PAP Smear


DEXA Scan or Heel Ultrasound

Endometrial Biopsy?

What is a Pap Smear?

What is a Pap smear?

A Pap smear is a screening test your doctor does to check for precancer or early cancer of the cervix. The cervix is the opening to the uterus, or womb. Usually Pap smears find problems early - while they are still easy to treat. Before Pap smears were available, cancer of the cervix was common and often fatal. Today, cancer of the cervix is rare and easily treated in women who have regular Pap smears.

What happens during a Pap smear?

Pap smears aren't usually painful and don't take more than a few minutes. Your doctor will insert a speculum into your vagina to spread the walls of your vagina apart. Your doctor will rub a soft brush or spatula against your cervix to scrape off some cells. These cells will be put on a glass slide, stained with a special dye and looked at under a microscope. Your doctor may also do a bimanual exam to check your uterus (womb) and ovaries and a breast exam to finish your female screening.

What should I do to prepare for a Pap Smear?

  • Make an appointment with your doctor or health unit.
  • Do not douche for three days before the examination.
  • Do not use have sex, use tampons, or birth control foams or jellies for 5 days before the exam.
  • For 48 hours before the exam, take showers instead of a tub bath.
  • Tell your doctor if you are having any signs of infection like discharge or itching. These problems may need to be taken care of before your Pap smear.

Does an abnormal Pap smear mean I have cancer of the cervix?

Not necessarily. While an abnormal Pap smear may be a sign of cancer, many different changes on your cervix can cause an abnormal Pap smear. Pap smears can be abnormal if the cervix is inflamed or irritated. This can be caused by an infection of the cervix, douching, menopausal changes, or irritation. The cervix may also be going through some changes called dysplasia. Dysplasia means the cells on the Pap smear look abnormal under the microscope. Dysplasia isn't the same thing as cancer but may lead to cancer if it is not treated.

LSUMC-S Family Medicine



Mammography should be used along with a monthly breast self-exam and an annual professional exam to detect breast cancer at the earliest stage possible.

Mammography is a low-dose X-ray technique used to examine both non-symptomatic and symptomatic women. It's recommended that a baseline mammogram but taken even when there is no reason to believe there may be a lump or cyst, the baseline is invaluable to compare against later mammograms.

Special equipment and specially trained technologists are required to perform mammography. Your mammography facility should be approved by the FDA regulated system creasted by The American College of Radiology. Radiologists are required to undergo special training in mammography.

When getting a mammogram, the patient undresses above the waist, and the technologist positions the breast between two plastic plates. The plates are then pressed together to flatten the breast tissue. For years they've been telling us it's completely pain-free, but let's face it - it's not. There is some discomfort but it's not unbearable and it lasts for only a few seconds and then it's over. Some women experience soreness for a few days afterward and may want to take ibuprofin.

A typical screening mammogram consists of two views of each breast (one from above and one from the side). Normal procedure is for the technician to examine the pictures immediately to determine if any further x-rays or possibly an ultra-sound might be needed.

If anything irregular is detected, such as a mass, asymmetry, changes from prior mammograms, abnormalities of the skin, or enlargement of the lymph nodes, further testing may be recommended. This might include a sonogram of the breast; or needle sampling of a mass or cyst; or consultation with a breast surgeon.

If you have questions about mammograms, or want to find a place near you where you can get one, call the National Cancer Institute's toll-free Cancer Information Service at 1-800-4-CANCER



Standard X rays are not much help in determining bone-mineral density (BMD): You'd have to lose at least 25 percent before an X ray could detect it. The state-of-the-art test is DEXA (dual-energy X absorpiometry) with more than 700 machines in the United States. The test, which costs aboutest, $200, measures bone at the hip, spine, and/or wrist - where most osteoporosis-related fractures occur.

The test is not for everyone (for example, it wouldn't show much to someone in her thirties, unless she has significant risk factors, like early menopause or unexplained fractures). NOF guidelines recommend it for women who are taking corticosteroid medications; who've had a cracked or fractured vertebra detected by X ray; who have hyperparathyroidism; or menopausal women considering ERT.

DEXA is painless, safe, and quick. Fully clothed, you lie on an examining table as a scanner passes over you. The radiation used is one twentieth that used in a chest X ray, and the test is over in about twenty minutes. A physician then compares your BMD to the peak bone density for two populations: "young normal adult," to show how much bone you may have lost; and your own age group, to indicate where you stand for someone of your age, sex, and size.

After nearly five years of NOF lobbying, a bill was recently introduced in Congress that would require Medicare to standardize its coverage of DEXA and other approved methods of diagnosing osteoporosis. The hope is that third-party carriers will follow suit.

To find out where you can get a BMD test, call the NOF at 800-464-6700.

A much less expensive test for bone density is an ultrasound on the heel, which is reported to be just as accurate in predicting hip fractures, according to Didier Hans, PhD.

As part of a study on risk factors for hip fracture, Hans monitored 5,662 women (mean age: 80) for hip fracture during a 2-year period. They obtained baseline ultrasound measurements of the heel and DPXA measurements of femoral bone mineral density. Heel ultrasound variables included the speed of sound through the bone and broad-band ultrasound attenuation.

After adjusting for age, the researchers found that low heel ultrasound measurements and a low femoral bone mineral density were similarly associated with an increased risk of hip fracture. For each standard-deviation decrease in ultrasonographic or densitometric values, the hip-fracture risk was approximately doubled.

"Ours is the first large prospective study of ultrasound and DPXA in a general population that showed that ultrasound can be used to establish bone quality and therefore the risk of hip fracture," says study coordinator Hans. "We've shown, at least in elderly women, that ultrasound of the heel can predict the risk of hip fracture as well as DPXA.

"The speed of sound measurement of the heel may give us good information about bone elasticity and density, while the broad-band ultrasound attenuation may reflect bone architecture status," he continues. "Ultrasound is also much less expensive and faster than densitometry, and it is radiation-free."

Dr. Hans is at the University of California, San Francisco. Previously he was a research assistant and director of ultrasound and DPXA at Hopital E. Herriot in Lyon, France


Hysterosonography Detects Endometrial Abnormalities Better Than Biopsy

A study recommends that doctors should stop performing endometrial biopsies prior to ultrasound for women experiencing postmenopausal bleeding.

Theodore J. Dubinsky et al., of The University of Texas Houston Medical School, evaluated how biopsy as a method of diagnosing endometrial disease compared with hysterosonography, a considerably less painful method.

One of the most common reasons for postmenopausal women to visit their doctor is for vaginal bleeding. For years, gynecologists have believed that taking a biopsy of the endometrium, the uterine lining, was the first step in discovering the cause of the bleeding.

Recently, it was discovered that an abnormal endometrium can be seen with ultrasound as an area of thickening. Investigators began performing hysterosonography on postmenopausal women with endometria greater than 5 mm in thickness.

Hysterosonography was performed by placing a speculum into the vagina, cleaning the cervix, placing a small tube through the cervix into the uterus, removing the speculum (leaving the tube in place), and then slowly putting sterile saline into the uterus while watching with ultrasound.

The study found that 36 of 81 women had unnecessarily undergone a biopsy when the hysterosonogram showed no evidence of abnormality. In the remaining 45 women, biopsy had missed the cause of the bleeding.

A review of the pathology reports revealed that out of over 200 biopsies performed on postmenopausal women, only 9 (4.5%) were positive. For women in which the hysterosonography indicated an endometrial cause for bleeding, biopsy detected only 9 of 54 (16%) cases.

"These conclusions represent a major change in the way postmenopausal women are evaluated, and this change is of extreme importance to the public," said Dr. Dubinsky. "Hysterosonography is considerably less painful and is able to detect endometrial abnormalities better than biopsies."

Dr. Dubinsky revealed his findings during his presentation entitled, "Transvaginal Hysterosonography: Comparison With Biopsy in the Evaluation of Postmenopausal Bleeding," presented at the American Institute of Ultrasound in Medicine's 39th Annual Convention, March 29, 1995.

Women's Health Weekly, May 1 '95, News Section, p. 9.



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Some symptoms may also be associated with thyroid, heart disease and other medical conditions and your primary caregiver should be consulted.

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