What is Pap Smear Test and Why is it important?
Pap Smear Test
Pap Smear Test / Papanicolaou test is the method of cervical screening used to detect potentially precancerous &cancerous processes in cervix by exfoliating cells from cervix & analyzing microscopically.
Cervix is the interior most portion of uterus which is cylindrical in shape that allows semen passage in uterus during sexual intercourse.
Worldwide, approximately 5, 00,000 new cases of cervical cancer &2, 74, 000 deaths are resulted from it annually, making it the second most common cause of death from cancer in women. (WHO, 2018). In case of Nepal, according to Human Papilloma virus & related cancers Fact Sheet 2018, 10.16 million Nepalese women aged 15 years &older have risk of developing cervical cancer ranking cervical cancer 1st most frequent cancer among Nepalese women.
But fortunately, the incidence of cervical cancer has been decreased by 50% in the past 30 years largely due to the increasing use of cervical cancer screening. Mainstay of cervical cancer screening has been Pap Smear Test developed by Dr. Georgium Papanikolaou & Dr. Durel Babe in 1940’s (American college of Obstetrician &Gynecology, 2016)
In the Pap Smear Test, the collected cells are released into vial of liquid preservative that is used in by laboratory to produce a slide for microscopic evaluation of cells.
Pap smear remains an effective, widely used method for early detection of precancerous & cervical cancer while it may also detect infections & other abnormalities.
Who should have a Pap Smear Test and How Often?
In general, doctors recommend beginning of Pap smear testing at the age of 21 up to 65 years for every 3 to 5 years who are sexually active.
However, in many countries, Pap smear is not recommended in non-sexually active females since about 99% of cervical cancers are attributed by infection from Human Papilloma Virus (HPV) which are transmitted sexually.
Furthermore, if the result of the Pap smear are abnormal, depending on the nature of abnormality, test may need to be repeated every 6 – 12 months.
If you have certain risk factors, which are mentioned below, regardless of age, needs Pap smear test more frequently.
- A diagnosis of cervical cancer or a pap smear showed precancerous cells.
- HIV infection
- Weakened Immune system due to organ transplant, chemotherapy or chronic corticosteroid use.
Pap Smear Screening is still recommended for those who have been vaccinated against HPV since the vaccine do not cover all of the HPV types that can cause cervical cancer. Also, the vaccine does not protect against HPV exposure before vaccination.
If you had a hysterectomy (surgical removal of uterus) because of abnormal cancerous cells or cervical cancer, you should continue to have Pap smear.
If the uterus is removed but cervix is still there, then regular Pap smear is needed until the age of 65.
Who can consider stopping Pap smear?
- Never had sexual contact
- Under the age of 21, regardless of sexual history
- Over the age of 65 if previous test of cervical test have been negative.
- Has surgical removal of uterus along with cervix for reasons other than abnormal cervical cancer.
How can you prepare for Pap smear?
- Avoid intercourse, using any vaginal medicine, spermicides form cream/jellies before 2 days before having a pap smear.
- Try not to schedule Pap smear during menstrual period.
- Empty bladder before Pap smear.
What you can expect during Pap smear?
Pap smear is performed in doctor’s office & takes only few minutes.
You may be asked to undress from waist down & need to lie down on your back on examination table with knee bent.
Then the doctor will insert vaginal speculum that holds the walls of vagina apart. A soft brush & flat scraping device called a spatula is inserted into the vagina to obtain sample of cervical cells.
Then the samples are transferred into a container holding a special liquid to study under microscope to look for characteristics in cells that indicate cancer or precancerous condition.
Results of Pap smear
- Normal Result:
If only normal cervical cells were discovered, result is negative. There is no need for any further treatment/testing until next schedule for Pap smear.
- Unclear result:
If the cells collected from the cervix is unclear/normal/abnormal doctor may recommend testing right away to rule out any problem or may repeat Pap smear in 6 months or year.
- Abnormal Result:
If abnormal/Unusual cells were discovered, you’re said to have positive result & to rule out cervical cancer/ precancerous ells, further test i.e. colonoscopy using special magnifying instrument to examine tissue of cervix, vagina is performed. Doctor also may take tissue sample from any area that appear abnormal & then send to lab for further analysis & a definite diagnosis.
By Soni Kayastha