We're told that we're supposed to have them regularly, but just how important is it to have a pap smear? Joanna Hall found out during the health scare of a lifetime.

If you can't remember the last time you had a pap smear, make an appointment today.

Like many women, I'm not too fond of pap smears. It's a test that falls into the same category as a visit to the dentist - I hate going, but know I have to for the good of my health.
And as I found out in August 1999, putting it off can have serious consequences. The results of what I expected to be a routine check-up revealed that I had CIN 3 or Severe Dysplasia, a high-grade pre-cancerous abnormality of my cervix which, if left untreated, can lead to cervical cancer.
I remember asking my doctor, "How can this have happened to me?"
I'd been having regular pap smears since my early twenties and was only just into my thirties. I also remember wondering what could have happened if I hadn't been screened at all.

risk factors
Cervical cancer is one of the most preventable and curable of all cancers - if detected and treated early. Unfortunately, however, according to the Commonwealth Department of Health and Ageing, three out of four women who develop the disease have never had a pap smear, or have not had one within the recommended two-yearly interval. Around 1000 new cases are diagnosed every year in Australia and more than 300 women of these women die. Professor Neville Hacker is Director of the Gynaecological Cancer Centre at The Royal Hospital for Women in Sydney. "Any woman who has ever had sex should have a pap smear, starting at two years from the time that they first became sexually active," he says. "They should continue having tests every two years until they are at least age 70." Professor Hacker explains that cervical cancer takes, on average, 10 years to develop and the risk of developing it increases with age. "It is rare in teenagers and uncommon in women in their 20's, but the risk starts to go up as women reach their 30s," he says. "The most common age group is 45 to 55." Other risk factors include smoking, having multiple sexual partners, and becoming sexually active in adolescence. "There is also a very strong link with Human Papilloma Virus (HPV or genital warts)," says Professor Hacker.

know the signs
HPV is one of the most common sexually transmitted diseases; there are many strains of the virus, most of which are harmless, but around 30 types are spread through sexual contact, and some can lead to cervical cancer.
"Most cases of cervical cancer also have HPV present," says Professor Hacker. "But it doesn't mean that these women have been promiscuous. Many will only have had one or two sexual partners."

Professor Hacker stresses the importance of screening every two years, as many cervical cancers do not present any symptoms until the disease is advanced. He also advises women of all ages to report any unusual symptoms such as unexpected bleeding, discharge or pain to their doctor, even if their last pap smear was normal.
Women can also opt to have one of the newer tests, called Liquid Based Cytology or LBC, in addition to the conventional pap smear. LBC tests are processed differently from a pap smear and appear to offer a higher rate of detection.

As if to prove this point, my abnormal cells were detected by one of these tests, called a ThinPrep, and were missed by a pap smear.

get tested
Tests such as the ThinPrep are widely available but they are currently not approved for a Medicare rebate. If you choose to have one, you have to pay; mine was around $50, but the fee varies depending on what the pathology lab charges. You won't have to pay the full cost, but will have to make a co-payment. There is no set fee, practitioners set the fee of their choice - so check out the cost beforehand.
Another way to detect gynaecological problems is to be tested for HPV. "Most abnormalities, especially in young women, won't be cervical cancer," says Professor Hacker. "They can occur for a number of reasons including infection or inflammation, or because of HPV."
In 1992, Kath Mazzella discovered a lump in her vulva that was eventually diagnosed as cancer. In 1994, the Perth-based mother of three underwent radical surgery that included removal of her clitoris, vulva and lymph glands. Six weeks of radiation treatment followed.

just do it
Post-surgery, Mazzella quickly realised that there was little support for women with gynaecological problems, whether cancerous or not. This situation motivated her to found the Gynaecological Awareness Information Network, or GAIN.
"GAIN's primary aim is to educate and raise awareness about gynaecological conditions, and to offer support by connecting women with similar problems," says Mazzella. "I want to encourage women to challenge the stigma attached to gynaecological issues. We should not feel uncomfortable discussing issues that are so important to our health."
Mazzella's advice to women who forgo pap smears because they are embarrassed is simple. "Don't bury your head in the sand," she says. "Throw your embarrassment out of the window, and take charge of your own gynaecological health."
I couldn't agree more. After being diagnosed with CIN 3, I underwent a treatment called a wire loop excision, a relatively painless procedure that burns off the abnormal cells using a mild electrical current. Now I have a pap smear and a ThinPrep test every year, and so far both continue to be negative.

� For more information visit: www.cervicalscreen.health.gov.au or www.gynsupport.com (GAIN).