My favorite cancer test
No parent in their right mind will admit they have a favorite child.
But kids know. The boy says I favor his sister because the second something breaks, somebody cries or the dog barks, I always holler his name first. He gets punished more severely because he’s older, he’s bigger … he was there.
The girl says I favor her brother because – everybody knows Chinese favor their sons.
“You’re different,” I say. “I love you equally.”
But for what I do in primary care, I admit that I have my favorites, absolutely. Among the screening tests, an 80-year-old test for cervical cancer, developed by a Greek immigrant Dr. Georgios Papanikolaou, better known as the “Pap smear,” is it.
You see, unlike hard scientific disciplines such as math, chemistry and physics, medicine is, well, messy because nature is messy. But when it comes to cervical cancer screening – we’ve got this.
First, we know the cause of cervical cancer: a virus (human papillomavirus, or HPV). Second, we have great tests – Pap, liquid cytology, HPV – safe and relatively inexpensive. Third, after the initial infection, it takes 10 to 20 years before cancer develops. We have time and the tools to cure it.
Pap test is the poster child of all cancer screenings. Moreover, recent guidelines advocate a longer screening interval between testing, which further helps women, especially young women.
Over half of all adolescents will be infected with HPV within three years of their first sexual contact. We have a saying: HPV infection is the rule not the exception. Fortunately, most infections are low risk, and 90 percent clear within months to two years.
If we screen too aggressively, we’ll end up with lots of abnormal tests that may resolve given time. But the treatments can potentially compromise the integrity of the cervix and have been associated with complications such as preterm delivery, devastating women who haven't had children.
Now we recommend the first screening at age 21. Not younger.
Between 21 to 29, we test every three years. Between 30 to 65, we test every five years. In women who’ve been tested regularly and have had normal results, we stop after age 65.
I tell my patients to remember to do it when they turn 30, 35 … or to use their youngest child’s age as a reminder – when Sparkplug turns 5, 10, etc.
A common question: How about detecting cancers of the ovaries and uterus? Doesn’t the test kind of keep track of them? No, it doesn’t. Cervical cancer screenings only detect abnormality in a narrow transition zone at the opening of the uterus, woefully inadequate for any other purpose.
I lost my eldest aunt to cervical cancer. According to 2009-2013 National Cancer Institute stats, women over 65 accounted for one-third of all cervical cancer deaths. Most had never been properly screened.
After my aunt's death, my mother sighed, “Out of eight girls and one boy, she was our mother’s favorite.”
I was about to say, “I thought Chinese favor their sons.” But I held my tongue.