An Overview of Pap Smear Test

The Pap smear test is a highly valuable, simple, cost-effective, and safe method for detecting early signs of precancerous or cancerous cervical cell changes that might indicate cancer. Establishing this test as a routine screening procedure is crucial to alleviating the burden of treatment, reducing morbidity, and preventing mortality.

Cervical cancer is a growing global health concern and a significant cause of death among women worldwide. The occurrence of cervical cancer is widespread, but there is a notable difference in incidence between developed and developing countries. Developed countries have successfully reduced the number of cervical cancer cases, while developing countries, like India, continue to bear a heavy burden of this disease. In fact, according to World Cancer statistics, over 80% of all cervical cancer cases are reported in developing countries with limited resources. This difference can be attributed to a lack of awareness and challenges in implementing effective cytology-based screening programs in these regions.

India accounts for over one-fifth of all cervical cancer-related deaths globally. Annually, 122,844 Indian women receive a cervical cancer diagnosis, and the disease claims the lives of 67,477 women.

In light of this, it is crucial that all women aged 30 and above prioritise regular cervical cancer screening, even after reaching menopause. The Pap test is widely recognised as the benchmark for cervical screening programs. Combining the Pap test with an HPV DNA test enhances the sensitivity for detecting cervical abnormalities. Educating the community about the Pap smear test’s purpose and the recommended screening frequency through extensive educational initiatives and media campaigns is essential.

As per the American Cancer Society’s guidelines from 2012, the Pap smear test is a standard screening procedure for cancer that should be performed every three years. Additionally, a combination of a Pap smear and HPV DNA testing is advised as a screening method every five years. By promoting these recommendations and ensuring widespread access to screening, significant progress can be made in reducing the impact of cervical cancer globally.

Why is the Pap Smear Test done?

Routine healthcare includes a Pap test and pelvic exam, which are essential for identifying abnormal cells that can potentially lead to cancer. By undergoing regular pelvic exams and Pap tests, most cases of cervical cancer can be detected at an early stage, enhancing the chances of successful treatment.

The Pap smear test is a valuable tool for diagnosing not only cancer cells but also other vaginal and cervical issues like precancerous cells, inflammation, infections, and abnormal cells.

In combination with a Pap test, healthcare providers may also perform an HPV test. This test determines the presence of HPV (human papillomavirus), a critical risk factor for cervical cancer in women over 30 years of age. By combining both tests, healthcare providers can better assess the risk of developing cervical cancer.

Frequency of Pap Smear Test/Pap Test

The frequency of Pap tests is determined by various factors such as health history, age, and the results of previous Pap or HPV tests. Generally, individuals do not require Pap smears after the age of 65.

Certain factors may lead to more frequent cervical cancer screenings or continuing screenings beyond the age of 65 years. These factors include:

• Individuals who have the human immunodeficiency virus (HIV) or are immunocompromised due to other medical conditions or treatments like chemotherapy may require more frequent cervical cancer screenings. These circumstances can increase the risk of cervical cancer and warrant closer monitoring through regular screenings. It is advisable to consult with a healthcare provider to determine the appropriate screening frequency based on specific health conditions and medical history.
• If you were exposed to diethylstilbesterol (DES) while in your mother’s womb, it can elevate your risk of developing cervical cancer. This medication has been linked to an increased susceptibility to cervical cancer. It is important to be aware of this exposure and discuss it with your healthcare provider to determine the most suitable screening approach for cervical cancer.
• If you have undergone treatment for cervical cancer in the past, it is crucial for your doctor to consider this history when determining the appropriate cervical cancer screening approach and frequency.

If you have undergone a total hysterectomy (removal of both the uterus and cervix) for non-cancerous reasons, regular screening for cervical cancer is generally not necessary. However, if a hysterectomy was done due to cervical cancer or precancerous conditions, it is important to consult with your healthcare provider to determine the appropriate follow-up care required. On the other hand, if you have undergone a partial or supracervical hysterectomy (removal of the uterus but retention of the cervix), routine cervical cancer screening should continue as recommended. It is essential to have a conversation with your healthcare provider to discuss your specific medical history and receive personalised guidance regarding cervical cancer screening following a hysterectomy.

Preparations required for the Pap Smear Test

• Your doctor will provide you with a detailed explanation of the procedure and will be available to address any questions or concerns you may have.
• Inform your healthcare provider if you have any sensitivities or allergies to medications, tape, or latex.
• In most cases, no specific preparation is required before the test.
• Make sure to inform your doctor about all medications (over the counter and prescription) and herbal supplements you are currently taking.
• Provide information to your healthcare provider regarding the timing of your last menstrual period and any birth control methods or hormone therapy you are using.
• If you have a history of bleeding disorders or are taking medications that affect blood clotting (such as anticoagulants or aspirin), it is important to inform your healthcare provider.
• Inform your healthcare provider if you are pregnant or suspect that you might be.
• Refrain from using spermicidal products, vaginal medications, jellies, creams, or douches for the specified period recommended by your healthcare provider before the test. Avoid sexual intercourse within twenty-four hours before the test.
• You may be informed to empty the bladder before the Pap test.
• Follow any additional instructions provided by your healthcare provider to adequately prepare for the test.

What to Expect?

Before the Pap Smear Test

Before a Pap smear test, it is important to consider the timing, especially if you are menstruating. Menstrual blood and other tissue can interfere with the accuracy of the test results. It is generally recommended to schedule the Pap smear one to two weeks after you expect your period. According to the American Cancer Society, an alternative option is to wait at least five days after your period ends before having the test. This allows for a cleaner sample and more reliable results. It is always a good idea to consult with your healthcare provider for their specific recommendations regarding the timing of the Pap smear test.

If your menstrual cycle is irregular and you realise that your period will coincide with your scheduled Pap smear appointment, it is important to contact your healthcare provider’s office as soon as possible. In such cases, they may advise you to reschedule the appointment. However, some healthcare providers may proceed with the Pap smear if your menstrual flow is very light. The decision will depend on the individual provider and their assessment of the situation.

To ensure an accurate result from the Pap smear test, it is important to avoid certain things before the test. These include:

• Sexual intercourse: Refrain from having sex for 48 hours before your Pap smear.
• Spermicides: If you are not sexually active, it is unlikely that you will be using spermicides; however, it is important to note that you should not use spermicidal foams, jellies, or other birth control products for 48 hours before your Pap smear.
• Vaginal lubricants: Avoid using any vaginal lubricants for at least 48 hours before your Pap smear.
• Tampons: Do not insert a tampon for 48 hours before your Pap smear.
• Vaginal douches: It is generally not recommended to douche (intravaginal cleaning with a liquid solution), but if you do, it is important to stop using vaginal douches for at least three days before your appointment.

If you happen to forget or unintentionally engage in activities such as intercourse, douching, or using anything in the vagina within two days before your appointment, it is important to promptly contact your healthcare provider or nurse. They can guide you on whether it is necessary to reschedule your Pap smear appointment.

During the Pap Smear Test

During a pelvic exam, your healthcare provider will perform the Pap test in a private room at their office. The entire procedure typically takes just a few minutes. While the test may cause some discomfort, it is generally not painful. To minimise discomfort, emptying your bladder before the examination and trying to relax your muscles while taking deep breaths might help.

When you arrive for your Pap test, your healthcare provider may ask you some basic questions related to the test. These questions may include details about your medical history, previous Pap test results, any symptoms or concerns you may have, and information about your menstrual cycle. It is important to answer these questions openly and honestly to ensure appropriate care during the procedure. Questions may include:

• Are you currently pregnant?
• Have you taken any medications recently?
• Do you use any form of birth control?
• Do you smoke?
• Are you experiencing any symptoms such as itching, redness, or sores?
• When was your last menstrual period, and how long did it last?
• Have you ever received abnormal results from a previous Pap test?
• Have you undergone any surgeries or procedures related to your reproductive organs?

Before beginning the Pap smear procedure, you may be required to change into a gown. This can be done in a private area or while your healthcare provider steps out of the room to provide you with privacy. During the actual procedure, you will lie on your back on the examination table. Your heels will be placed in the stirrups located at the end of the table. This positioning allows for better access during the examination.

Next, your healthcare provider will gently insert a lubricated speculum into your vagina. The speculum is a plastic or metal instrument that gradually opens and spreads apart the walls of the vagina. This process may cause some discomfort or sensation, but it is typically brief and manageable.

After visually inspecting your cervix, your healthcare provider will utilise either a cotton swab or a cervical brush to carefully collect cell samples from two specific areas on the cervix:

• The ectocervix: This refers to the part of the cervix that is closest to the vagina.
• The endocervix: This refers to the portion of the cervix adjacent to the body of the uterus. This area, known as the transformation zone, is the site where cervical cancer usually develops.

During the collection of cells, you may experience a sensation of pulling or pressure, but it is generally not painful. Your healthcare provider will carefully spread the collected cells onto a glass microscope slide or place them in a container with a preserving liquid to maintain the sample’s integrity. The sample will then be sent to a pathologist for evaluation and further examination.

After the Pap Smear Test

After undergoing a Pap test, you can resume your regular activities immediately. It is normal to experience minor vaginal bleeding following the test. However, it is important to notify your healthcare provider if you notice excessive bleeding. If the Pap test reveals abnormal cells and an HPV test shows a positive result, your healthcare provider may recommend additional tests to further assess the situation.

Risks associated with the Pap Smear Test

Although a Pap smear is a safe and reliable method for cervical cancer screening, it is not without limitations. False-negative results can occur, which means that the test may show no abnormality even when abnormal cells are present.

Receiving a false-negative result does not imply that an error was made during the test. Several factors can contribute to a false-negative outcome, including:

• A limited number of abnormal cells present in the sample
• Insufficient collection of cells during the procedure
• Interference from blood or inflammatory cells obstructing the visibility of abnormal cells

While abnormal cells can go unnoticed during a Pap smear, it is important to remember that cervical cancer typically takes several years to develop. If abnormal cells are not detected in one test, subsequent tests are likely to identify them. Time is on your side when it comes to early detection and intervention for cervical cancer.

Takeaway

Pap smears, also known as Pap tests, play a vital role in identifying abnormal cervical cells that could potentially develop into cervical cancer. It is important for individuals between the ages of 21 and 65 to consult with their healthcare provider to ensure they are up to date with their Pap smears. Detecting precancerous or cancerous cells on the cervix at an early stage can significantly improve the likelihood of successful treatment.