Common questions about gynecologic cancers.

Q What type of Pap test should I get?

A Currently, there are two types. The conventional Pap test is a swab of cells taken from your cervix and fixed on a slide. The newer, liquid-based Pap tests such as ThinPrep and SurePath use a solution that helps preserve the cells scraped from the cervix as well as remove mucus, bacteria, and other cells from the specimen that may interfere with the reading.

Although most recent studies show that the liquid-based Pap tests allow added precision in diagnoses, health care professionals emphasize that any Pap test is better than none.

Also, don't assume that just because you had a pelvic exam, your health care professional did a Pap test. Always ask. And always call to find out the results if you haven't heard from your health care professional's office. Don't assume that "no news is good news."

Q I had a hysterectomy several years ago. Do I still need a Pap test?

A You might. First, keep in mind that the Pap test screens both the cervix and the vagina for abnormalities. Most guidelines say that if you had a hysterectomy and there was no evidence of pre-cancer or cancer, then you probably don't need to continue having Pap tests. However, if you had a hysterectomy, but still have a cervix, then yes, you need regular Pap tests. Most women have total hysterectomies in which the uterus and the cervix are removed. And, if your cervix was removed, but your hysterectomy was performed because of pre-cancer or cervical cancer, you'll still need a Pap test.

Q I haven't had a Pap test regularly because I don't have health insurance. Where can I go for help?

A The National Breast and Cervical Cancer Early Detection Program provides breast and cervical cancer screening services to underserved women throughout the country, including 13 American Indian/Alaska Native organizations. Services are either free or provided on a sliding scale based on your income. For information about access in your area, call 1-888-842-6355 (select option 7) or log onto http://www.cdc.gov/cancer.

Additionally, Medicare provides 100 percent coverage for a Pap test and 80 percent coverage of the pelvic examination once every 24 months. If you are at high risk for cervical or vaginal cancer, or if you are of childbearing age and have had an abnormal Pap test in the preceding 36 months, it covers these tests every 12 months. (14)

--Carolyn Y. Muller, MD

Associate Professor, Gynecologic Oncology University of Texas Southwestern Medical Center Dallas, TX

Q Why should I see a gynecologic oncologist if I have gyn cancer?

A The scientific literature generally finds that the more experience a physician has in cancer care, the better the outcome. Most obstetrician/gynecologists, however, only see one or two patients a year with a gynecologic cancer.

Studies find that when gynecologic oncologists are involved in a patient's care compared with ob/gyns providing exclusive care, patients gain improved and more accurate diagnosis, as well as increased rates of correct identification of disease progression, more cost-effective therapy and improved survival.

Gynecologic oncologists finish their training in ob/gyn and then train for another two- to four-years in all aspects of gynecologic cancers, including epidemiology, diagnosis, screening and how to combine surgical, chemotherapeutic and radiation therapies to improve survival.

--James W. Orr, Jr., MD

President, Society of Gynecologic Oncologists 

Fort Myers, FL

References

1 Federal Government Aids fight Against Gynecologic Cancer [press release]. Women's Cancer Network; June 20, 2003. http://www.wcn.org

2 American Cancer Society. Cancer Facts and Figures, 2004.

3 Detailed Guide: Ovarian Cancer. April 2004. American Cancer Society. http://www.cancer.org

4 Goff BA, Mandel LS, Melancon CH, Muntz HG. Frequency of symptoms of ovarian cancer in women presenting to primary care clinics. JAMA. 2004 Jun 9;291(22):2705-12.

5 Use of proteomic patterns in serum to identify ovarian cancer. Lancet. 2002. Feb 16; 359-(9306):572-7. PMID:11867112 [PubMed-indexed for Med Line]

6 Barnett GL, Friedrich CA. Recent developments in ovarian cancer genetics. Curr Opin Obstet Gynecol. 2004 Feb;16(1):79-85. Review.

7 Reynolds D. Cervical cancer in Hispanic/Latino women. Clin J Oncol Nurs. 2004 Apr;8(2):146-50. Review.

8 Sirovich BE, Welch HG. The frequency of Pap smear screening in the United States. J Gen Intern Med. 2004 Mar;19(3):243-50.

9 American Cancer Society. Detailed Guide: Cervical Cancer. http://www.cancer.org

10 New Cervical Cancer Fact Sheet. Centers for Disease Control. http://www.cdc.gov/cancer

11 ACS Cancer Prevention Guidelines. American Cancer Society. Updated January 1, 2004. http://www.cancer.org

12 Conrads TP, Fusaro VA, Ross S, et. al., High-resolution serum proteomic features for ovarian cancer detection. Endocr Relat Cancer. 2004 Jun;11(2):163-78.

13 Cancer Screening--Medicare Coverage, American Cancer Society, http://www.cancer.org

14 Gynecologic Cancer Fact Sheet. June 2004. Gynecologic Cancer Foundation.

15 2003 State of the State of Gynecologic Cancers. Gynecologic Cancer Foundation.

16 Ovary cancer (invasive), Trends in seer incidence and US mortality using the Joinpoint Regression Program, 1975-2000. http://seer.cancer.gov

17 Waggoner SE. Cervical cancer, Lancet, 2003 Jun 28;361(9376):2217-25. Review.

18 Crissman JD, Azoury RS, Barnes AE, et al. Endometrial carcinoma in women 40 years of age or younger. Obstet Gynecol. 1981 Jun;57(6):699-704. Review.

19 Oktay K, Buyuk E, Veeck L, et al. Embryo development after heterotopic transplantation of cryopreserved ovarian tissue. Lancet. 2004 Mar 13;363(9412):837-40.

20 Boldt J, Cline D, McLaughlin D. Human oocyte cryopreservation as an adjunct to IVF-embryo transfer cycles. Hum Reprod. 2003 Jun;18(6):1250-5.

21 Lin Fritschi, Gina L. Ambrosini, Ench V. Kliewer, et al. Cancer Registries Epidemiologic Research Group, Dietary Fish Intake and Risk of Leukaemia, Multiple Myeloma, and NonHodgkin Lymphoma, Cancer Epidemiol Biomarkers Prev 2004 13:532-537.