Mixed reaction to changes in Pap smear rules in Ontario

Sally Vusi, 21, has taken eight Pap smears within a four-year time span. Due to her family’s medical history, the Toronto university student was advised to take a Pap smear every six months. According to Vusi, African-Americans also have a higher chance of cervical cancer.

Vusi’s first Pap smear was the only test that came back with abnormal results, and her gynecologist also found “problematic” cells in her cervix. After going through further testing and procedures, Vusi found that she had irregular cells that could easily be burnt off.

Afterwords, her gynocologist suggested she take a Pap smear every six months to ensure that the irregular cells would not grow back again. Since then, Vusi’s Pap test results have been normal.

Many women like Vusi dread the experience of getting a Pap smear.  The possibility that something could be wrong just adds to the anxiety.
According to the Canadian Cancer Society,  approximately 550 women would be diagnosed with cervical cancer in Ontario and 160 women would die from cervical cancer each year. But the incidence and mortality rates for cervical cancer have been continuously declining by 1.4 and 2.9 per cent per year since 1998.
Which is why, since January 2013, OHIP will no longer cover annual Pap smears for women.
According to Cancer Care Ontario (CCO), new health guidelines recommend that women should take a Pap smear every three years, starting at age 21.  Alberta, B.C and New Brunswick have also recommended screening starting at age 21.

According to David Jensen, the spokesperson for the Ontario Ministry of Health and Long-Term Care, a main factor to the new changes in the guidelines was due to false positives.

“(These results) required followed-up services, which created a lot of anxiety for women. And at the end result, weren’t really necessary,” Jensen said in a phone interview.

Doctor Joan Murphy of CCO is the clinical lead for the Ontario cervical screening program. In a phone interview, she said that although the Pap smear is a system designed to limit harms, there are still potential harms.

“What happens more often is a false positive… when there’s no significant harmful condition present,” Murphy said.

She insists that annual Pap smears are “absolutely unnecessary” as they expose the women to more risks than benefits.

“It’s all about balancing the potential for harm and the potential for benefits,” Murphy said.

Even with her situation, Vusi believes that the new guidelines are reasonable.

“For the average person, [a test] once every three years is adequate. If there is an issue, you’ll have more recommendations,” Vusi said.

Women who require additional tests issued by the doctor due to abnormal Pap results will not have to pay for a lab analysis fee of about $20.00. However, for those who decide to take a test outside their doctor’s recommendations, they will have to cover the cost themselves.

Jessica Duong, 23, has only taken one Pap smear. She decided to get tested because she thought it was the responsible thing to do at her age. She found the experience of a Pap smear test uncomfortable, but still see it as an important routine for a woman’s health.

“In my opinion, I think it’s cool because you don’t have to go through that annoying thing every year, but at the same time if you don’t go through it every year, what if something happens the first two years? You won’t find out until the third year,” Duong said.

But Murphy said that the three-year interval is safer and efficient as the process it takes for normal cells to progress to precancerous changes, then to cancer, takes a very long time.

“We think it’s probably 10-15 years and there’s good evidence to support that. The likelihood of going from normal to cancer within that three year interval is just about zero,” Murphy said.

Murphy also believes that the new three-year interval system is the best way to protect women from cervical cancer. She warns that if women choose to take an annual test, they choose to expose themselves to harm, and they also choose to pay for that ‘‘privilege’’ of harm.

“I think anyone who chooses to take them [the Pap smears] annually and ignore the recommendation must be doing so under the assumption that the changes were made for cost containment and that is 100 per cent not true. I shared the process and know the economics of the screening was not even a question they looked at,” Murphy said.


About this article

By: Nicolette Mendoza
Posted: Apr 17 2013 12:41 am
Filed under: News Science & Health