A-Z About PAP Smear testing

'The PAP Smear test is key to prevention of Cervical Cancer'.

Hello!

This is Dr. Manu here, I am a full time practicing Consultant Gynecologist in Chennai. In this awesome round-up article we are going to discuss everything under the sun about PAP smear testing.

So then… 

What is a PAP Smear test?

Papanicolaou test, also called Papanicolaou test, is a test commonly used to detect cervical cancer, first invented by Georgios Nikolaou Papanikolaou, a Greek doctor who was a cytologist (a famous one at that).

Cervical cancer should be detected and treated early and this can be done if the Pap test is performed regularly.

Through this test, your gynecologist can find changes in the cells of the cervix that are the precursors of the actual cancer cells. 

Early detection of cervical cancer allows us gynecologists to administer highly specific treatments that have a  very high chance to be effective.

The biggest advantage of the PAP Smear test is of course it’s  due to its reproducibility and low cost and ease of performing.

Who should undergo PAP Smear testing?

The decision to make the PAP smear is individual to the patient, as recommended by your gynecology doctor. 

This test should be done once a year for two or three consecutive years, for all women who have started their sexual life and, if the results are negative, they will be repeated every three to five years if there are no additional risk factors. 

Here are some general recommendations  for the tests

  • It is recommended to all women over 21 and after 2 to 3 years of having started penetrative sexual intercourse. And, the testing is done again every 1 to 3 years
  • Known history of Immunosuppressive diseases like (HIV).
  • Women with a past vaccination history against Human papilloma virus (HPV)
  • History of a past genital Human papilloma virus (HPV) infection.
  • All Pregnant women
  • High risk Sexual relationships with multiple partners
  • Postmenopausal women and those who no longer have sex should also perform the PAP
  • Women whose uterus has been completely removed, (women operated on and without uterus) it is not necessary that they continue to perform the test, but this decision must be according to the treating gynecologist.
Is the PAP smear test procedure painful?

Interestingly, this test usually is not painful or uncomfortable; the PAP smear testing procedure lasts hardly 15-20 minutes.

Sometimes a biopsy is done at the time a colposcopy is performed and it can be a bit uncomfortable like a pinch, but this part lasts less than a minute.

Your gynecologist will suggest that you take an analgesic to help reduce the pain or discomfort you may have.

Steps before a PAP smear is performed
  • Do not schedule a medical appointment for a PAP smear during the menstrual period. The best time is at least 5 days after the menstrual period has ended.
  • Do not use tampons, spermicidal foam or jellies, other vaginal creams, moisturizers, or lubricants, or vaginal medications 2 to 3 days before the Pap smear test.
  • Avoid vaginal douching 2 or 3 days before the Pap test.
  • Do not have vaginal sex 2 days before the Pap test.

How is a PAP smear done?

The Papanicolaou test is a procedure used to obtain cervical cells to observe them under a microscope to detect the presence of cervical cancer. 

The doctor first places inside the vagina an instrument keeps the vagina open, just to get access and visualize the cervix well. Then, a small sample of cells and mucus from the ectocervix is taken. 

Next, your gynecologist inserts a small endocervical brush or a cotton swab into the opening of the cervix to take a sample from the endocervix.

When the patient does not have a cervix, because it was removed by hysterectomy, as part of the treatment of cervical cancer or pre-cancer, the sample will be taken from the cells in the upper part of the vagina.

It is usually easy to get an exocervical (ectocervical) sample because of accessibility of the squamous epithelium, however, the endocervical samples are also equally important as good sampling decreases the percentage of high false negatives.

Results of the PAP Smear test & treatments:

Normal results:

If there are no abnormal cells, the result of the test is considered normal.

Abnormal results:

A. Atypical cells of undetermined importance (ASCUS, AGUS).

B. Low-grade squamous intraepithelial lesions (L-SIL) or

C. Cervical intraepithelial neoplasia (CIN) grade 1. These are cellular and subtle changes, and most disappear without treatment. 

An abnormal PAP does not mean cancer; there are anomalies that tend to disappear spontaneously, while in other cases the patient must undergo other tests such as colposcopy and/ or biopsies to confirm the diagnosis and treatment.

It is estimated that out of every 100 women who made a PAP test, 93 will have results normal, 2 will require repeat testing because the sample was unsatisfactory, 4 will need follow-up smears and only 1 will need treatment. 

Unsatisfactory or inadequate sampling means the laboratory could not read your smear clearly and you need to repeat PAP smear testing in 3 months.

Moderate or High changes in Cervical intraepithelial neoplasia (CIN2), (CIN3): This means that the test has found a larger number of abnormal cells in your cervix. These cells are less likely to return to normal by themselves. 

Further testing is usually required.

This does not mean you have cancer but you will be advised a colposcopy at the hospital. If these studies confirm the presence of a malignant or premalignant lesion, treatment will be necessary.

The treatments depend on the type of lesion, the size and individual characteristics of the patient, but in general consist of removing or destroying the malignant tissue.

The most common method used to treat precancerous lesions of the cervix is the loop electrosurgical excision procedure (LEEP), in which an electrical current is passed through the thin wire loop that acts like a knife to cut the tissue.

Other methods less used to treat such tumors are cryotherapy, laser therapy, and conization. 

Screening guidelines recommend that women who have been treated for precancerous lesions or cancer should continue to be screened for at least 20 years, even if they are older than 65.

Carcinoma: Squamous cell suggests that the woman has a high probability to suffer from invasive cancer.

Abnormalities of glandular cells: Means the glandular cells look atypical, and their characteristics suggest the possible presence of cancer. The patient must do additional tests.

Adenocarcinoma: This means cancer of glandular cells, the pathologist examines the cells to indicate where the adenocarcinoma started (endocervix, uterus, or another part of the body)

I hope this article gave you some information about the PAP smear test. Please do share this article with all your friends and loved ones!. 

Now that you are enlightened about the benefits of PAP smear testing, to get yourself checked periodically!. As the age old saying goes…

“Prevention is better than cure”

References

  1. Koss LG. Cervical (Pap) smear new directions. Cancer. 1993 Feb 15;71(S4):1406-12.
  2. Gravitt PE, Paul P, Katki HA, Vendantham H, Ramakrishna G, Sudula M, Kalpana B, Ronnett BM, Vijayaraghavan K, Shah KV, CATCH Study Team. Effectiveness of VIA, Pap, and HPV DNA testing in a cervical cancer screening program in a peri-urban community in Andhra Pradesh, India. PloS one. 2010 Oct 28;5(10):e13711.
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