Essays Writting - Is pap smear an effective tool in early detection for cervial cancer?

Is pap smear an effective tool in early detection of cervical cancer?

Since the 1950’s, pap smear tests have been widely used in western countries to detect cervical cancer. However, there are some disadvantages relating to the test. Other forms of detection though including liquid base cytology, HPV DNA test and optoelectronic cervical screening have proven to be either costly, ineffective or impractical in application. For these reasons pap smears will continue to be used for some time to come.

Pap smear is a procedure or tool to examine cells collected from the cervix (the lower part of the uterus). The major objective of this test is to detect cancer or abnormal cells which might become cancer. It can also find non cancerous conditions such as infections and inflammation (National Cancer Institute (NCI), 2009, p.1) According to Women’s Health Queensland Wide (WHQW) (2007, p.1) cervical cancer is cancer of the cervix. There quite a few forms of cervical cancer but squamous cell (thin flat cells that form the surface of the cervix) carcinoma are the most common one. Usually other non cancerous abnormal cell changes occur before this type of cervical cancer take place however these abnormal cells at early stage can be found with a pap smear test.

The pap smear test is named after Dr Papanicolaou who discovered in 1928 that cells in the cervix change in appearance before becoming cancerous. Following this pap smears became a screening tool to find early abnormal cells and used to examine changes in the cervix (Australian Government Department of Health and Ageing (AGDHA), 2006, p.1).
Most industrialized countries use pap smear as a foundation of cervical screening tool. It has been widely used in the United States since 1950 (Waxman ,2008, p.1 ) and became available to Australian women in 1960 (Queensland Health Pap Smear Register, 2008, p.1). Furthermore, in 1991 pap smears became the primary cervical screening tool to reduce illness and mortality from cervical cancer (AGDHA, 2009, p.1).

The causes of cervical cancer are well understood. Genital human papillomaviruses (HPV) are the major contributory factor in cervical cancer. In facts in almost all cases of cervical cancer the presence of genital HPV has been found (Medical News Today, 2008, p.3). HPV is usually cleared by the body’s immune system; however abnormalities of the cervix may develop in some women who have constant infections (AGDHA, 2006, p.2). HPV is a sexually transmitted infection through sexual contact therefore the risk factors for cervical cancer are related to sexual behavior, which includes sexual activity with a number of different partners, becoming sexually active at a young age, sexual intercourse with a person who has multiple partners or intercourse with a HPV infected person (NCI, 2009, p.3)

Pap smear is a low cost, quick and simple screening tool for cervical cancer. In Australia, pap smear is covered by Medicare and there is no extra fee for the test (AGDHA, 2009, p.1). Having pap smear regularly every two years can prevent the most common form of cervical cancer in up to 90 percent of cases (AGDHA, 2006, p.10) Like all other screening devices, the pap smear has limitations and sometimes it will not discover early cell changes. This is because the smear did not hold enough abnormal cells and because of possible difficulties in interpretation (AGDHA, 2006, p.2).

The National Cervical Screening Program (NCSP) is the current way of cervical cancer control in Australia which uses pap smear as the screening tool. It has been a tremendously successful screening device in detecting and decreasing incidence and death related with cervical cancer, which is one of the most preventable and curable of all cancers. In Australian women it is the eighteenth most common cause of cancer mortality. Nevertheless, it has dropped from eighth place since the introduction of the NCSP using pap smear tests (AGDHA, 2009, p.1). According to Better Health Channel, (2008 p.1 ) regular pap smears in Australia save more than 1,200 woman per year from cervical cancer. It is also stated that having Pap smear is the best protection against cervical cancer. For example, the number of new cases of cervical cancer in Australia has continuously decreased and there were 734 cases in 2005 compared with 1092 cases detection in 1991. Furthermore, the statistics showed the mortality rate from cervical cancer has more than halved since the start of the pap smear program from 4.0 deaths per 100,000 women in 1991 to 1.9 deaths per 100,000 women in 2006 (AGDHA, 2009, p.2).

Although the Pap smear test is recognized as central to prevent cervical cancer it is also not always 100 percent accurate. The first disadvantage of Pap smear is false negative and false positive results. These results can happen and it can be upsetting and confusing for women (WHQW), 2007, p.2). A false negative is when a patient is told that the cells in the cervix are normal but in fact there are abnormal cells present on the cervix. A false positive is when a patient is told that abnormal cells are present in the cervix but in reality the cells are actually normal. False negatives delay the detection and treatment of unhealthy cells of the cervix however having regular pap tests boosts a women’s opportunity of finding any problems (NCI, 2009, p.4).

Another disadvantage is the abnormalities. Pap smear test results can be abnormal, which means cells on the surface of the cervix sometimes show abnormalities but are rarely cancerous. For example, in 2007 the National Cervical Screening Program in Australia detected 14,466 women in the target age group 20- 69 years with high-grade abnormalities (AGDHA, 2009, p.2). Also, about 55 millions pap test are performed each year in United states and from that number 3.5 million have abnormalities and must attend a compulsory medical follow- up (NCI, 2009, p.2).However, according to Better Health Channel, (2009,b, p.4 ) of the small number of pap tests that gave an abnormal result almost all of them are not due to cervical cancer but common infections or conditions which clear up naturally .

In addition, a pap smear test is invasive and unpleasant. Every woman who undergoes a pap smear test will verify that it is unpleasant. This is the reason why women easily forget to have pap smear (Country Women’s Association of New South Wales, 2006, p.27). Also some women find pap smear test embarrassing and humiliating and for this reason women wish to have longer intervals between smears and fewer smears. in their lifetime. (Dickinson, 200, p14)

A number of new technological developments in cervical cancer are now available to woman with extra cost. Currently there are a number of new cervical screening technologies including Liquid Based Cytology (LBC), HPV DNA testing and Optoelectronic cervical screening (AGDHA, 2008, p.2).

The first new technological development is Liquid Based Cytology. LBC is a technique of cervical sample preparation for examination. The samples can be collected in two ways, either directly from collection tools or rinsed in preservative fluid from pap smear collection tools (AGDHG, 2008, p.2). This procedure result gave a capability rate of LBC as a cervical screening tool that is higher than Pap smear test (Pui & Fock, 2006, p.1). However in Singapore a literature review was conducted to compare the sensitivity, specificity and cost implications with Pap smear test and the result showed that LBC gives a higher rate of false negatives, at a rate of 0.38 percent. Also, LBC has higher associated costs and it was concluded that it is not cost effective to replace Pap smears with LBC tests in Singapore (Pui & Fock, 2006, p.1). It is also claimed that LBC provides a better illustration of cells for examination, eliminating clumping and useless material such as mucus and blood. However in 2002, the Medical Services Advisory Committee (MSAC) in Australia reviewed this technology and found that there was insufficient evidence on the performance of LBC to facilitate effective comparisons to pap smears (AGDHA, 2008, p.1). Also in the same year a report on LBC was published by the MSAC stating that public funding should not be supported due to lack of evidence pertaining to liquid based cytology for cervical screening (cited in Women’s Health Queensland Wide, 2007, p.18).

Since the majority of cervical cancers are associated with persistent infection with human papillomaviruses (HPV), another new technology screening tool for cervical cancer is the HPV DNA test. This test can detect the presence of HPV infection in cervical cells (AGDHA, 2008, p.2). The Danish Cancer Society documented that a single HPV test is superior at detecting older women at risk for cervical cancer to pap smears (Medical News Today, 2006,
p.3).The study found that for women who are 40 and older, an HPV test is a more effective way to screen for potential cancer. Also, it has been proved that an HPV test is more sensitive than a pap smear but it has a moderately lower specificity which can not discover truly negative cases (Anttila, Hkama, Talonen, Nieminen, 2006, p.3). Though it is recognized that the HPV test is superior to pap smear tests as a screening tools its true benefits are still unidentified until a large enough study which compares it directly to the standard screening test, is carried out (MNT, 2008, p.1).For this reasons, the MSAC in Australia reviewed HPV testing for cervical screening in 2003 and decided that at that time there was insufficient evidence to support the use of the technology as a screening procedure (AGDHA, 2008, p.2).

Cohort analyses and comparison show that HPV DNA test highlight sensitivity for detection underlying high grade lesions more effectively than pap test. It has another advantage in that it can be performed on self. The clinically effectiveness of the HPV DNA testing is being further reviewed as it can be used in combination with pap test or as a stand alone test in primary screening as a test of healing. For example in United State of America HPV DNA testing was approved recently for use with the pap test for women 30 years and over (Garland, MS,200, p.5)

Optoelectronic cervical screening is the third new cervical screening technology which is a technique of the detection of the cervix abnormalities using an optoelectronic sensor to highlight abnormal areas of the cervix. This device is on the Australian Register of Therapeutic Goods in Australia however it is not suggested for use in cervical screening as a result of its low specificity (a high level of false positive), which increases women’s anxiety and unnecessary colposcopy investigations. (AGDHA, 2008, p.2).

In conclusion, pap smear plays a vital role as a cervical cancer screening tool and has successfully decreased the mortality rate from cervical cancer. Like any other screening tool Pap smear has advantages and disadvantages and it is not always 100 percent accurate, however before any new technology is recommended for use as the screening tools there must be sufficient evidence for its practicality, effectiveness and cost effectiveness. Pap smears will continue to be used as the primary method for screening until there is sufficient evidence indicating the superiority of new cervical screening technologies.


Reference List
Anttila, A, Hakama, M, Kotaniemi-Talonen, L, Neiminen, P, 2006, Alternative Technologies in Cervical Screening: a randomized evaluation Trial,Journalist Pub Med Central Public Health Vol. 6, PP. 252, viewed April, 22, 2009 from http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1621071

Australia Government Department of Health and Ageing 2006, The Pap Smear, National Cervical Screening Program, National Government Department of Health and Ageing, Australia, Viewed May 26, 2009 from

Australia Government Department of Health and Ageing 2008, New Technologies for Cervical Screening, National Cervical Screening Program, National Government Department of Health and Ageing, Australia. Viewed May 26 2009 from

Australia Government Department of Health and Ageing 2009, Facts and Key Statistics, National Cervical Screening Program, National Government Department of Health and Ageing, Australia. Viewed May 26 2009 from

Better Health Channel 2008, Pap Tests for All Women, Better Health Victoria, Australia.
viewed May, 05, 2009 from

Better Health Channel 2009, Pap Tests Explained, Better Health Victoria, Australia.
Viewed May, 05, 2009 from

Country Women’s Association of New South Wales (15 June 2006), Submission-inquiry in to Gynawcological Cancer in Australia, viewed June 22 2009 from http://www.aph.gov.au/senate/commitee/clac_ctte/complete_inquries/2004-07/gynaecological.cancer/submissions/sub16

Dickinson A, J, 2002 For Debate: Cervical Screening .Time to change the policy, The Medical Journal of Australia viewed June 23 2009

Garland, M,S, 2003 Can we really beat cervical cancer Medical Journal of Australia, viewed 23/06/09
http://www.mja.com.au/public/issues/178-12-160603/gar-10077-fm-2.html

Medical News Today 2008, How does HPV Testing Compare to the Pap Test for Cervical Cancer Screening, 26 March, viewed 30 April, 2009, http://www.medicalnewstoday.com/ariticles/101730.php

Medical News Today 2006, HPV Test Is a Better Long-Term Predictor of Cancer Cell Abnormalities than Pap smear,5 November, viewed 30 April, 2009, http://www.medicalnewstoday.com/ariticles/55590.php

National Cancer Institute 2009, Pap test, National Institute of Health, USA. Viewed 12 April 2009 ,

Pui, A, & Fock, C, 2006, Suitability of Liquid Based Cytology as a Cervical Screening Tool in Singapore, ‘Handb Health Technol Assessment’ Volume 3, p 206, viewed 10/05/09 from http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=103724972.html

Waxman, AG, 2008, Cervical Cancer Screening in the early post vaccine era, Obstetrics & Gynecology Clinics of North America, Department Of Obstetrics and Gynecology, pp. 537-548 viewed 5 May 2009,

Women’s Health Queensland Wide 2007, Cervical Cancer: Student Fact Sheet, Queensland. Viewed 11/05/09 from

Vitamin C group servey

Vitamin C group consist of 4 people. First of all we write the quetionaire together and print out 40 copies for our servey. It is so difficult to work as a group and it is hardly to find the time to sit down together and work together becasue if one person can sit another person can not. However, we told each other that we all have to sit down and work together otherwise we couldn't finish our power point on time.Then one person in our group left so only 3 of us continued to work.At last we sat together, work together, draw our graph together, make power point for presentation, draw the conclusion and presented at last. I am so worry at first that we couldn't finish our work on time because by the time the other group finish their work we still in the half way. And yet I am the person who has to give Vit C servey presentation but I have sore tongue and i couldn't give the presentation but in the last minute before the presenation start so the rest of my group have to give presentaion. And again before the presention Padmini said our graph is wrong so we have to fix it and we did fix it but we lose the file and we have to work on it again but at last everything work out well and I am really thank God. Working as a group is hard however this is teach us alot to manage with stress, to improve in communitation ,to have skill in working as a team work and time managing.

Reflective Journal, W7

This week is extremely tough week for me as I have to try to finish my report on herbal medicine. I can say that it’s not a magic for me as I have to pick up the text that relevant to my report then I have to paraphrase it and give in text reference. I spend most of my time with this report and I still I didn’t finish it on due date. To finish one heading like extent use of herbal medicines it took me like almost a day and I struggle very hard with it. It doesn’t mean that I don’t understand the text. I understand it clearly but it is hard to me to do it.

Mersaline told me that I need to spend more time on writing my annotated bibliography as it is not clear and she said maybe I don’t understand the text so I have to resubmit it again. I spend my whole week end on bibliography with out sleeping and eating. I tried my best and I thought I have done the best but when I saw my paper come back with all the red correction I felt very desperate and think to my self that I didn’t do well yet. To improve my writing, summery, paraphrasing, in text referencing skill I have to keep up to practice more and more or the other way is to write to the teacher very often so I might get some feed back.

Not even that I have to give academic presentation to pass the module too. In this presentation assessment it is not like the way you pick up any topic that you like and you present it in front of your community. Any way I find it a bit easier compare to my other task and I am more likely happy with it when I know how to do it and how to present it to be competent to pass the module.

As for computing class, it was like the thunder hit me as everything done by internet and online staff and my brain need to work very fast with full concentration. When the teacher gives the instruction and direction I just follow my best other wise I lost my way and went off the tract.

I just want to say to Darren that I try so hard and try my best. But I didn’t see my self improving or maybe I am better with practical thing but please don’t be upset with me. Sometimes when I cant do it as the teacher prefer I’m not dare to look at the teacher and maybe they might think that I don’t really try hard.

Step by step I believe that I can do better. Thank you

Reflective Journal, W6

As I read about and did so many research on herbal medicine I know better about herbal medicine, their efficacy, benefit, side effect and scientific report as well as its safety. I my self use herbal medicine and when ever I got sick, catch cold or headache I don’t want to visit my GP as I have to line up very long and wait for many hours, instead of doing that I treat my self at home and I feel better shortly.

I took some dietary supplementary and omega 3 as I see my self very skinny and sick of the food but since I learn about the safety of the herbal medicine and some herb can give bad allergic and harm your body I have to read the label weather those dangerous herb are mixing or not. By reading the label on the bottle and consult your doctor before hand I believe you can save your self from harmful drugs.

Darren I find is so hard to do my report on herbal medicine as I don’t really know how to write about it. Most of the researches that I did, more likely the author have same idea and they write nearly the same thing but only the vocabulary were not the same. In this case how I’m going to give reference to them.

Right now I feel like my mind went blind and I felt very nervous because I’m afraid that I cant finish this report on time.

Journal writing (W4 )

As the time passes by quickly, we arrived to week 5 and I started to feel anxious bout my writing and researching assignment, which I have to write to pass this course. When my writing teacher mentioned about annotated bibliography for the first time I took it very easily because I think that is it similar to a general bibliography but when I have learned about the real annotated bibliography I just sighed deeply and hold my breath.

When I started doing my research I didn’t look at the topic properly so I was just doing the research only about acupuncture but then my classmate said that we have to focus only on the herbal medicines. Then without hesitation and tiredness I have to start doing the research again, but to me to doing the research again doesn’t mean that I lose my life entire life. To repeat my researching again I gain more skill in how researching as well as reading. I found some articles are very useful but some are not use full at all and they don’t give any argument or evidence to support the text.

In reading class I did a summery so far with my teacher but I know myself very well that it was not a good summary and I am very weak in summary. I know very well that I didn’t do well as the teacher requires and sometimes I didn’t understand the whole text too. When I read the text I know which sentence is the main key but when it came to the summary I was totally lost.

I am ok with my note-taking skill so far and I can manage to cope with it. We will have computing theory test so soon and I can say that with computing class I can do it well but am not really expert in it

Over all, this course has given me so much knowledge and skill and no matter what, I have to try harder compared to others

Week 3

Education is the most important thing for me in my life. Some people told me that I was getting older and older each year but why am I still studying now? For me, age is only the number that humans can count but building my self with such education and seeing my self in a different level with professional employment is my main target in life.

Last semester I was studying AIN course and I found it very easy including theory and practical. Nevertheless this EAP course is the golden bridge for me to bring me across to the university to fulfill my dream. To me this course is the major path to lead me to my tertiary education. When I first started this course, I thought whether I could do it or not. I have found it very difficult when it comes to the writing class as well listening class as I am very slow to pick up the main point from the context and very poor in analyzing and summarizing the main idea.

Last Thursday I was so down and hopeless when my writing teacher asked me to write about the deductive and inductive writing. I found it very hard to get started and even the last minute when I have to hand over my paper I still didn’t have the idea what to write about. In my community some people say that I am very bright, smart, clever and easy to pick up such a new skill but when it comes to this course I am not clever anymore. I thought about what makes me became like a turtle and what barrier that stop me in my study.

I thought again maybe I was not familiar with an Australia learning style that newly introduced to me and because of my language barrier I am struggling badly. I’m so happy and feel encouraged that my teachers understand our oversea students’ learning situation and style. As well, they are ready to train us to be a professional in the future.

At last I would say that life is not always as easy as I expected. Slowly and slowly I believe that if I try hard I can do it. My knowledge and my education level might not be sufficient as others but I believe deeply that where there is a will there is a way.

Journal Writing (W2)

When I at last enrolled to EAP course I said to my self that this course will be a trigger and prepare me with academic knowledge to access university to achieve my degree. 11th February 2007 was my first day to EAP class and Mersaline was introducing the EAP course, which cover many units such as speaking, listening, reading, writing, research and computing. She also talked about how the examination will take place, rules, compulsory tasks and course instruction. I can understand Mersaline’s English very well and I think I can cope with EAP well and manage the course well. But then when I come to Darren class I was totally lost and I felt so down as my English is very simple compared to academic English.

Before I thought reading is simple and I like reading a lot but then when I learned about how academic cultures reading and writing are linked together it seems to be very difficult to me. Academic reading is extremely different compared to general reading as the texts need to be skimmed, scanned and predicted. I never learned about English Academic in my life so I felt very nervous. The writing unit is very demanding and I can see clearly that all the text, article hand outs that Darren gave as well his English are academic and I can understand only 70%. I find it hard to write the academic writing and I really don’t know how to get started.

I remembered the first day when Darren gave the class the text about deforestation and I have to write the comparison about the academic culture in my country with my own experience, just then my mind went blind. I just sat still and really didn’t know what to do. Then I decided to write something which I was not so sure whether my writing is relevant to what the teacher required.

Nevertheless I calmed my self down and encouraged my self that I came to EAP class to gain such knowledge, learn from the teacher and grasp what they teach. And if I did any mistake by writing, I’m sure that the teacher will correct me so I tried to finish my writing and hand over my writing paper to Darren without hesitation.

I see that all the teachers are very nice, expert, well educated with abundant knowledge and information to input to the class. The class is very lucky to have the entire expert teacher and they are more than happy to help the class whenever there was a problem in our study.

Listening, seminar presentation and computing unit are alright with me at the moment and finally I can say that no matter how hard this course is, I would not give up. Instead I will give all the effort and try my best to pass the course and be competent.