Kim (34) did a Pap smear when she was 30 and was told the result was not good. She tells her personal story to Santé.
Annoying, but useful. That's how my friends, who were the first to turn thirty, described their smear for the cervical cancer population screening. I was 29 and knew that shortly after my next birthday, an envelope from the RIVM would also fall on my doormat. It seemed especially embarrassing to me, with your legs in braces, but I wanted to participate to make sure I didn't develop cervical cancer.
Every year about 700 women in the Netherlands get this form of cancer. Without this research, there would be 1,300 according to RIVM. In addition, it is the most common cancer in women between the ages of 35 and 45. So the sooner any abnormal cells are found, the better, I thought. In the end I got that first smear test before my birthday. Because months before the call for it fell on my mat, the GP noticed that something was not right.
I had made an appointment because I had been suffering from interim bleeding for a while. The GP referred me to a gynaecologist, who took biopsies. The result:Pap3b, an indicator for 'severe abnormality of the cells'. HPV was also found:human papilloma virus, the cause of cervical cancer.
Still, I wasn't too worried. Because as long as the result wasn't 'cancer', I was there in time, right? Besides, the presence of HPV doesn't mean that much. Eighty percent of sexually active people (women and men) get it at some point without noticing. And in most cases, the body clears it up on its own. I had the affected tissue burned away on an outpatient basis and even then I was more concerned with my embarrassing position than with my health. The treatment was effective. In controls, the Pap result slowly dropped to a normal score and eventually the virus disappeared. So nothing to worry about. Or is it?
If you have ever had an abnormal Pap smear:you are not alone. “Every year thousands of women are confronted with it,” says gynecologist Jacqueline Louwers of the Diakonessenhuis in Utrecht. There are six Pap classifications (Pap refers to Papanicolaou:the inventor of the Pap smear):1, 2, 3a, 3b, 4 and 5, the former being normal and the latter being the most abnormal.
With Pap3, treatment is required in half of the cases; with higher results this is almost always the case. That result in itself says little about the seriousness of the abnormality, says Louwers:“A Pap result gives an indication that something is wrong, but it only becomes clear when a biopsy has been taken. In theory you can have cancer with a Pap2 result and there is nothing wrong with Pap4, although in practice the chance is small.”
A biopsy indicates how deep the abnormalities are in the tissue based on a CIN (cervical intraepithelial neoplasia) result. There are three categories:
Unfortunately, such treatment was not sufficient for Wendy (30). Not all abnormal cells were found to have been removed. In a few months she should have another Pap smear to see if the Pap classifications have normalized. She finds it exciting, because her first result (Pap3b and HPV) had a significant impact on her.
“The letter said 'pre-stage cervical cancer', but I only remembered the word 'cancer'. Crying, I called my husband and my mother and told my father I didn't want to die. That sounds very dramatic, but that's how it really felt. If the result of my next smear is Pap3b again, I want the cells removed immediately. And if not, I want my uterus removed. I just don't want to go through this again.”
It is more common that the abnormal cells have to be removed in two steps, says Louwers. “But in most cases, the Pap rash normalizes after one treatment.” Apart from blood loss in the weeks after the procedure, a loop excision has no consequences for your health. However, it can slightly increase the chance of a premature birth. “The deeper the tissue that needs to be removed, the greater the chance. And if you have undergone a loop excision twice, that chance is also greater.
Although the risks remain small – during pregnancy, for example, extra check-ups by a gynaecologist are often not even necessary.”
Know that an abnormal Pap smear does not have to stand in the way of a pregnancy
Michelle (32). She got a Pap smear when she was 24 because she couldn't get pregnant. It turned out that she had Pap3a and that she was seven weeks pregnant. “I was very scared when I heard that – about the results, but also about losing my baby. I got a viewing survey. Terrifying, that rumbling at my uterus, but luckily the pregnancy went well. After giving birth, I had semi-annual checkups. After a while, when I had Pap3b, cells were burned away. I have been 'clean' for four years."
Good to know:abnormal cells are not cancerous in most cases, but could become cancerous in the long run. Louwers:“If the human papilloma virus is present on the cervix for a long time, it can eventually cause cancer. In general, it takes ten to fifteen years.” That is why it is so important to be examined. Abnormal cells generally give few complaints, except for some interim blood loss and contact bleeding after sex. Today, girls can receive the HPV vaccine within the year they turn 13, which protects against two dangerous strains of HPV, which cause 70 percent of all cervical cancers. You cannot prevent infection without a vaccine.
Louwers:“HPV is not a venereal disease, but it is sexually transmitted. If you are not sexually active, you cannot get this virus, but that is not an issue for most people.”
It is not clear why one body clears the virus quickly and the other does not. Louwers:“What we do know is that women who take drugs that suppress the immune system, for example for Crohn's disease or AIDS, are more at risk of developing cervical cancer if they have HPV. Their body cannot clear the virus properly. What helps:quit smoking. Women who smoke have a harder time getting rid of the virus.”
The best thing you can do anyway to prevent later misery:make an appointment as soon as you get a call for a smear. Because if you have an abnormal result, you are in most cases on time. With that attitude I will also look forward to my next research, because in a month I will be 35. Put that embarrassment aside and then I will hopefully be back for another five years.
Since 1996, all women in the Netherlands between the ages of thirty and sixty have regularly received an invitation from RIVM to participate in the cervical cancer population screening. This is a free test, intended to detect the disease at an early stage. Participation is not mandatory. The examination is carried out by means of a swab, which you can have at the doctor's office or with a self-sampling test (the letter states how you can request this).
Since 2017, the smear is first tested for human papilloma virus. If this is present, the same smear is tested for abnormal cells. Every five years you are invited for a study, but since 2017 women in their 40s and 50s without HPV have been invited again after ten years. Women without HPV only need to have a Pap test five times instead of seven. And women who have tested HPV positive at the age of 65 will receive another invitation five years later.
Source:Santé April 2019, text:Kim van der Meulen , image:Getty Images
