Pap smear test, also known as cervical smear is a screening test aimed at early diagnosis of precancerous and cancerous lesions in the cervical canal. The cervix is the tubular portion of the lower part of the uterus ending in the vagina. Early detection of cancer or other health conditions which may lead to the cancer in future in the cervical canal increases the chance of cure.
Pap smear test is recommended in every woman aged between 21 and 65 years and it should be repeated at an interval of 3 to 5 years.
Indications
Pap smear test is a screening test for early detection of cervical cancer; usually pelvic examination is carried out at the same sitting with Pap smear. In women aged above 30 years Pap smear test is recommended along with a test for the presence of infection by Human Papilloma Virus (HPV). HPV infection is one of the common sexually transmitted infections; infection by some of the subtypes of HPV may lead to cervical cancer.
Women between 21 years of age are recommended to do this test at an interval of 2 to 3 years, whereas in women above 30 years the recommended time interval between two Pap smear tests should be 3 years. However, in certain high risk patients the test is recommended most frequently; these categories of patients include patients diagnosed with cervical cancer or with precancerous lesions on previous Pap smear test, women exposed to diethylstilbestrol while in the uterus (before birth), known patients of HIV, immunocompromised patients like patients who had organ transplantation or taking corticosteroids on regular basis etc.
Certain women can stop taking the test; they are
1. Women who have undergone complete removal of the uterus along with the cervix (total hysterectomy); however, if the surgery was undertaken to treat the underlying cancer of the reproductive organ, then the Pap smear test may be required to be done at regular intervals whereas if the underlying cause was non cancerous as for management of uterine fibroids, Pap smear test can be discontinued
2. Older women: the test can be discontinued in women between 65 and 70 years of age if there were regular Pap smear test with normal results. However doctor may recommend the test in these women if they are sexually active with multiple sex partners at the same time
Associated risks
The test as such has got no significant risks but like other diagnostic test Pap smear test can give false negative results, normal report despite having abnormal cells. Usually this type of situation may arise if there is an insufficient number of collected cell, the small number of abnormal cells, blood and other inflammatory cells are in abundance which mask the actual number of abnormal cells etc.
However, if there is false negative result on one occasion, there is a high chance that these undetected abnormal cells will be detected on the next test and most of the time it is not very late for treatment as cervical cancer takes years to develop.
Preparations
To increase the chance of getting correct result, some preparations are required; like, avoiding intercourse, application of spermicidal jelly or vaginal douching for at least 2 days before taking the test as the above mentioned things may lead to false negative result. Also the test should not to be scheduled during menstruation for the same reason mentioned above.
What to expect
This procedure is undertaken at the doctor’s office and usually takes a few minutes and is painless. At first the patient is asked to strip down below the waist and lie on her back with legs folded at the knee joint and heels supported with stirrups. Next, the doctor inserts a speculum to keep the vaginal walls apart so that the cervix becomes visible. Then he or she collects the samples of cells from the cervical canal using a brush or spatula.
The patient can continue normal routine life after taking the test. The doctor sends the samples of cervical cells to the laboratory for examination under microscope.
Results
Normal test result is reported as negative whereas there certain terms to describe abnormal test results. These are
1. Atypical squamous cells with undetermined significance (ASCUS): the cervical canal is normally lined by the thin and flat squamous cells. Sometimes the cells become slightly abnormal in appearance, but not clearly precancerous or cancerous. In these cases further tests are conducted to detect presence of HPV, if negative no further tests or treatment is required other than regular screening, but presence of HPV require further investigation.
2. Squamous intraepithelial cells: this result suggests that the cells could be precancerous. If low grade change is there, then full blown cancer is years away, however high grade change require further testing
3. Atypical glandular cells: these might be considered abnormal, but cannot be considered to be clearly precancerous without additional tests
4. Squamous cell cancer or Adenocarcinoma: it means that there is clearly cancerous lesion present in the cervix.
Abnormal Pap smear test result require further testing by using colposcope, where tissues are collected from sites which look abnormal.