Women should begin to have annual pap tests at the age of 18 or when they become sexually active. Pap smears should also be repeated 4 to 6 months after changing a sexual partner if your annual pap is more than 6 months away.

    Why do you have this test done? I've asked many groups of women this question and few if anyone can answer "because I am trying to protect myself from cervical cancer."

    And, when questioned, no one can ever tell me where this cancer comes from.  That is because only recently (within the last 5 to 10 years) could the medical community even begin to answer that question.  Today, we know that cervical cancer is sexually transmitted by the Human Papilloma Virus (HPV). There are over 100 known papilloma viruses......some of them cause warts on our hands, on our feet, men on their penis, women on their cervix, and in both men and women warts on their genitals.  These warts have to have the right "soil" or anatomical site to grow....and some of these warts that grow on the cervix and penis, can cause cervical or penial cancer.

    Recently, we've become aware of host resistance/susceptibility factors that play a part in people acquiring these viruses.
  The goal, with this research, is to develop a vaccine so that every sexually active person can be vaccinated against this disease...thus eliminating it.  But that is the future and not now. For now, prevention and reducing risk is the key!

    Your chances of developing cervical abnormalities increases with every new sexual partner. Every time you have sex with someone, you are having sex with every other person they have ever had sex with.....it's just that simple!  If you and your partner are virginal, you have less of a chance of introducing viruses into your relationship.  If you are virginal and your partner has had many partners, your chances of being exposed to these cancer producing viruses increases significantly.   It only takes once with the wrong partner.

    In the past, physicians use to blamed our mothers for passing on these viruses during our birth through the vaginal canal.  In the case of infants developing warts on their vocal cords, we know this is true.  Today, we're less certain about transmission during birth.  What seems to prevail is that complications from surgical delivery for every women with HPV infections are higher and associated with more deaths than care of HPV problems from vaginal births.

DECREASING RISK: 

    Women who smoke, are vitamin deficient, have been infected with the herpes virus, genital warts, or HIV are at an increased risk of developing cervical abnormalities. About 5% of all paps in the US note cervical dysplasia.  Younger women also seem to have more aggressive viruses when they are diagnosed with cervical dysplasias.  

Risk Factors for Developing Cervical Abnormalities 
"RISKY BEHAVIOR"                                 RELATIVE RIS
 Age at first intercourse(<18)                                                2.76
Deficient diet intake of beta-carotene(<5,000 IU/day)         2.814
  Smoking(10+ cigarettes/day)                                                3.06
  Multiple sexual partners(2 - 5)or                                          3.46
Partner with multiple partners                                                3.46
  Oral contraceptives(5 - 8 yrs)                                               3.66
  Deficient diet intake vitamin C(<30mg/day)                             6.717

   The lesson here is simple, modify your lifestyle and reduce your risk!
More about this later.

WHAT PAP SMEAR SHOULD BE DONE AT MY ANNUAL EXAM?

   The ThinPrep is routine at NEWS.  We have been using this test for over 4 years now and are convinced that this is the best cervical cancer detection test to date.  Many studies point to its 65% increased accuracy when compared to the traditional pap smear.

    As the triage care is better defined with this testing, physicians and insurance companies alike will yield to it's superiority....for now you may have to seek out physicians who use this test and pay for the testing out-of-pocket.   But complain to your insurer and demand they pay towards the cost of the ThinPrep what they would have paid for the traditional pap.

        FACT: ThinPreps are around $65 and traditional paps are $20 to $40.  You draw your own conclusion!  I think you're worth it!

PAP SMEAR REPORTING:

     All of the following conclusions are drawn from the ThinPrep and HPV-ASSAY performed at the Reference Pathology Services in Utah.  Dr David R Bolick has been a most accessible clinician and is clearly a dedicated professional.  I thank him for all of the discussions we've had in the past and will have in the future!

    When you get your results from your pap smear, it will be reported in one of the following modes.  The sophistication of your physician or the lab they use will be exposed when the results are reported to you. If they report a "class" result, this is an outdated system.....the newest system is the Modified Bethesda System.
    IF YOUR HEALTHCARE PERSON DOES NOT GET BACK TO YOU WITH THE RESULTS, FIND ANOTHER HEALTHCARE WORKER!!!!!
    Get a copy of your report and know what was on your report!  This doesn't take a rocket scientist to understand.

Comparison of classifications systems for reporting pap smears.

    CLASS     DYSPLASIA                         CIN*                 MODIFIED BETHESDA SYSTEM
     I              Benign                                 Benign                               Normal       
     II            Benign with inflammation    Benign with inflammation  ASCUS**
     III          Mild dysplasia                      CIN I                                Low grade SIL***(LGSIL)
     III          Moderate dysplasia             CIN II                              Low grade SIL (LGSIL)
     III          Severe dysplasia                 CIN III                            High grade SIL (HGSIL)
     IV            Carcinoma in situ                 CIN III                            High grade SIL (HGSIL)

* CIN = Cervical intraepithelial neoplasia
**ASCUS = Atypical Squamous Cells of Undetermined Significance, favor inflammation
**ASCUS = Atypical Squamous Cells of Undetermined Significance, favor dysplasia
***SIL = Squamous intraepithelial lesion

UNDERSTANDING YOUR PAP SMEAR RESULTS:

    The Bethesda System is the latest classification and the easiest to understand.  Your pap smear results are either "NORMAL," "ASCUS," "LGSIL," or "HGSIL."

THERAPY FOR NORMAL PAP SMEARS:
    The best way to ensure a continued normal pap is to decrease or eliminate the risk factors that cause abnormal paps.  So simply...don't engage in sex before the age of 18, don't smoke or have a sexual partner who does smoke (nicotine is carried in the ejaculate secretions!), limit the number of partners (and pick partners who also limit their partners).  Oral contraceptives in and of themselves are not at fault here, with the risk of pregnancy lowered, women may engage in more sexual encounters than they normally would have if they were unprotected. OC use also leads to the decrease of Vit. C, B6, B12, folic acid, riboflavin, and zinc.  The main culprit here seems to be the decrease in folic acid within the cells of the cervix.

    Adopt a natural health program that includes exercise and a nutrient rich, toxin free diet. Take additional supplements if necessary.  Support your immune system and organs like your liver and kidneys, that help clean the body's cells. 

THERAPY FOR ASCUS, LGSIL:
    First, all cervical abnormalities will not always progress to cervical cancer.  Many of these abnormalities will clear up on their own.   The problem is we don't which ones will and which ones won't. There is, however, increasing knowledge to help us determine which lesions we can take a "wait and see," "change life-styles and see," or a need to "immediately intervene medically." This knowledge comes from the HPV-ASSAY.

    NEGATIVE LR-HPV and NEGATIVE HR-HPV
    What is going on here?  The HPV-ASSAY is only testing for the more prevalent viruses and therefore may not be picking up the virus that is causing the abnormal pap.  In these cases, I generally do a colposcopy to rule out any abnormal colposcopic findings.  If there are none, I use life-style modifications.  If I find abnormalities on the colposcopy, I do biopsies to rule out dysplasias.

    POSITIVE LR-HPV and NEGATIVE HR-HPV 
        Because Dr. Bolick's study, showing a decreased incidence of HGSIL in ASCUS or LGSIL patients with +LR-HPV's, is the same conclusion I am finding with my patients,I am more convinced that using lifestyle modifications and follow-up paps every three to six months until normal paps are again obtained, is a viable option. I need to caution you that these conclusions are only valid if your pap findings are based on the ThinPrep and HPV-ASSAY.
    I define persistence as the same or worsening pap smear on two 3 month occasions and I then treat as noted below.

THERAPY FOR PERSISTENT OR RECURRENT ASCUS, LGSIL:
Treatment should be according to the ACOG (American College of OB-GYN) guidelines and carried out by a trained physician.

THERAPY FOR HGSIL:
Is carried out according to the ACOG guidelines.(more later on this point)

LIFESTYLE CHANGES FOR ALL ABNORMAL PAPS

   DECREASE RISK FACTORS

LIVER SUPPORT:

        This is a complex topic all by itself and will be addressed in another article.
        For now the simple use of either ThistleComp or Super Thistle X by PhytoPharmica will nutritionally support liver and bile functions.

STIMULATE YOUR IMMUNE SYSTEM:

These guidelines should not be a substitute for medical care.  If your HealthCare practitioner will not consider Functional Medicine Therapies, then you need to find another HealthCare practitioner who will!  There always is a point that disease has taken over the body and traditional medicine needs to be employed. You need to have someone help you monitor your individualistic health in a partnership mode.

Don't assume your own healthcare find a trained professional to be a partner!