Pap Smear – What, Why & How

Pap smear or Pap test is a screening test for cervical cancer in women. 

This means that it can be used in general population to identify women who have a high risk of developing cervical cancer in future. By doing so, we can offer close monitoring & initiate early treatment regime to prevent the development of cervical cancer in these women. 

Cervix is the narrow lower part of the uterus that connects to the vagina. Pap smear involves the procedure to collect cells from this area by  trained medical personnel, which are then examined under a microscope to assess their structure & to check for any abnormal, precancerous or cancerous looking cells. It can also be coupled with DNA testing for HPV-DNA to detect human papillomavirus (HPV) infection. 

Infections of HPV are the single largest risk factor for the development of cervical cancer. However, majority of the times, HPV infection regresses spontaneously or remains at a low grade and  not all women with HPV infection will develop cervical cancer. Early screening can aid in providing better cure or prevent the development of cancer by taking the necessary precautions.

I feel okay, why should I get a Pap smear test done?

In majority of the cases, cervical cancer may not give any symptoms or give only mild, insignificant symptoms in the early stages and by the time noticeable symptoms develop, the disease may have already advanced to a late stage where treatment & complete cure might be impossible.

In India, cervical cancer is the second most common cancer in women ( the first being breast cancer) and every year approximately 1,22,844 women are diagnosed with cervical cancer. 

It is a shattering realisation that India accounts for nearly 1/4th of the world’s cervical cancer deaths. Hence, screening & early detection are the mainstay of the health programme regarding cervical cancer, so as to minimise the incidence & deaths from this dreaded disease.

How to prepare for the Pap test?

For better accuracy of the test results, you should start preparing 48 hours prior to the test. Follow these tips

• Do not use sprays, douches, scent, creams, jellies, spermicides near your vagina.
• Avoid having sex or using lubricants and don’t insert tampons, medications, suppositories into your vagina for upto 2-3 days prior to the test. 
• It is advisable to not take the Pap test while you are menstruating as heavy flow can affect the result. Ask to reschedule your Pap test if it has been scheduled to be conducted on the day of your periods. 
• Empty your bladder before you take the test to avoid discomfort. 

What happens during the Pap test? 

• The test takes about 10 to 15 mins and will be done at your doctor’s clinic. 
• You will be asked to lie down on your back with your knees bent and feet placed apart on the table or in the stirrups. 
• Your doctor will insert an instrument called speculum into the vagina which will hold the vaginal walls open for your doctor to see the cervix. When done by a trained person, this is not a painful process, so don’t worry about it. 
• After this, samples of the cells of the cervix will be taken using a soft brush or spatula.  The sample of cells will be taken from the ectocervix, which is closest to the vagina and from the endocervix which is the inner part of the cervical canal, connecting it to the uterus.
• These cell samples will be transferred into a special liquid or onto a glass slide which will be sent to a laboratory for evaluation. 
• The test does not hurt. You might just experience a little discomfort or a feeling of pressure in your pelvic area. 
• You can go about with your usual day to day activities soon after the test.

What do the results mean?

You will get the results within 1-3 weeks. As any other test result, it can either be abnormal or normal.

A positive result does not necessarily show that you have cancer, rather it simply calls for more investigation. 

• Normal results: When no abnormal cells are detected the results are said to be normal. 
• Abnormal results: There could be various reasons for an abnormal Pap smear result like
  • Inflammation (dysplasia).
  • Infection due to HPV or other causes of infection.
  • Cancer or precancer.
  • Error in the lab test. 

What happens if I get an abnormal Pap smear test report?

In case of abnormal results, your doctor may offer further steps based on the type of abnormality in the test report.

• For an inflammation or infection, a repeat test may be suggested after treating the infection
• A repeat test may also be done in case of a lab error
• If the test suggests a suspicious, cancerous or precancerous condition, your doctor may perform a procedure called Colposcopy and biopsy. 

In a Colposcopy, the doctor will use an instrument called colposcope to have a magnified look at the cervix, vagina & vulva. These tissues are examined through a magnifying camera lens with a green filter to look for abnormal blood vessels, & also after application of highly diluted acetic acid / Lugol’s iodine solution to identify abnormal areas. 

A sample of the tissue (biopsy) is then taken from any abnormal looking areas for further evaluation.

How often should I get the Pap smear done?

It is recommended that the Pap test be performed every 3 years for women aged 21 to 65years.

For women above the age of 30, the Pap test should be combined with HPV test. The HPV testing can be performed every 5 years.

Women above 65 years of age or those who have undergone surgical procedure to remove the uterus and cervix (hysterectomy) will not need the Pap test. However, the risk factors vary from person to person.

What are the risk factors for developing cervical cancer?

If you have the following risk factors your doctor may recommend more frequent Pap tests:

• Onset of sexual activity at a young age ( <18 years age).
• Multiple sexual partners. 
• Smoking. 
• Pelvic Infections & PID, especially chlamydia infections.
• Women taking Oral contraceptive pills for long durations ( 5 years or more). 
• Young age ( < 20 years) at first pregnancy & childbirth.
• Low socio-economic status.
• Weak immune system due to chemotherapy, autoimmune disorder, organ transplant, HIV infection etc. 
• Not getting vaccinated against HPV.
• Presence of HPV infection. 
• Precancerous cervical cells. 
• Being exposed to diethylstilbestrol (DES) before birth.
• Overweight.

The good news is that “cervical cancer is the easiest gynaecological cancer to predict & prevent” with the help of early screening and taking the HPV vaccination. 

Pap test is the gold standard in early screening of cervical cancer. 

It has gained widespread use that has resulted in substantial decline in incidence of cervical cancer globally. 

The aim of this article is to educate you about the Pap test, its importance, procedure, results that’ll help you take informed decisions and take the necessary precaution.

How can I prevent cervical cancer?

The two most important steps that you can take to prevent cervical cancer are

• Get regular Pap smear & HPV –DNA tests done as advised
• Get an HPV vaccine

We hope that by reading this piece of literature you are encouraged to get yourself screened which will further help to reduce the incidence of cervical cancer.