Pap Smears and Mamograms – Why are they important?

Cancer is a disease of cells. It will grow or multiply abnormally into a tumour. Those do not spread to other part of the body is benign tumour but some maybe precancerous and can turn into cancerous in future if it is not treated. Malignant tumour which is cancerous may multiply very fast and spread to other organs. When these cells invade via blood stream, lymphatic drainage or direct invaded from cell to cell, will form another tumour which is known as metastasis tumour. So, it is very important to have regular screening after certain age. Some cancer is preventable.

Who is at risk?

According to Malaysia Oncology Society, breast cancer is the commonest cause of cancer among the women. One in every 19 women in this country is at risk. What are the risk factors for breast cancer? Family history, especially the first degree relative, with breast cancer has higher risk of breast cancer. Those carry BRCA 1 and BRCA II genes are at higher risk.

Other risk factors include high fatty diet, early menarche, late menopause, nulliparous, exposure to radiation or it can turn from a benign lump to a malignant tumour. Breast feeding can reduce the risk of breast cancer. High risk women of breast cancer are advised to avoid long term hormone replacement therapy.

Self-breast examination

Self-breast examination is the most uncostly method to detect breast lump which is recommended for every women. Although it is lack of sensitivity, self-breast examination should be done every month, 7 days after the period ends. During menstruation, breast may be felt lumpy and it may give false alarm. When you notice there is changes in the size or shape of your breast, changes of the skin or nipple, feel a suspicious lump in your breast or abnormal discharge from the nipple, you should seek consultation from a doctor.

Your doctor will examine your breast and give appropriate advice and proceed with further investigation to rule out breast lump. Looking at the figure given by National Cancer Society Malaysia, about 4,000 women are diagnosed each year, mostly between 35-60 years old with 40% affected below the age of 50. Men can also develop breast cancer but it is rare.

When to do a screening?

Regular breast screening is highly recommended. Mammogram is X-ray of the breast. It is to screen for breast cancer. Women above 50 years old should start mammogram screening, until the age of 75, provided she is healthy. It should be done every one or two years. If suspicious cluster of microcalcification (tiny deposition of calcium) is found in the mammogram, needle biopsy may be needed for further confirmation of the malignant cells.

Those with strong family history of breast cancer should be screened as early as 40 years old or even earlier upon recommendation by the doctor. Women below 40 years old with a lump felt in their breast should undergo breast ultrasound to confirm the breast lump. Mammogram is not carried out routinely for those below 40 as they may still have dense breast tissue which reduce the sensitivity of mammographic features.

Should women with breast implant undergo mammogram? Yes, you should, but please inform the radiographer or the radiologist regarding the implants so that special steps are taken to maximise the mammographic view. There is low dose of radiation during the mammogram.

The benefit for breast cancer detection far outweighs the side effect of radiation by the mammogram itself. Breast cancer is curable if it can be detected early. Regular breast screening test will not prevent you from having breast cancer but it improves the prognosis of the breast cancer when it is being treated early. Early detection and appropriate early treatment will save life. Cure rate for Stage I and Stage II can be as high as above 80%.

Cervical Cancer

National Cancer Society Malaysia documented that over 1100 women are diagnosed with cervical cancer in Malaysia each year. Risk of cervical cancer increases after 30 years old and peaks at ages 60–69 years old. The most common cause of cervical cancer is due to Human Papilloma Virus (HPV) infection. Most women will be infected with HPV somehow in their life time but usually it will go off on its own. There are more than 100 type of HPV in the environment and only few high risk types of HPV such as HPV 16, HPV 18 etc, will develop cervical cancer. If one is infected with high risk HPV infection, it may lead to cervical cancer. Smoking is also one of the risk factor for cervical cancer.

Thus, it is very important to do regular pap test to screen for cervical cancer. Women who are sexually active should start to screen for cervical cancer after one year. Those who fall into the age group for 20-30 years old may have to do pap test screening yearly if they are sexually active and have multiple sexual partner or having sex with someone who has multiple partners.

After the age of 30, women tend to reduce their sexual partner to one and pap test screening three years interval is allowed provided the previous pap test for the three subsequent years are all normal. If the pap test and HPV DNA test show normal, five year interval for pap test screening is sufficient. Pap test usually will be screened until the age of 65. Patients should always discuss with their doctors if they have any concern.

The best time to do your pap test is between Day 10 to Day 20 of your period. The doctor will insert a speculum into your vagina and use a brush to swap your cervix, around the internal os (the small opening of your cervix). The procedure may just take less than 5 minutes. If the pap test results turn out to be abnormal, you will be referred to a gynaecologist for further evaluation. Pregnancy is not contra-indicated for pap test screening, but you may choose to do it after delivery.

There are two methods of pap test, the conventional type of pap smear or the Liquid base, Thin Prep. Thin Prep usually gives a more satisfactory sample compared to conventional pap smear, but it is more costly.

Is vaccine available?

Early detection for cervical cancer saves life. By doing regular pap test, many cases of cervical cancer can be picked up at early stage, even cervical intraepithelial neoplasm (CIN), which is premalignant cells and usually curable.

Vaccines to prevent HPV is currently available in the market. HPV is easily transmitted through sexual contact. Pre-sex teenagers are advised to be vaccinated to prevent the HPV 16, 18 which are the commonest type of HPV infection that can cause cervical cancer. Vaccination provides strong protection against selective type of HPV infection but it does not treat existing HPV infection. Women who are not exposed to sexual activity are less likely to be infected with HPV, thus, vaccination before sexual activity is more beneficial.

Combination of regular pap smear screening and vaccination give greatest protection against cervical cancer. Breast cancer and cervical cancer have been haunting women around the world. With the current facility available, we are easily reached for health screening. Sufficient health screening will definitely improve the prognosis of the early detectable breast and cervical cancer among the women. Healthy lifestyle is important to ensure high quality of living.