Mam and Pap Day
My titas made a day of seeing their gynecologist together. They would band together, 2 or 4 of them at a time, see their doctor, have a mammogram and pap smear, then go out to lunch and have their nails done at the spa after. I grew up knowing that breast cancer was very common in my family, the youngest was my cousin at the age of 29. In honor of their experiences, my family takes the mam and pap day very seriously. The women I have looked up to all my life are fighters. The strong women in my family gave me the strength to become an obstetrician/gynecologist – a doctor for women. Of course, I have since learned that not only is breast cancer common in my family, but breast cancer is the most common cancer in Filipino women today. Cervical cancer is the second most common cancer in Filipino women. Therefore a mammogram and pap smear can truly save lives.
Breast cancer affects 1 in 8 women in their lifetime. The risk factors are many but the exact cause is uncertain. Risk factors for breast cancer include:
- Older age – Half of all women diagnosed are over age sixty-five
- Early-onset of menses or late menopause
- Diets high in saturated fat
- Older age at birth of first child or never having given birth
- A personal history of breast cancer or benign (noncancer)
- A family history, particularly a mother or sister
- Treatment with radiation therapy to the breast/chest
- Breast tissue that is dense on a mammogram
- Taking hormones such as estrogen and progesterone
- Moderate alcoholic intake – more than 2 drinks per day
- Gene changes – including BRCA1, BRCA2, and others
Symptoms are vague and early breast cancer does not cause pain. Even so, a woman should see her doctor about breast pain or any other symptom that does not go away. Some symptoms may include any changes in how the breast or nipples feels or looks (any lumps or skin changes of the breast or underarm area) or nipple discharge.
An Early Breast Cancer Detection Plan should include monthly self-breast exams starting age 20, mammograms every 1-2 years starting 40 and every year after 50. Of course, early mammograms for women with a family history (mother or sister) with breast cancer. I recommend friends, sisters, mother/daughter to call each other the first of each month to remind each other to do their breast exams as a way to tell them you love them and care about them. Of course, I also recommend a low-fat diet, regular exercise and avoid smoking or drinking more than 2 drinks a day.
Cervical cancer is a cancer of the cervix, the opening to the uterus. Unlike other cancers, cervical cancer is not passed down through family genes. Cervical cancer is caused by certain types of a virus—human papillomavirus or HPV.
There are no symptoms associated with precancerous or early cervical cancer. Those with advanced cervical cancer present with very heavy bleeding (usually between periods)
A Pap test and pelvic exam are important in detecting abnormalities of the cervix that may lead to cancer. Most invasive cancers of the cervix can be prevented if women have Pap tests regularly. Also, as with many types of cancer, cancer of the cervix is more likely to be treated successfully if it is detected early. I recommend a pap smear every year no later than age 21. And for low-risk women who test negative for HPV, a pap smear every 3 years.
Women ages 65 to 70 who have had at least three normal Pap tests and no abnormal Pap tests in the last 10 years may decide, after talking with their clinician, to stop having Pap tests. Women who have had a hysterectomy do not need to have a Pap test unless the surgery was done as a treatment for precancer or cancer. Women who have received the HPV vaccine still need to have pap tests.
There is now a vaccine against HPV that may prevent at least 75% of cervical cancers called Gardasil and I recommend that all of you discuss this with your doctor. I have met some women who have received Cervarix, another HPV vaccine, in the Philippines. Cervarix is currently awaiting FDA approval in the US.
There are so many reasons why women do not see their gynecologist. Some of them include that they were too busy, not married, no symptoms, expensive, afraid, too young, ashamed, want a lady doctor, got sick, not yet time, don’t like, or simply not aware of the importance. Ultimately, we, as women, have to support and encourage each other that preventative care is important. No matter how embarrassing or personal these exams may be, we need to take care of ourselves first before we can continue to become the good mothers, wives, friends, daughters that we strive to be every day.
Maria Josefa Apigo, MD
Doctor Apigo is a board-certified physician, who has been practicing OB/GYN in Phoenix since 1999. Her biggest focus is on the patient's care and welfare. which includes follow through and continuity of care for women.