Centre Médical Mercier-Châteauguay

Screening for Cervical Cancer

Dr. Edith Provençal

Screening for cancer of the cervix by Pap smear (Pap test) has been standard practice for over 40 years in Quebec. It has been estimated that since then, the frequency of this cancer and its mortality rate have decreased by more than 70%. Nevertheless, nearly 300 cases of cervical cancer still occur each year in Québec.

Recent discoveries about the human papillomavirus (HPV), now recognized as the cause of cervical cancer, have led to the development of new techniques for detecting HPV infections, and to changes in the screening recommendations.

The Pap test screens for both cancer and precancerous conditions. I often tell my patients that if we find precancerous cells, the Pap test has done its job: we have detected the problem before the cells turn into cancer. Screening should be started at age 21 in women who have been sexually active for the last 2 to 3 years. Since cervical cancer is virtually non-existent before the age of 20, women under that age are not tested. Women over age 65 are no longer tested if the results of the last 2 tests in the last 10 years were negative. Patients who have undergone a total hysterectomy for benign reasons are also not tested, since they no longer have a cervix. However, women who have been vaccinated against HPV should still be tested, because even though the vaccines offer very good protection, they do not cover all the genotypes.

There are various possible outcomes when we get the tests back. Results may be normal (including benign reactional changes associated with inflammation) or abnormal (low or high grade lesions) including abnormal cells of undetermined significance commonly known as ASCUS. In some such cases, we need to take the Pap test every 6 months to make sure everything goes back to normal.

A traditional Pap smear is placed directly on a microscope slide, which is sent to the public laboratory in your area for analysis. We now have Pap tests "in liquid medium". The sample is taken as usual from the cervix but instead of putting it on a slide, the sample is immersed in liquid. Once at the lab, it will be spread on a slide and read. The results are quite comparable. The advantage is in the speed of delivery (results in 3 days vs 2-3 months) and the possibility of doing further testing if the result comes back showing ASCUS. The same liquid sample can be used again to test for HPV, thereby eliminating the need to have the patient come back for a second appointment to get a new sample. If there is no HPV, the Pap test will be done again in 12 months. However, if the sample tests positive for HPV, the patient will be automatically referred for a colposcopy (further examination done by a gynecologist, biopsies). Then the patient just has to come back 6 months later for a new Pap test to compare results.

At Centre Médical Mercier-Châteauguay, we offer the possibility of Pap tests on slides or in liquid medium. While there is an additional charge for performing the Pap test using the liquid medium, it can save you the extra visit in the event of abnormal results.

Nasal Hygiene

Dr. Edith Provençal

Why is nasal hygiene so important for your children? Unfortunately, small children generally don’t know how to blow their noses. In addition, with the exchange of viruses in daycares and with children’s developing immune systems, they generally catch an average of 6 to 8 colds per year or about 2 colds per month during the winter season. There are not many ways to prevent colds aside from regular hand washing (at least after daycare and before meals) and good nasal hygiene. Keep in mind that your nose is the antechamber of your respiratory system.

The other challenge is to get enough salt water in your nose to be effective. The amount of saline water is very important: that's why you have the impression that vaporizers don’t seem to work. We would like to share with you our recommendations on how to perform nasal hygiene.

For a child under 2 years of age, we suggest lying the child on their back with their head straight. Apply 1 full dropper (1 ml) per nostril and use a baby nose aspirator (better than a bulb) to suction secretions. Reapply another full dropper (1ml) per nostril and again aspirate nasal secretions. If your child still has nasal secretions, repeat the operation with 1 ml of saline solution each time, until your child has a clean nose with good air flow. A good time to use this technique is when your child is lying down for a diaper change, for example.

For children over 2 years old who are able to blow their nose properly, have them sit on a chair with their head in a neutral position. Ask your child to look you in the eye to focus their attention and help them keep still. Make sure their nose is relaxed. Apply a first cycle of 5 sprays in each nostril without breathing the spray in. Then tilt your child's head a little forward and flush 1 nostril at a time. Apply another cycle of 5 sprays in each nostril and flush your child. You can repeat more cycles until your child has good air flow.

Remember, your child must practice blowing their nose before they get a cold. Take some time when the child is not congested to practice making a cotton ball move by blowing air out their nose! Children usually think this exercise is really fun, especially once they understand the principle of exhaling through the nostrils.

We recommend that you use these techniques for all your children (and yourself) at least once a day during the months of September to May and 3 to 6 times a day when you have a cold.

Saltwater Recipe

Boil 3 cups of tap water and 1 teaspoon of table salt for 10 minutes in a clean pan. Stir the water well to dissolve the salt.
Empty any remaining saline solution from the small bottle of Salinex each week and clean the bottle with hot, soapy water and rinse thoroughly. You can use the dishwasher (the bottle will last about 4 months).
Pour the required amount of salt water into the bottle.
You can keep the rest of the prepared solution in the refrigerator in a clean, closed container for up to 7 days. Use this solution to refill the small Salinex bottle during the week.

N. B. Keep the bottle at room temperature to avoid squirting cold water into your child's nose.

What Should an Annual Checkup for an Adult Entail?

Dr. Edith Provençal

NWe’d like to take this opportunity to explain what an annual checkup for an adult should entail, according to the most recent recommendations for primary prevention. Contrary to certain popular beliefs, it is not enough to simply take a blood test to check everything. Blood test results are notorious for giving a false sense of security. Everything we do depends on a complete evaluation of all factors, along with the data collected by our nurses.

Everything starts with that data collection. How can we evaluate your condition if we don’t know anything about you? It's like asking your mechanic to diagnose your car without mentioning anything that concerns you or telling him what year and model he is dealing with!

The questionnaire starts with your age (which is the biggest factor in decision making) as well as your personal and family medical history. Already with this information, we can begin our action plan. We also take an assessment of your lifestyle habits regarding your use of tobacco, alcohol and drugs as well as your eating habits and your level of physical activity. A review of your vaccination history will complete this stage of your evaluation.

We then review any questions you have about your health. This step is started by the nurse and then finalized by the doctor. At that point, the doctor will know what to focus on in the physical examination depending on your questions. The basic recommendations for physical exams for adults is to take blood pressure, determine the body mass index (according to weight and size) and measure the waist.

It is only after this process that the doctor and nurse can set up any further investigation. Blood tests must always be targeted according to Québec, Canadian and US recommendations. In short, there is no "routine" blood test recommended for adults under age 40 years unless a there is a specific problem.

For people over 40, a checkup is recommended every 1 to 3 years to screen for diabetes and check cholesterol levels. For adults age 50 and over, we must add a test for blood in the stool (every 2 years) and for the prostate-specific antigen in men. We must not forget the mammography for women (every 2 years) and osteodensitometry (1 to 3 years) for menopausal women and for men over age 65, to detect osteoporosis.

Canadian recommendations mention cervical cancer screening or cervical cytology (Pap test) from age 21 until age 69 in patients who still have their uterus (every 2 to 3 years).

We are sure that many of you will be surprised by these official recommendations. It is important for you to understand that the state of your health is not simply determined by a blood test, but by a general evaluation of all your personal factors. In addition, note that these lines are only a summary of the recommendations regarding the periodic medical examination of adults published by the Public Health Department, the Montreal Health and Social Services Agency and the Collège des Médecins du Québec. (April 2011).

The health sector is a world in constant evolution. New technologies and scientific breakthroughs mean that we must constantly change our ways of doing things. The good news is that we will always keep you informed, because we believe that each patient should be the master of his or her own health.