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Pap Question ????

eihtak
Posts: 850
Joined: Oct 2011

Hi everyone.......I have a question that like so many I seem to get conflicting answers on, and it may be just that everyones personal situation is different. I am 54yrs old, and 2yrs post treatment for anal cancer and 1yr post treatment for breast cancer. I feel great! My mom died of ovarian cancer and so I had genetic testing for mutated BRAC gene since there is a relation between breast and ovarian cancer,.......  I do not carry it.

My question is in regards to how often do other women in my age group have a pap test after pelvic radiation? It seems our chances for cervical cancer may be increased due to treatment. I already have some concerns about my higher risk for ovarian cancer. I have an appointment coming up later this month so will ask my doctor, but just wondering on others and pap tests.

Thanks.........Wisconsin is in the high 60's today!!!! Heat wave this weekend!!!!! Lol

mp327's picture
mp327
Posts: 2944
Joined: Jan 2010

It used to be recommended that women have a pap annually.  However, that has changed (like so many other guidelines) and they are recommended now every 3 years (I believe), providing pap comes back normal.  HOWEVER, I do not think that this recommendation applies to women who have a history of abnormal paps or any type of cancer that is considered HPV-mediated.  I continue to get a yearly pap, just as I have for the past 40 years.  My insurance covers one annually at full cost, they are virtually painless, and only a once-a-year inconvenience, so I say we have nothing to lose by getting one each year.  That's just my own personal opinion.  The link below will take you to an article published last year that addresses issues concerning frequency of pap smears and age groups.

http://well.blogs.nytimes.com/2012/03/14/new-guidelines-advise-less-frequent-pap-smears/

eihtak
Posts: 850
Joined: Oct 2011

I was told every 3yrs by one doctor, but my onc will order one if I want sooner I'm sure. (Hes so good that way) In May it had been 1yr since my last one, and though a little uncomfortable since radiation it was most definately not that bad. I think I will make an appointment for one yearly also.

Thanks again

mp327's picture
mp327
Posts: 2944
Joined: Jan 2010

You're welcome!  One thing I'd like to add.  I have heard, but have no direct knowledge, that it can be common for paps to come back abnormal in women who have had pelvic radiation.  Like I said, this is just what I've heard from other posters on different websites.  It might be a good idea to ask your doctor about this.  I hope yours will come back negative!

Lorikat's picture
Lorikat
Posts: 558
Joined: Jul 2011

You are right about abnormal pap after radiation...  My first one was abnormal.... 6 months later, normal.  I had a hysterectomy years ago and have been told I really don't need to have them now.  IDK!  I think I'll keep it up fort awhile same as Martha!

Marynb
Posts: 1134
Joined: Aug 2012

Funny you should bring this up, i have an appointment for pap nextmweek. Since my bad scans, we are on the hunt for cancer cells. I am nervous about whether they will actually be able to get in there. Whenever I have an anascope there is bleeding for days due to the weakened skin.

We shall see.

eihtak
Posts: 850
Joined: Oct 2011

The first time I had a pap after radiation treatment was a little over a year ago (and was about one year post treatment. My gyn had to use a pediatric speculum, about the size of my little finger! I have been using my dilator almost daily and am pretty sure it will go much better this time along those lines. I think bleeding after is pretty normal.

That brings something else to my mind.......I still (2yrs post) have some very light bleeding almost undetectable, just a tinge, but daily. It is normal with a colostomy as I have to have some mucus discharge and so wear a pad 24/7. Sometimes the "tinge" is mixed with that, but I can tell that sometimes it seems to come from the vaginal area. Sorry if this is too disturbing to anyone. I was told a year ago that that was normal, but wondering if anyone else has such bleeding.......again VERY light.

mp327's picture
mp327
Posts: 2944
Joined: Jan 2010

I am almost 5 years post-treatment and have been very diligent with dilator use.  I have occasions when I bleed.  I think it's within the realm of normal.

Marynb
Posts: 1134
Joined: Aug 2012

I am not looking forward to this at all, or any of the next 2 weeks. Thanks for mentioning the pediatric speculum.

jcruz
Posts: 233
Joined: Jan 2013

My ob-gyn told me she was using a pediatric speculum when she did an exam in November.  And silly me, I had never thought about speculums being different sizes.  I was so relieved that she was able to use it without too much discomfort.  At that point I was only 1 month post-tx and she was following up not just on the cancer treatment but the surgery she performed in August on my Bartholin's glands.  I'm back to seeing my primary care doc (an angel!) and asked her to use the small speculum in April when she did the pap and it was not painful at all.  I was so happy.  I see my surgeon on Monday for an exam - hoo boy I am not looking forward to that.  He said he'd do the DRE in the office and if I could tolerate that he'd do the anoscopy then too but if it was too painful for me he'll schedule me for an exam under anesthesia.  I'd rather just get it over with in the office and not think about it again for 6 months.  Crossing my fingers.

I'll continue thinking of you in the next two weeks, hoping for the best.

jcruz
Posts: 233
Joined: Jan 2013

 

My oncologists and ob-gyn are recommending that I get a pap every 6 months.  I'm just 7 months post-treatment and I don't know how long they'll want to do that.  I had one in April and it was normal and also negative for HPV.  I just looked at my test results and it says “HPV, High Risk” --not detected.  I don’t think I’ve ever been told anything beyond the normal/abnormal reading before so I think this is the first time I was tested for HPV.  I’m a little vague about this now but it was explained to me that they wanted to do the paps more frequently because of the “field effect”.  I just did some reading to see if I could come up with a way of explaining that to myself and anyone who is reading this but I really can’t.  I hope that someone else can step in here and help.  Now I know I’ve got another question for my next appt. in a couple of weeks with my med onc.  I’ll have to write down his answer when I ask about the frequency of paps and what “field effect” actually means in the context of HPV and anal cancer.

lizdeli's picture
lizdeli
Posts: 521
Joined: Jul 2009

I was told to get them annually as long as they come back normal.  I had my first one 5 months after I finished treatment. Doctors told me that it was important to stay on top of it because of the risk of cervical cancer related to HPV, although I never tested positive for HPV.  And the tumor I had tested negative for HPV.  I gave up trying to figure it all out.....

Liz

sephie's picture
sephie
Posts: 528
Joined: Apr 2009

hey liz and all,  i was told by gyno at MDA every 3 years for pap but i begged her to do them annually due to radiation.... so she has done annual, so far...all normal... no HPV....But i am going on 4 years post...     so we will see if i can keep getting her to do them on me....... sephie

lizdeli's picture
lizdeli
Posts: 521
Joined: Jul 2009

I think they may have been a little cautious with me since I had lymph node involvement and was Stage 111a.  I have my annual pap/check up done locally and not at MDA.

Liz

sephie's picture
sephie
Posts: 528
Joined: Apr 2009

yes, you might be correct ... i  had no lymph node involvement..i was too afraid to have my check ups done here in my hometown due to the fact that the proctologist had mis diagnosed my bubble sore on my anus for about 1 year....i do not have much faith in docs here but will probably change to a gyno here after the 5 year point....i did find a girl gyno here who seems more on the ball with radiated tissues in the vagina and etc.....   thx i go back in July for osteopotosis and skin checks... also seeing endocrinologist cause my TSH was too high.....  thx   sephie

NYinTX's picture
NYinTX
Posts: 64
Joined: Feb 2013

I was under the impression (MDAnderson MD discussion) that once you have HPV, you have it for lie in your cells....the issue is whether your immune system kills off the cancer-causing HPV 16-18, etc., which it usally does, given our SCCA is rare. Also, I was told at MDA that pap smears may detect cervical or abnormal cells only if you by chance hit that spot, just like in a biopsy. You can miss abnormal cells which are adjacent and never know it. ..... 

Phoebesnow
Posts: 448
Joined: Apr 2011

That's scary.  I have had abnormal apps in the past, that would turn normal in a few months.  Maybe because they biopsied a different area?  Now that worries me.

 

Lorikat's picture
Lorikat
Posts: 558
Joined: Jul 2011

Yikes Phoebe!  Same here!

NYinTX's picture
NYinTX
Posts: 64
Joined: Feb 2013

maybe they mnissed the spot or maybe your immune system killed the abnormal cells; I stopped doing paps for that reason, and a pap would not have picked up my anal cancer since it was not growing in the cervix!!  Routine smears are not know for being reliable.....but then maybe the smear will detect something, so if it doesn't hurt you (like a CAT scan) or cost you an arm and a leg, why not do it justin case? 

jcruz
Posts: 233
Joined: Jan 2013

Women with anal cancer are at increased risk for cervical cancer because of the HPV infection.  So my doctors have recommended a pap smear every 6 months and I’m perfectly willing to go along with that recommendation. As NY in TX said it doesn't pose potential risk as scans may and it's quick and usually painless. My insurance will pay for more than one in my case as long as it's ordered as part of my cancer follow-up care.

 

I had to try various search strategies before I could find an article that a non-medical person like me could understand but I did find this quote from a 2009 article in the San Francisco Examiner that helped me understand the phrase "field effect" -- "STDs like gonorrhea or herpes are generally limited to one area of the genital tract; however, HPV produces what is known as a field effect, in layman’s terms this means it gets everywhere. When a woman or man is infected with HPV all of the skin of the lower genital tract is potentially at risk. Some HPV strains are benign and only cause warts, while others can lead to cancer.”

NYinTX's picture
NYinTX
Posts: 64
Joined: Feb 2013

 

CHECK OUT  http://www.1-800-oncologist.com/print/2885

 

http://www.1-800-oncologist.com/news-article/hpv-test-may-help-diagnose-abnormal-pap-smear-cervical-cancer

 

March 27, 2013

When a Pap Smear Just Isn’t Enough

HPV test may help diagnose abnormal Pap smear as cervical cancer

(dailyRx News) If Pap smear results come back as abnormal, don't panic. An HPV test might help shed a little light on what exactly "abnormal" means for some tests.

A recent study looked at the effectiveness of lab testing for cervical cancer from Pap smear samples.

The results of the study showed that a DNA test for human papillomavirus (HPV) may help detect one of two potentially cancerous cells in the cervix.

"Ask a MD about a HPV test and a Pap smear."

Marc Arbyn, MD, from the Unit of Cancer Epidemiology at the Scientific Institute of Public Health in Brussels, Belgium, led an investigation into two different types of tests that screen for cervical cancer.

For this study, 39 previous studies that included 13,196 women were selected to compare test results of cervical cancer screening tests.

All of the women in the study were given Pap smears to test for precancerous cervical cells or lesions.

The studies looked at the accuracy of two different types of lab techniques used to test Pap smear samples: the Hybrid Capture 2 High-Risk HPV DNA Test (HPV test) and cytology.

HPV is a risk factor for cervical cancer, and testing for the virus with the HPV test could point to whether a woman could really be at risk for cervical cancer.

Cytology is done by a trained lab technician who looks through a microscope at the cells taken from the Pap smear for anything out of the ordinary.

Two types of cervical cell abnormalities are atypical cells of undetermined significance (ASCUS) and low-grade squamous intra-epithelial lesions (LSIL).

Typically, after a woman gets a Pap smear, the results are sent to a lab for cytology. If the cytology results are abnormal, another Pap smear is done, which gets sent to the lab for another cytology.

This process can continue for multiple tests and is called “repeat cytology.” Abnormal test results do not necessarily mean pre-cancer. More expensive and invasive tests are available to help determine whether cervical cells are precancerous. These tests include colposcopy and biopsy. 

The results of the study showed that the HPV test was 91 percent accurate at finding moderately serious lesions and 95 percent accurate at finding very serious lesions in patients with ASCUS cells.

But the HPV test was only 71 percent accurate at finding moderately serious lesions and 57 percent accurate at finding very serious lesions in patients with LSIL cells.

The authors recommended that women with ASCUS-type lesions have an HPV test, while women with LSIL-type lesions might need repeat cytology, or colposcopy and biopsy, if those are accessible.

This study was published in March in The Cochrane Library.

The Cochrane Gynaecological Cancer Review Group, the European Commission, the International Agency for Research on Cancer, the Belgian Foundation Against Cancer and other public and private institution, agency and foundation funding was used for external support of this project. No conflicts of interest were declared.

Conditions: 

Cervical Cancer Cancer

Reviewed by: 

Robert Carlson, M.D

Review Date: 

March 25, 2013

 

Last Updated:

March 28, 2013

Source:

dailyrx.com

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