The cervix is the lower, narrow end of the uterus. It opens into the vagina. The cervix is covered by a thin layer of tissue, and more than nine out of ten cervical cancers originate in these surface cells.

Dysplasia is a type of cervical disorder that occurs when there is a change in these surface cells. The normal, benign cells are replaced by abnormal cells. Dysplasia is not cancer. These abnormal cells can, however, turn into cancer cells if they are not treated. Cancer develops when the abnormal cells move into deeper tissues or spread to other organs. The cells grow out of control and can no longer perform their normal functions.

Dysplasia may precede cancer by many years. That's why regular Pap smears are so important. The Pap smear can detect the pre-cancerous stages (dysplasia) in the cervix. This gives the gynaecologist time to investigate and manage the cells before they progress to cancer.

According to the National Cancer Institute in the US, approximately 15,000 women there are diagnosed with cervical cancer each year and about 5,000 die. Cervical cancer is almost 100 percent curable if detected early.

What causes cervical cancer? The most important risk factor for cervical cancer is infection with the sexually transmitted infection called Human Papilloma Virus (HPV). It is believed that this virus interferes with the functioning of substances that keep cervical cells from growing out of control and becoming cancerous. There are, however, other unknown factors involved in the development of cancer.

So, just because a woman has HPV does not mean that she will develop cervical cancer. Also, there are hundreds of types of HPV. The ones that are most often associated with cervical cancer are HPV16 and HPV18. There are benign types (HPV6 and HPV11) which are more often associated with genital warts.

How can I prevent HPV? Since HPV is sexually transmitted, women can decrease their risk of cervical cancer by practising safe sex. This means always using a condom and practicing monogamy.

The more sexual partners a woman has, the greater her risk of exposure to HPV. However, even safe sex may not be 100 percent preventative. That's why regular pap smears are essential for early detection and management.

Patients can request that their doctor use the ThinPrep Pap test for cervical cancer screening. This test was implemented at King Edward VII Memorial Hospital in November 2003.

More than 30 published studies with over 400,000 patients have shown the ThinPrep Pap Test to be significantly more effective than the conventional smear for the detection of precancerous lesions.

When should I get a Pap smear? In July 2003, the American College of Obstetrics and Gynaecology (ACOG) issued new guidelines regarding Pap smear frequency. Many women no longer need an annual Pap. ACOG also says that the Pap can often begin later than previously recommended.

This is somewhat misleading, however, because many women associate their annual Pap with their annual internal pelvic exam. ACOG cautions that annual pelvic exams are still advised for all women over the age of 21.

First Pap: women should have their first Pap approximately three years after their first sexual intercourse or by age 21, whichever comes first.

Women up to age 30: should undergo annual Pap testing since these women have a higher likelihood of acquiring high-risk types of HPV.

Women age 30 and older: there are two screening options:

i) Testing using Pap smears alone. If a woman 30 or older has a negative result on three consecutive annual Pap smears, she may then have her Pap every two to three years.

ii) Testing using the Pap test combined with a test for high-risk HPV: using this new option, women who test negative on both tests may have repeat testing with the combined tests every three years. If only one of the tests is negative, however, more frequent screening will be necessary.

I recommend that any women who is high risk, has multiple sexual partners and/or doesn't use protection should continue with their annual Pap smear. It's all about prevention.

@EDITRULE:

Dr. Woods started practising in Bermuda as an obstetrician/gynaecologist in March 1998. She received her Doctor of Medicine from Howard University College of Medicine in 1992. Following that she spent three years of residency at Howard University Hospital and completed her training at the Parkland Memorial Hospital in Dallas, Texas.