Pap Smear Test

Pap smear test is a screening test for cervical cancer. Pap smear test saves thousands of lives from cervical cancer hence we recommend for sexually active women to do regular Pap smear test and this could be lifesaving. Studies from Western world have shown that cervical screening test prevents 70% of cervical cancer deaths. If whole population of women attended screening regularly, 83% of cervical cancers could be prevented. Pap smear test is not a test to detect cancer but it looks for pre-cancerous cells in the cervix. These pre-cancer cells can develop into cancer if they are left untreated. So, stop cancer before it starts.

Where is cervix situated in the body?

Cervix also known as neck of the womb and is the lower most part of the womb (uterus). Cervix is a tubular structure and has two parts – ectocervix & endocervix. It also has two opening known as internal & external os / orifices. 

The cells lining the ectocervix is known as Squamous epithelial cells and the cells lining then endocervix is known as glandular cells. 

Cancer arising from the squamous epithelial cells is known as squamous cell carcinoma (SCC) and cancer form glandular cells is known as adenocarcinoma

What is cervical cancer?

When cancer originates from the cervix it is known as cervical cancer. In 2018, India had 97,000 cases of cervical cancer and 60,000 deaths due to cervical cancer. Cervical cancer has been ranked in the top three cancers affecting younger women who are less than 45 years of age.  

We now have the knowledge that persistent infection with high risk human papillomavirus (HPV) is the main cause for initiating cervical cancer and this knowledge has opened a new pathways for primary and secondary prevention. Primary prevention is by taking HPV vaccination and secondary prevention is by getting regular Pap smear test.

Why do I need a Pap smear test?

  • A Pap smear test can save your life. It can find cervical cancer cells early. When cervical cancer is caught early and treated, the chance of success is very high. Pap smear tests not only identifies cancerous cells but it is good in picking up abnormal cervical cells (precancerous cells).

  • Cervical cancer doesn’t develop overnight. Before cancer can develop there is a condition called precancerous condition and it is known as cervical dysplasia or cervical intraepithelial neoplasia. After being exposed to HPV infection, cells of the cervix will undergo some changes and develops cervical dysplasia. Remember precancerous conditions is not cancer. But, if this condition is not identified and treated they can turn into cancer. It is said that if precancer condition is untreated it may take about 10 – 15 years for it to turn into cervical cancer, but in rare cases this can happen even in less time.

  •  By identifying and removing these precancers areas we can prevents cervical cancer over 95% of the time.

How is Pap smear test done?

  • Pap smear test takes only five minutes and in India it is usually carried out by a doctor in the clinic. Make an appointment for your Pap smear when you will not be having your periods. You will be asked to lie on your back  on the examination couch with your knees bent. Doctor would perform an internal examination and will gently insert a speculum into the vagina so that they can see your cervix. Then they will use a special soft brush to collect cells from the cervix and send it to a laboratory for testing.

How should I get prepared for the test?

  • For two days before going for the test, do not - douche, use tampons, keep any vaginal pessary medications or have sexual intercourse. 

  • The best time to go for a Pap smear test is after your menstruation stops.

How often should I get Pap smear tests?

Are there exceptions for regular Pap tests?

Sometimes women who may not need regular Pap tests such as:

  • Women who are older than 65 and if they have had three normal result Pap smear tests or two normal co-tests (Pap + HPV) in a row within the last 10 years, and the most recent test should be within the last 5 years.

  • Women who have undergone hysterectomy and who do not have a history of cervical cancer or abnormal Pap test results in the past. 

Talk to your doctor before stopping regular Pap tests.

Who needs Pap tests more often?

In some high risk cases your doctor may recommend getting Pap and HPV tests more often if:

  • There is past history of abnormal Pap smear test results or cervical cancer. Such women may need to be tested more often, because their past history puts them at higher risk of recurrence in the future.

  • Women with HIV as  they are more at risk of developing cervical cancer because of a weakened immune system. All women with HIV should get their initial Pap smear test at the time of the HIV diagnosis and a second Pap test 6-12 months later, so talk to your doctor. If there are three normal Pap tests results in a row, women with HIV can go for follow-up Pap smear tests every 3 yearly.

  • Your mom was exposed to diethylstilbestrol (DES) during pregnancy while carrying you in the womb.  It has been noted that daughters, and possibly granddaughters, of women who were exposed to DES during pregnancy have a higher risk of developing cervical cancer.

Does Pap smear test procedure hurts?

  • You might experience some discomfort or pain – try to relax by taking in slow and deep breaths this will help you to relax your muscles.If it is painful, tell the doctor straightaway as they may be able to reduce your discomfort.

I have taken HPV vaccination, do I still need Pap smear test?

“Yes” you should still attend for your regular cervical screening tests, even if you have received the HPV vaccine that’s because the vaccine does not guarantee complete protection against cervical cancer

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