Don't be shy for Pap Smears if done by Male doctors.

In view at the fact that Pap Smear has saved million of lives worldwide, to my personal opinion, one shouldn't feel shy about getting your Pap Smear done by a male doctor.

In Klinik Wan & Keluarga, we conduct Pap Smear by using the Thin Prep Pap Smear only, as conventional Pap Smears yield a significant number of false negative in it's result due to poor sampling collection and deposition of samples onto the slides.
In case if you are shy about the doctors being a male, and that the examination seemed "violating", well, to the doctor who sees both the male and female genitalia day in and out, it's nothing sexual.
Personally, its no difference from looking beneath the hood of my car to see what's wrong with it.

Seriously! I am not trying to be funny here. I am genuinely concern for your well being because you meant a lot to someone, either your parents, boyfriends, husbands,children, and my aunt was to my uncle. And I see the trauma that my uncle bears up til today, though it's been seven months since her passing due to pancreatic cancer.
Normal price for Thin Prep Pap Smear is RM90, but at Klinik Wan & Keluarga, we charge at only RM60, believing that access to proper health care it a basic human right.
Don't take chances.. Talk to your doctor today.

Thin Prep Pap Smear

Designed and patented since 1996, Thin Prep Pap Smear is the answer to the flaws in Conventional Pap Smear. Today, over 90% of Pap Smear done in US is by Thin Prep Pap Smear.
It has it's advantages over conventional Pap Smear in many ways.

In Thin Prep Pap Smear, it's advantage begin with the use of a specially designed sampling brush, to enable a more thorough collection of both ecto and endo cervix.

The central longer bristles and the shorter adjacent ones fits snugly onto the ectocervix, and samples are collected by rotatory movements while in contact with the surface of the cervix.

Compared to Conventional Pap Smear that was designed back in WWII, no doubt it has saved thousands if not millions of lives.

With the conventional Pap Smear, early non malignant changes can be detected early for intervention before it turns malignant.
Though 85% of cervical cancers are squamous cell carcinoma, the other 15% are adenocarcinoma, which most of the time arises from the endocervix, the inner part of cervix that faces the uterus.Due to the design of the wooden spatula, though it is able to collect a good sample from the ectocervix, but not the endocervix.

The flaw of the conventional Pap Smear arises from the sampling as well as the deposition of the samples collected onto the slides.

Smearing of the sample collected onto the glass.

Fixing the sample onto the slide with a cytofix chemical. Unfortunately, the possibilities of a false negative(early signs of pre-malignant changes has occurred but unable to be detected) is as high as 50%.This is due to as the deposition of smear takes place, only 20% of the sample actually gets deposited onto the slide, while 80% of sample remained on the wooden spatula.

of which often gets tossed into the bin...

Besides the poor sampling method, Thin Prep Pap Smear goes through two level of screening, where the samples are initially screened by an imaging device. Upon detection of abnormal cells, the samples  is then reconfirmed by a pathologist.
While conventional Pap Smear is normally screened by a pathologist, where the report is based upon the experience of the person doing the screening.
Upon detection of abnormal cells, the existing sample collected through Thin Prep Pap Smear can be sent for HPV DNA, while another separate sample is needed for conventional Pap Smear.

So, ladies, insist upon Thin Prep Pap Smear from your doctor. Unfortunately, not many general practitioner are aware of the availability of such test.

During the Cervical Cancer Prevention Week, Klinik Wan & Keluarga will be conducting Thin Prep Pap Smear at a lowered price at RM45. Normal price for this price is RM90.
You need not worry about hygiene as the speculum used to collect samples are disposable ones.

Protect yourself against cancer today.
A note that i feel compelled to say. With the availability of this vaccine today, in addition to the campaign which is regularly held, it would be a crying shame if you procrastinate upon getting vaccinated, and unlucky enough on day to be diagnosed to have cervical cancer.
Cervical cancer is not limited to those who have multiple partners,but to you as well. There is always a possibility of contracting cancer in every woman. The possibility wouldn't be as remote as you thought to be considering it being ranked number 2 among mortality secondary to cancer.

How accurate is the conventional method of screening for Cervical Cancer?

This post is written based upon the observation and personal experience of the author, and not influenced by means of payment or any other form of remuneration by any pharmaceutical companies or parties.
With the discovery of Pap smear more than 50 years ago, death due to cervical cancer has been reduce significantly throughout the years worldwide. With the production of first ever Cancer vaccine back in February 27,2006, it marked  a milestone in the history of medicine where personally I felt its significance is in par with the landing of the first man on moon.
With the second vaccine produced by pharmaceutical giant, GSK, it added on to the arsenal at our disposal in the fight against cervical cancer. However, despite these development over the years, even with the marked reduction of mortality, it makes no difference to the family member and patients who was diagnosed with this killer disease.
Somehow, with the presence of these vaccines, some individuals developed this false sense of security that their immunity against cervical cancer last forever, in actual fact false. These vaccines prevent future infection of HPV(Human Papilloma Virus), but does not cure the already existing HPV.
Though vaccinated, one still needs to be screened annually. Last year alone, I had three patients who has sisters who never missed any of their annual Pap Smear, and each time was told to be normal, unfortunately, 5-6 month later, died of cervical cancer.
Despite the marked reduction of occurrence over the years, it makes no difference to these family members and victims who had succumbed to this killer disease which is currently ranked number 2 as the cause of death among women.
In my previous post, I had wrote on why Cervarix is far superior to Gardasil.

Deciding on getting the vaccination done is by far one of the best decision made in a woman's life. If you have decided to totally avoid from contracting this killer disease, vaccination MUST be followed up with annual Pap smear.
Unfortunately, the conventional Pap smear which most clinics perform have a high incidence of false negative. (when a patient have an early changes in the endocervix, which conventional Pap smear fails to detect, and hence its reports comes back as normal)
Such error is tragic to the victim and their family member.

Error occurs especially when cervical carcinoma arises from the inner part of the cervix, where conventional Pap smear's methodology of sampling is relatively poor, hence yields an inaccurate result, which gives a false sense of security to the unfortunate patient. This form of cervical carcinoma is called cervical adenocarcinoma.

While sampling from carcinoma that arises from the ectocervix as illustrated on the diagram above, cancer arising from the endocervix is not easily detectable.

A conventional Pap Smear kit.

The sampling is done using a wooden spatula which is then smeared on a glass slide, which then "fixed" with a chemical called cytospray which then is then looked at under a light microscope by a pathologist.
This method is proved to have high incidence of false negative due to several factors:-
1.majority of cells not collected
2.Non- representative transfer
3.Clumping and overlapping of cells
4.Obscuring materials
Hence since 1996, an improvised version that lessen the false negatives up to 30% was introduced. It is called Thin Prep Pap Smear.

The Thin Prep Pap Test is a liquid-based pap test that employs a fluid transport medium to preserve cells and an automated process to eliminate debris and distribute a representative portion of cells on a slide in a uniform, even layer. A Thin Prep Pap Test slide is clearer, easier to read, and minimizes obscuring blood, mucus, and non-diagnostic debris, enabling increased accuracy for both manual assessment and computerized assessment of the cells. The Thin Prep Pap Test process improves the quality of the sample, preparing a slide that is more appropriate for diagnostic review.

The additional advantage of Thin Prep Pap Smear is that if there exist any abnormality in the cytology report, the same sample can be sent for HPV DNA testing to determine the subtype of HPV(Human Papilloma Virus), or for further test for sexual transmitted diseases.

Hence ladies, with the availability of an improvised Pap Smear, insist upon it to your doctor that you want this method instead of the conventional Pap smear.

More accurate method of screening for cervical cancer

Now that our government has taken the initiative to provide free Cervical Cancer Vaccine to school children, i felt happy that the Ministry of Health recognize the need to take action against this number 2 killer among Malaysian women. I felt disappointed that doctors are not taking their time explaining the need, implication, protection rate ,screening method, and many more related to the vaccination and follow up on the screening as such.
Its rather unfortunate to know that most doctors in Malaysia in the private sector are still using the conventional "Pap smear" for screening for cervical carcinoma.
Have you heard of stories of patients who regularly goes for their annual pap smear and was told to be normal, but died after a few months? ......due to cervical cancer?
Do you know that false negative results (which means patient has cancer or pre cancerous lesion but was not detected by conventional pap smear) is between 10%-50%!













The above two pictures are the conventional Pap smear kit, where by using a spatula inserted into the vagina until the end of the wooden spatula touches the cervix, a rotatory movement to get samples from the surface of the cervix.
However, the high false negative result is due to missed or inadequate sample collection from the endocervix.(the deeper part of the cervix).
Thin prep pap smear is an improvised version of Pap Smear.
Thin prep pap smear was introduce back in 1996, and currently being widely used in the US where conventional Pap Smear is almost obsolete. In view of the faulty collection of samples and high percentage of misinterpretation of the result, Thin Prep was designed to solve the problem.

Unlike conventional Pap Smear, where the samples are fixed on a slide, the sample collected from Thin Prep are placed in a solution medium.
As Pap smear's result is purely based on human's ability to detect the abnormal cell, Thin Prep undergoes two process instead. First, they would be subjected to a Thin Prep imaging, where a computer will scan through the sample to look for presence of abnormal cells. Upon completion of the first step, then a review by experienced pathologist to confirm the finding.
As you can see, the designed of the collection brush for Thin Prep pap smear is designed differently (on the right) where the central longer bristles are made to reach the endocervix, while the peripheral outer shorter ones are for the ectocervix.
This enable Thin Prep sample collection to be far more efficient and a more complete sampling obtained.






Hence whenever you are going for your routine check up, be sure to ask for Thin Prep Pap smear instead. It is surprising to know not many general practitioner do not know about the availability of such improvised Pap smear.
In conclusion, insist on Thin Prep method to prevent the possibility of a false negative. It gives a more accurate for diagnosing intraepithelial lesions, higher degree of accuracy detecting high grade lesions in the genital tract, decreased number of misinterpretations of Pap results, improved sample collection noted with use of Thin Prep preparation, amd the same sample can be used to test for other problems and disease including HPV and sexually transmitted diseases without having need to collect another sample.