By Dr Rishu Agarwal, MD (Pathology)
The pap smear also called a pap test is the standard test used for early detection of cancer, and precancerous cells of the cervix. It is a painless, non-invasive procedure that doctors and other specially trained healthcare providers use to screen for cancer of the cervix. The pap smear is a screening technique. It is used to detect cervical cancer or cervical abnormalities that might become cancer in women who don’t have symptoms of these conditions.
What is the purpose of the pap smear?
Each year 15,000 women in the United States are diagnosed with cancer of the cervix. Regular pelvic exams and pap smears enable most pre-cancerous conditions to be detected and treated even before cancer develops.
Who should have it?
– Any woman who is sexually active
– If not sexually active then anyone aged 18 years and older
– Women who have had a hysterectomy (surgery to remove the uterus, including the cervix) should ask their health care provider’s advice about having pelvic exams and pap tests.
How frequently should one have a pap smear?
The American Society of Obstetrics and Gynaecology (an international body that governs gynaecology practices) recommends the following guidelines for early detection:
Age Frequency
21 – 29 yrs Once a year
30 – 69 yrs Every 2 to 3 years if you have had three normal pap smears is a row.
70 yrs and older You may stop having pap smears if you have had normal pap smears
over the past 10 years.
Regardless of age the woman should be examined
annually if she has the following risk factors:
– Early sexual activity
– Multiple sexual partners
– Past history of sexually transmitted diseases
– Family history of cervical carcinoma
– HIV, HPV (venereal warts) or HSV (genital herpes)
– Intake of oral contraceptive pills for more than five years
– Weakened immunity due to organ transplantation or prolonged steroid intake
– History of smoking
When should one have it?
The best time is between 10 and 20 days after the first day of your menstrual period.
For about two days before the pap test avoid douching, spermicidal foams, creams, jellies or vaginal medicines, which may wash away or hide abnormal cells.
Do not have the pap test at the time of your menstrual period as the blood can obscure the specimen reading.
Why are regular pap smears so important?
Regular pap testing is important because:
– No one can predict who will develop cervical cancer.
– This procedure enables healthcare providers to detect early pre-cancerous changes in the tissue of the cervix and treat them before they become cancerous.
– Women who have regular pap smears are much less likely to develop cervical cancer than are women who don’t have the test regularly, because they get early treatment for pre-cancerous conditions.
What happens during the pap test?
A wooden spatula (scraper) and/ or a small brush are used to collect a small sample of cells from the cervix by gentle wiping. The cells are placed on a glass slide and sent to a medical laboratory to be checked for abnormal changes that may appear years before the cancer develops. This is a painless procedure and requires no analgesia or anaesthesia.
The results
Negative result – A ‘negative’ result means that a sample looked normal. If the results are negative then no further action is usually needed. However, you should:
– Contact your health care provider if you experience unusual discharge, bleeding or pain.
– Have regular pap tests as recommended.
– Take steps to reduce your risk of cancer, ie, avoid smoking; if sexually active then use a latex condom to help protect against certain types of sexually transmitted diseases that could predispose to cancer.
Positive result – A ‘positive’ or ‘abnormal’ test result means some changes in the cells were observed.
What does an abnormal pap test mean?
Infection – even with no symptoms, an infection can cause cell changes, for example:
– Yeast infections
– Chlamydia
– Genital herpes
Irritation – cervical cells may be irritated by:
– Birth control devices, eg, diaphragms or cervical caps
– Vaginal creams, douches or tampons
Low oestrogen levels – If postmenopausal, a decline in the hormone oestrogen can cause inflammation.
Pre-cancerous changes – These are the conditions where some cervical cells show changes that, in time, may turn into cancer. Many women also show consistent signs of HPV infection (Human Papilloma Virus).
Low-grade squamous intraepithelial lesion – abnormal cells are found in the basal layer of cervix.
High-grade squamous intraepithelial lesion – abnormal cells are found in middle or upper layers of the cervix.
Invasive carcinoma – abnormal cells are widespread and frank carcinoma has developed.
What happens after an abnormal pap test?
If the suspected cause is infections/ irritation or inflammation, the treatment can be medications with a repeat pap smear in three to six months.
Low grade squamous intraepithelial neoplasia may be handled in one of two ways:
– Colposcopy, a special examination of the cervix
– Pap tests every three to six months to monitor the condition, since it may go away on its own, but this cannot be confirmed without repeat tests.
For other high grade lesions, colposcopy is needed and possibly a biopsy.
Putting it all together
Here is a summary of the important facts and information related to a pap smear.
– The pap smear is the only procedure that can detect early cancerous or potentially cancerous conditions of the cervix and vagina.
– The pap smear is a screening technique. It is used to detect abnormalities in women who do not have any disease symptoms. It is not a diagnostic procedure.
– The pap smear cannot prove that a woman doesn’t have cervical cancer.
– A girl or a woman who is at least 18 years old or who is or has been sexually active should have a pap smear every year unless her doctor says she should be tested more or less often.
– Having regular pap smears is the most important thing a woman can do to protect herself from cervical cancer.
We will discuss colposcopic examination of the cervix in a future column.
