Pap Smear: Reasons, Procedure and Results
Pap Smear also termed as the Pap Test is a screening test done by your doctor or nurse for the presence of abnormal or precancerous cervical cells.
The cervix opens into the vagina and is the lower and narrower portion of the uterus. If not treated on time, these abnormal cells can turn into cervical cancer.
Reasons for doing Pap Smear
A pap smear is done to determine the precancerous and cancerous cells around the cervix that would later lead to cervical cancer.
Along with the Pap Smear, your doctor may recommend you to undergo the HPV test (human papillomavirus) for the detection of abnormal cervical cells.
When to get the Pap Smear?
Women aged 21 to 65 should have a Pap Smear done routinely.
Women aged less than 21 years old do not require it however, women in the age range may require it every 3 to 5 years.
You should be getting the Pap Smear more often if: (in case recommended by the doctor)
- You already have cervical cancer. The doctor may recommend you to get a Pap test again to be sure of the kind of abnormal cells you have and how they can be treated.
- There are health issues like HIV.
- You have undergone chemotherapy or organ transplant and now have a weak immune system.
- There is exposure to diethylstilbestrol (DES) before giving birth
- You have used chronic corticosteroid
- There is a history of smoking.
Do sexually inactive people also require Pap Smear?
Many cervical cancers occur due to the sexually transmitted HPV virus but all cervical cancers are not viral.
Hence, every woman above the age of 21 should get a Pap Smear every 3 years and if advised by the doctor, an HPV test every 5 years.
The Procedure of carrying out Pap Test
Pap Smear is carried out by putting a speculum in your vagina by having you lie on a bed with your knees bent and feet resting in stirrups.
The speculum will keep the vaginal walls open for the doctor to access the cervix and collect cervical cells with a spatula or a brush.
The Pap Smear can be slightly uncomfortable when inserting the speculum or scraping the cells. The cells may be transferred to a glass slide to be tested in the laboratory under a microscope. The pain may lead to little irritation or cramping.
In some cases, there might also be a little vaginal bleeding. If all these conditions continue, you should consider consulting your doctor.
Before you go for a Pap Test there should be a few precautions to take:
- You should not be on your period. You should consider postponing your appointment if it occurs during your menstruation period.
- Refrain from having sexual intercourse two days before the test or use any lubricants.
- Avoid use spermicidal foams, vaginal creams or powders at least two days before the test.
- Do not douche. Avoid using water except for only on the outer part of the vagina. This can otherwise rinse or wash away the cells that are required for the test.
- Do not try inserting tampons, suppositories or creams in the vagina.
- You can have the Pap Test in the first 24 weeks of pregnancy or after 12 weeks of birth. Anything in between may be more uncomfortable and it is advisable to wait till 12 weeks after delivery.
Results of Pap Smear
Your next Pap Smear should occur in 3 years and if you had an HPV test with it then you can have your Pap Test after the next 5 years.
Maybe the status of your cervical cells is ambiguous and the doctor cannot figure out if they are normal or abnormal.
To rule out any complications that may further advise, the doctor may recommend you to take another test like the HPV or to come for another Pap Test in the next 6 months.
After all, cancer is better diagnosed early, hence getting a Pap Smear within six months to a year would be ideal to get rid of any ambiguities.
If the cervical cells are abnormal, it does not directly mean that you have cervical cancer.
While your result will be positive because of these unusual results, whether they are cancerous or not will be discovered by their type.
One type is the Atypical Squamous cells of undetermined significance (ASCUS). These cells are thinly layered on the cervix. If the Pap test indicates some abnormality, it cannot be determined if they are actually precancerous or not.
To best way to get them checked is to send the sample for another analysis and this time check for viruses that cause cervix cancer like the HPV virus.
If these high risk viruses are absent then the presence of ASCUS does not indicate cervical cancer, however if they exist then further tests are conducted to be sure.
The cells, Squamous intraepithelial lesion in the result indicate that these cells are precancerous.
However, there is not much to worry yet. If the characteristics, shape and size wise changes of the cells indicate that it is a low grade change in the precancerous lesion then it is likely that the cancer is a few years away from developing.
Hence, the patient benefits from their early stage detection. However, if the change is high grade then unfortunately, the cancer might develop earlier in a few years and more testing would be required for further diagnosis.
As the name suggests, Atypical glandular cells secrete mucus and grow between cervix and uterus. These cells come more in the unclear category rather than abnormal because even though they are slightly abnormal, further tests are needed to see if they are even precancerous and cancerous.
The most certain form of cancerous cells in the cervix would be Squamous cell cancer and adenocarcinoma cells.
The squamous cancer cells will be found in the flat surfaces of the vagina and cervix and the adenocarcinoma cells are found in the mucus. These are so apparently abnormal that a doctor would mostly without any doubt send the patient to further examination.
If there is still uncertainty regarding the test results or there is an assurance of abnormal cells, the doctor may recommend you to get the colposcopy and biopsy.
The colposcopy uses a colposcope to insert a speculum in the vagina.
The colposcope magnifies the tissues around the cervix for a better view and if found cancerous,the doctor will take a tissue sample,which is the biopsy, so that the doctor can check tissues around the cervix clearly and send that sample for further tests.
When should you stop getting the Pap Smear
The Pap Smear is recommended to most people in the age group of 21 to 65.
It is possible to stop taking the Pap test after the age of 65 because if you have kept with a routine checkup and have always been normal then you no longer need to worry about it.
The Pap Smear test only applies to women with a cervix.
In case, you have had a hysterectomy and have removed your cervix, as long as your previous Pap Smear results came negative, you no longer need to worry about getting cervical cancer.
It is always good to be careful if there is a history of cancer in the family along with immunity issues.
Risks of Pap Smear
Pap smear is an accurate test. In fact frequent testing reduces cervical cancer by up to 80 percent.
However, it is likely that it can sometimes miss some abnormal precancerous and cancerous cells. Your doctor will be fully aware of this and may recommend further tests for the confirmation of cervical cancer.
There will be a very slight pain during the test and at most it can lead to cramping. Therefore,it is a very bearable test.
Like every other test, there is a chance of error and there can be a false negative.
This does not mean that there has been a mistake by the lab but that there can be a lesser number of abnormal cells in the sample. Or an insufficient number of total cervical cells sampled as well as inflammation leading to inflammatory cells hindering the way to the abnormal cells.
Even if the chances of this happening are low, it is better to be regular with your Pap Smear.
Sexually inactive people have this misconception that they don’t need to be tested.
It is better to have tests regularly between 3 to 5 years to be on the safe side.
HPV virus for instance, can remain dormant for many years and then surge immediately.
So cancer, caught soon diagnosed cancer is most effectively treated.
If you have been sexually active with many partners then it is undeniable that you should definitely get a Pap Smear.
Sexually active women are at a risk of contracting either the HPV virus or the cervical cancer. So you should get the Pap test every 3 years.
It is better to be careful because cervical cancer links with HPV virus. Moreover use any barrier method to prevent sexually transmitted infections.
The Pap smear wraps up in a few minutes but it helps save your life and protect you from a greater turmoil.
If you have never had a Pap Smear do not delay it now. If it has been long since you last got a Pap test, you should hurry for one.
Pap Smear is an essential check for all women, put your health first!