regularly for general health checkups and turning to them only when the matter gets out of hand.
Of course, understanding the need for a pap smear will only come once there is a comprehension of cervical cancer itself. Generally, the disease is caused due to a sexually-transmitted virus called Human Pappilomavirus (HPV) which can lie dormant for upto 25 years once a woman has been infected without exhibiting any symptoms of infection. According to Dr Khan, “The symptoms begin to manifest themselves as the patient’s immunity weakens by which time it is often too late for a full recovery.”
During the past eight years, two vaccines called Cervarix and Gerdasil have been administered globally to help prevent the spread of HPV. Nonetheless, both doctors advise that girls should have themselves vaccinated against HPV just before they get married to prevent any problems in the future. Since 2006, both vaccines have been licensed to over a 100 countries and included in the national immunisation plans for at least 40 countries in 2012, including Canada, Australia, the United States and United Kingdom as well. Awareness regarding the vaccine has spread to Pakistan but there still remains a long way to go before it is included in regular medical practice.
Although still unsatisfactory, Dr Khan feels that Pakistani doctors and women have taken a big leap forward and adopted the vaccine into their practices. One to two patients, every month, visiting Dr Khan’s clinic are now vaccinated against HPV and Dr Khan continues to encourage them to get regular pap smears once they are sexually active. “This way, women can save themselves and their families from exuberant treatment costs, excruciating pain and worst of all, a great deal of mental trauma.”
*Names have been changed to protect privacy.
The HPV virus lives in mucous membranes, such as those in the genital area or on the skin. Keep your eyes open for the following symptoms and consult a doctor should you have any.
• Raised, flat, pink or flesh-coloured lumps around the genitalia.
• Common lumps may appear elsewhere on the body. These may be rough, raised bumps that usually occur on the hands, fingers or elbows. They may also be painful or prone to injury or bleeding.
• Plantar lumps can occur as a result of HPV, usually on the heels or balls of your feet. They lumps are hard, grainy growths that cause discomfort or pain.
• Flat lumps caused by HPV generally grow on your face, neck or on areas that have been scratched. They are flat-topped, slightly raised lesions darker than your regular skin colour.
SOURCE: MAYOCLINIC.ORG
Published in The Express Tribune, Ms T, November 16th, 2014.
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