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Dear Sun Doc

How often should women have a pap smear test for cervical cancer? I recently went to see a gynaecologist due to heavy menses and he advised that I take the test yet I had taken a similar one early last year.Joan

Dear Joan

Cervical cancer is a leading cause of disease and death for women and it is therefore vital to get cervical cancer screening regularly for early detection and treatment. The natural history of cervical cancer takes many years, thus allowing for screening and treatment of any early lesions. Most of the time, the changes that lead to cervical cancer begin with infection with Human Papilloma Virus (HPV). According to the national cancer screening guidelines, any woman who has ever had sexual intercourse is eligible for cervical cancer screening.

Women under 30 years of age: Pap smear is the recommended primary screening test, with re-screening every three to five years if the test is normal

Women over 30 years of age: Human papilloma virus (HPV) test is the recommended primary screening test. In case the test (or resources) are not available or there is risk of loss to follow up, then visual inspection with acetic acid (VIA) can be done.

Women 50 to 64 years: screening every five years using HPV testing or pap smears

Women >65 years: no screening, unless advised by the doctor

Women who have low immunity due to HIV or any other reason: screening every year if using pap smear or VIA, or once every two years if using HPV testing

During pregnancy and after delivery: screening can be done during the first trimester of pregnancy and from six weeks after delivery. Anyone who has received HPV vaccination should also be screened according to the guidelines.

Symptoms of cervical cancer include vaginal bleeding after intercourse, bleeding in between your periods or bleeding after menopause; a watery, blood stained discharge that has a foul smell, low abdominal pain or pain during intercourse. Therefore, doing cervical cancer screening is reasonable as one of the tests whenever there is abnormal bleeding. Heavy periods can also occur due to hormonal imbalance, dysfunction of the ovaries, uterine fibroids and other growths in the uterus including cancer, having an intra-uterine device/coil for contraception, having a bleeding disorder, other diseases like liver or kidney disease, or as a side effect to some medications.

It is advisable for you to be seen by a gynaecologist for a thorough evaluation to find the exact cause of the heavy bleeding and treat it.