Pap smear: Everything you need to know about it

By Dr Veena Aurangabadwala, Gynaecologist, Zen Multispeciality Hospital, Chembur

A Pap smear, also called a Pap test, is a procedure to test for cervical cancer in women. Thus, detecting cervical cancer early with a Pap smear gives you a greater chance at a cure. Here, we brief you what it is all about.

The Papinocolou smear, popularly known as the “Pap smear” was invented by a Greek physiologist Georgios Papanicolaou, who first sampled and smeared the vaginal fluid of his longtime girlfriend every day to study abnormal changes in the cervical cytology. He, later on, conducted these tests on his friends and was able to detect cervical cancer in one of them even before any symptoms.

What is cervical cancer?
Cervical cancer is a very slowly progressing cancer, and very rarely gives any early symptoms, such as white discharge, foul-smelling vaginal discharge or bleeding after intercourse. It cannot be identified by any imaging technique in the precancerous or early precancerous stage. This has made cervical cancer one of the most common cancers among Indian women, with very poor survival and high mortality rate, as most of these cases are detected at the advanced stage.

How Pap smear can be helpful in detecting cervical cancer

Pap smear is an economical and easy test which can be done with a pelvic examination in the outpatient department or doctor’s clinic. Hence, it is the method used to screen and detect cervical cancer in women. In this test, the cervix is viewed through a speculum with the patient in the dorsal position. Cells are scraped from the cervix and examined under a microscope to check for disease or other problems.

Types of Pap smear

There are two types of Pap smear based on the technology used – Conventional Pap smear and the Liquid-based cytology (Thin prep /SurePath). The liquid-based cytology is the preferred technique of use. Thus, it is more accurate and is better in predicting early precancerous changes.

When is it recommended?
Pap smear is recommended every 3 years for every sexually active woman from 21 to 65 years of age. Women aged 30 and older can consider Pap testing every five years if the procedure is combined with testing for HPV (Human Papilloma Virus DNA). Women are considered to be at ‘high risk’ of cervical cancer, if they have a weakened immune system due to HIV infection, chemotherapy or long term steroid use, being on immunosuppressive medications due to organ transplant, previously diagnosed with cervical cancer or Pap smear showing precancerous cells, or have history of smoking or using birth control pills for many years, or those with multiple sexual partners and should undergo more frequent Pap smears.

How to prepare yourself for a Pap smear?
To ensure that the Pap smear is most effective, women must avoid intercourse, vaginal douching, use of any vaginal medications or spermicidal jellies for 2-3 days before undergoing a Pap smear, as this would wash away the abnormal cells. Women should also not schedule a Pap smear around the time of monthly menstrual cycles. A Pap smear can be performed even during pregnancy. Women may experience slight vaginal discomfort and minimal bleeding during the Pap smear test but can get back to their routine activities immediately after the test.

When should women doing a pap smear?
Women should consider stopping Pap smear tests beyond the age of 65 years if their previous Pap smears showed negative results, or if they’ve undergone a total hysterectomy, i.e. removal of the entire uterus with the cervix, for a non-cancerous condition such as uterine fibroids.

Take-home message: If the Pap smear test is abnormal, the doctor may recommend a procedure called colposcopy using a special magnifying instrument (colposcope) to examine the tissues of the cervix, vagina, and vulva. The doctor also may take a tissue sample (biopsy) from any areas that appear abnormal. The tissue sample is then sent to a laboratory for a definitive diagnosis. It is important to remember that the Pap smear is just a screening test and can be incorrect. Hence, an abnormal Pap smear report requires further testing to reach the correct diagnosis. This is also the very reason why Pap smears need to be repeated periodically, even if the previous tests were normal.