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Pap Smear - by Susun Weed

George Papanicolaou, a pathologist, pioneered this non-invasive screening test in the 1920s. It is not diagnostic. False negative results will occur 10-20 percent of the time.[1]

A Pap smear is a sample of the tissues of the cervix (and sometimes vagina). In order to collect this sample, women are asked to lay back and put their feet up in stirrups. If this position makes you uncomfortable in any way, tell the examiner you want to put your feet on the examining table. With your knees spread, a speculum is gently fitted into your vagina and opened, making the cervix visible. Breathing deeply and relaxing will make any strange sensations easier to bear.

A small implement and a tiny brush are used to collect cells from the outside of the cervix and from inside the cervical os, like using your fingernail to scrape cells from the inside of your cheek, it is not painful, and there is rarely any bleeding.

The collected cells are either preserved in liquid (best) or smeared directly on a slide. Liquid preservation is required for HPV-DNA testing. Pathologists "read" Pap smears with a microscope, looking for cellular changes, such as cells with large black nuclei (cancer).

The vagina is best kept in its natural state for at least 24 hours prior to the Pap smear: avoid douching, intercourse, spermicides, vaginal hygiene products and sprays, and the insertion of boluses, pessaries, or hormonal creams. For the best results, keep it totally natural for three days before your Pap. Cancel your Pap smear if you are menstruating or have had vigorous sex the night before, as it won’t be accurate.

The original classification of Pap smear results - into four broad categories - created confusion on the part of patients and doctors, and resulted in hundreds of thousands of women being frightened into harsh treatments.[2]

Since 1988, a clearer system, the Bethesda, has been used. It was hoped that expanding the categories and giving more specific information about the cells in the smear would limit the amount of over-treatment. Unfortunately, the new classifications have doubled the number of women with abnormal results, so, instead of fewer needless hysterectomies and drug prescriptions, twice as many women are told they need treatment.

 

"Unfortunately, informed consent rarely enters the Pap test equation. … The need to be fully informed about the risks as well as benefits is even stronger for anyone undergoing a screening test, which by definition is given to healthy people without symptoms."[3]

 

There are at least 30 different variations in the spectrum from healthy to cancerous cervical cells. The Bethesda system shows these:

·       Negative for lesions

·       Organisms present

·       ASC-US (Atypical squamous cells of undetermined significance)

·       ASC-H (As above, but may include HSIL)

·       LSI L(Low-grade squamous epithelial lesion)

·       HSIL (High-grade squamous epithelial lesion; dysplasia; cervical carcinoma in situ)

·       AGC: Atypical glandular cells

·       CIN II, CIN III (cervical intraepithelial neoplasia)

·       AIS: Endocervical adenocarcinoma in situ

·       Squamous cell carcinoma

·       Adenocarcinoma

 

There is controversy about what level of abnormality requires further tests or treatment, and how often women need to have a Pap smear done.

 

Pap Abnormalities - What to do?
                                              

·            Conservative guidelines send women with ASC-US for a colposcopy.[4] Liberal practitioners rely on DNA testing along with repeat Pap smears to follow women who are HPV-DNA free (99.5 percent of women negative for HPV-DNA are cancer free[5]). At CIN II/ III they schedule a colposcopy. Only half of women with CIN III will progress to cervical cancer in five years.[6]
 

·            If you have a "bad" Pap report, redo the smear in 3-6 months before you agree to any treatment or even any further diagnosis.

 

"For every person who benefits from early detection, many more are diagnosed with a cancer they did not need to know about."[7]


 

Pap Smear - How often?

·            A visit to the gynecologist for a first Pap smear is a worthwhile part of any young woman’s puberty (menarche) ceremony. Remember, it is not necessary to have sex to be infected with HPV.

·            The American Cancer Society says all women under the age of 65 should have a yearly Pap smear. This includes women without a uterus (in one-third of hysterectomies done in the USA the cervix is left) and even those without a cervix (as smears from the vagina can reveal vaginal cancer).

·            In countries with socialized health care, Pap smears are done every third year since cervical cancer grows so slowly.

·            However, Pap test results are notoriously inaccurate, with a false negative rate of 10-60 percent. Yearly testing is thought to make up for this deficiency.

·            Computerized screening (PAPNET) promised to correct false results from human-read Pap smears, but has actually increased ambiguous findings and over-treatment.[8]

·            The safest course for sexually active women who are under the age of 25, sexually active women of any age who have multiple partners, and any woman whose sole partner has other partners, is to have a yearly Pap smear. However, given that women who have annual Pap smears are the most likely to be over-treated, that may not be the healthiest thing to do! Protect yourself by refusing invasive tests or treatment until two or even three more Pap tests, taken at least three months apart, show abnormalities.

 

"Based on solid evidence, regular screening with the Pap test leads to additional diagnostic procedures (e.g. colposcopy) and [surgical] treatment for low-grade squamous intraepithelial lesions (LSIL), with uncertain long-term consequences on fertility and pregnancy. These harms are greatest for younger women, who have a higher prevalence of LSIL, lesions that often regress without treatment.

 

"Additional diagnostic procedures were performed in 50% of women undergoing regular Pap testing. Approximately 5% were treated for LSIL. The number with impaired fertility and pregnancy complications is unknown." National Cancer Institute website, 2006

 

For those, like myself, who prefer to avoid doctor visits, a visual exame is as good, and may be better. Nurse-midwives in Zimbabwe were asked to take a Pap smear, then to swab the cervix with a mild vinegar solution and (with the aid of a flashlight) to check for white areas that signal abnormal cells. While 77 percent of the positive vinegar tests were accurate, only 44 percent of the positive Pap smears were correct.[9]

To check yourself, you’ll need only a speculum, a mirror, a flashlight, white vinegar, and cotton swabs.

A study of 2,763 postmenopausal women who had Pap smears annually for four years found 110 women with abnormal results, but only one woman who actually had cervical cancer.[10]

 

"Even in the context of a major clinical trial, which would presumably employ the most skilled pathologists, these specialists disagreed with one another’s diagnosis [of Pap smears] at an alarmingly high rate."[11]



[1] "Accuracy of the Papanicolaou test in screening for and follow- up of cytologic abnormalities: a systematic review," K.Nanda MD et al., Ann Intern Med, 132:810-819, 2000 

[2] "The New Pap Test Report: Revised guidelines mean less fear and anxiety," Women’s Health Advisor, August 2002

[3] "One Way to Avoid Unnecessary Testing," HealthFacts, 2001

[4] "2001 Consensus guidelines for management of women with cervical cytological abnormalities," JAMA, Vol 287:2120-2129

[5] "HPV Test Clarifies Ambiguous Pap Results," Health News, 2001

[6] Medical Self Care Book of Women’s Health, Bobbi Hasselbring, Sadja Greenwood MD, Michael Castleman, Doubleday, 1987

[7] "Cancers that do not kill, prevalent and usually treated aggres sively," Health Facts, Aug 2006

[8] "One Way to Avoid Unnecessary Testing," HealthFacts, 2001

[9] "Vinegar Swab Reveals Cervical Problems," Science News, 155(219)

[10] "Pap Smears Still Necessary After Menopause," Focus on Healthy Aging, May 2001

[11] "Interpretive variability is substantial for all types of cervical specimens," M. Stoler MD and M. Schiffman, MD, JAMA, March 21, 2001



Susun Weed, green witch and wise woman, is an extraordinary teacher with a joyous spirit, a powerful presence, and an encyclopaedic knowledge of herbs and health. She is the voice of the Wise Woman Way, where common weeds, simple ceremony, and compassionate listening support and nourish health/wholeness/holiness. She has opened hearts to the magic and medicine of the green nations for three decades. Ms. Weed's four herbal medicine books focus on women's health topics including: menopause, childbearing, and breast health.

 

Visit her site  for information on her workshops, apprenticeships, correspondence courses and more or contact her at:


Susun Weed

PO Box 64

Woodstock, NY 12498

Fax:  1-845-246-8081


For permission to reprint this article, contact us at:
susunweed@herbshealing.com

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Legal Disclaimer: This content is not intended to replace conventional medical treatment. Any suggestions made and all herbs listed are not intended to diagnose, treat, cure or prevent any disease, condition or symptom. Personal directions and use should be provided by a clinical herbalist or other qualified healthcare practitioner with a specific formula for you. All material contained herein is provided for general information purposes only and should not be considered medical advice or consultation. Contact a reputable healthcare practitioner if you are in need of medical care. Exercise self-empowerment by seeking a second opinion.

 

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Browse the publishing site - Ash Tree Publishing - to learn more about her alternative health books.

 

Venture into the NEW Menopause site to learn all about the Menopausal Years the Wise Woman Way.

Or Join the Forum! Susun Weed’s Wise Woman Forum - an open space for discussion. Make yourself at home, post a message or start a discussion. This place is for you to share your questions, concerns, and comments with other wise women like you. Take a moment to register and become part of the community. Enjoy!
 

 

Susun Weed’s books include:

 

Wise Woman Herbal for the Childbearing Year

Author: Susun S. Weed. Simple, safe remedies for pregnancy, childbirth, lactation, and newborns. Includes herbs for fertility and birth control. Foreword by Jeannine Parvati Baker. 196 pages, index, illustrations.

Retails for $11.95 Order at: Ash Tree Publishing

 
Healing Wise 

Author: Susun S. Weed. Superb herbal in the feminine-intuitive mode. Complete instructions for using common plants for food, beauty, medicine, and longevity. Introduction by Jean Houston. 312 pages, index, illustrations.

Retails for $17.95 Order at: Ash Tree Publishing

 

New Menopausal Years the Wise Woman Way

Author: Susun S. Weed. The best book on menopause is now better. Completely revised with 100 new pages. All the remedies women know and trust plus hundreds of new ones. New sections on thyroid health, fibromyalgia, hairy problems, male menopause, and herbs for women taking hormones. Recommended by Susan Love MD and Christiane Northrup MD. Foreword by Juliette de Bairacli Levy. 304 pages, index, illustrations.

Retails for $16.95 Order at: Ash Tree Publishing

For more great info on menopause, visit the site.

 
Breast Cancer? Breast Health!

Author: Susun S. Weed. Foods, exercises, and attitudes to keep your breasts healthy. Supportive complimentary medicines to ease side-effects of surgery, radiation, chemotherapy, or tamoxifen. Foreword by Christiane Northrup, M.D. 380 pages, index, illustrations.

Retails for $14.95 Order at: Ash Tree Publishing

For more great info on Breast Health, visit Susun's Breast Health site.



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