To My Patients,

Cervical and Uterine Cancer Update

Cervical cancer remains the number one cancer in women and the number two cause of death from malignancy worldwide.  It is particularly prevalent in third-world countries where Pap Smears are not available.

In the U.S., cervical cancer is the thirteenth cause of cancer death in women.  It is caused by the HPV virus, which is sexually transmitted.  Adenocarcinoma of the cervix is a different type of cervical cancer that arises from the inner canal of the cervix rather than from the outer surface.  It is not as common as the squamous cell carcinoma, but is harder to detect by a Pap Smear.

Screening should be initiated within three years of intercourse or no later than 21 years of age.  It should be done annually if conventional pathology testing is used.  If a liquid-based cytology (ThinPrep) is used, then Paps can be done every other year if the patient has three consecutive normal tests.  An annual pelvic exam is still recommended.   If a patient has had a hysterectomy, then no further Paps are required if the surgery was done for benign disease.  Any women with a history of abnormal Paps, DES exposure, or who is immuno-compromised should continue with regular Pap smears even after a hysterectomy.  Again, annual pelvic exams are still recommended for women who have had a hysterectomy.

If a patient has ASCUS (atypical squamous cells of undetermined significance) then the pap should be repeated.  If that pap shows ASCUS again, then colposcopy with cervical biopsies are necessary since ASCUS is the most common Pap test diagnosis before invasive cancer is detected.

It is better not to have a pap test if the patient is on her menstrual cycle or if she has a significant vaginal infection.

Postmenopausal bleeding is the most common symptom for uterine or endometrial cancer.  About 12 – 15% of women with bleeding after the menopause have this cancer.

Endometrial biopsy in the office or a transvaginal ultrasound are options for evaluation of postmenopausal bleeding.  However, if the ultrasound shows an endometrial thickening of 5 mm or greater, then sampling of the uterine cavity must be done.

The best test is an outpatient hysteroscopy with a D and C for endometrial specimens.  While saline infusion sonohysteroscopy is as accurate as a hysteroscopy, there is some risk that cancer cells can be pushed out of the uterus into the pelvis during this technique.

In our office, we recommend and prefer to use liquid-based cytology Pap (ThinPrep) testing on all patients, however, not all Insurance Companies / Payors will reimburse for this type of testing. Determination of coverage may depict which type of Pap Smear is a covered benefit.

Any women with bleeding after menopause must be thoroughly evaluated to rule out polyps or uterine cancer.

          To learn more about ThinPrep visit this thinprep.com. 

If you are due for an annual pelvic exam please contact our office at

281.893.1246 to schedule an appointment

Randy Birken, MD
www.gynfo.com