What is PAP smear?
Pap smear or the Papanicolaou smear is a screening test done to diagnose the cancer of the cervix (mouth of the uterus) at an early stage. In this test, a PAP smear brush is used to scrape the mouth of the uterus and the scraping is sent for histopathology (microscopic examination) to look for cells with abnormal changes. These abnormal cells have the potential to slowly develop into cancerous cells.
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What is cervical cancer?
Cervical cancer is the cancer of the cervix (mouth of the uterus) and is the second most common cancer among women, next only to breast cancer. It is caused by certain subtypes of a virus called Human Papillomavirus (HPV). This virus is sexually transmitted. Although the incidence of cervical cancer among women is rising, this cancer is vaccine-preventable, and early precancerous changes can be detected with a simple PAP smear test before they develop into cervical cancer.
Why is PAP smear test done?
There are very few cancers that can be diagnosed at a stage early enough to be prevented or treated adequately. Pap smear is done for:
- Early detection of cervical cancer: PAP smear helps in the early detection of cancerous changes so that early treatment can be initiated. This increases the likelihood of successful treatment.
- Early detection of precancerous changes: Cancer of the cervix starts with certain early changes in the cervical cells called Precancerous changes. These are not visible to the naked eye and do not have any symptoms. These changes can slowly progress into full-blown cervical cancer. If such changes are detected on PAP smear, early treatment can prevent their progression to cervical cancer. Early detection of precancerous changes by the PAP smear and early management makes cervical cancer one of the very few preventable cancers.
Who should get the PAP smear done?
PAP smear screening should be started at the age of 21 years for every sexually active woman and should be done at regular intervals thereafter. The interval depends on your age, family history, and the results of your previous PAP smear tests. Following are the general recommendations for PAP smear testing:
- Age < 21 years: Cervical cancer is rare before 21 years of age, so PAP smear testing is not recommended below age 21 years.
- Age 21- 65 years: All sexually active women 21-65 years of age should get a PAP smear test done once every three years. If two tests are normal in a row, then the interval between the tests can be increased to five years. After every test, your healthcare provider will decide the interval for your next test.
- Age > 65 years: If the PAP smear tests remain normal, Pap smear screening should be stopped at 65 years of age.
- Special conditions: You may have to undergo PAP smear more often than usual in certain conditions:
- A Pap smear result positive for precancerous cells or cancer cells.
- Immunocompromised states: like HIV infection, Immunosuppressive medicines, chemotherapy
- Family history of cervical cancer
- Previous history of cervical cancer or abnormal PAP smears.
- Co-testing: Sometimes, your healthcare provider may perform an HPV test (Human Papillomavirus test), in addition to your PAP smear. A combination of the two tests (PAP smear and HPV DNA) is called Co-testing and is much more reliable than a single test. If Co-testing is performed, it should be repeated every five years.
What are the risks of PAP Smear test?
PAP smear is a simple outpatient screening procedure and there are very few procedure-related risks with this test. Some drawbacks or side effects of this test are:
- False negative test: Pap test is an excellent screening tool for recognizing precancerous or cancerous cells in the cervix. But it is not 100% accurate and in rare cases, a false negative test may be obtained. A false negative test means that precancerous or cancer cells are present, but were not detected in the PAP smear. It can be because of many reasons like inadequate sample, sample from a site distant from the site with abnormal cells or too low amount of abnormal cells to be detected in early stages of cancer. That is why PAP smear is repeated every three years to cover these inherent drawbacks of the test.
- False positive test: A false positive result means that the PAP test results indicate the presence of abnormal cells, while in fact the cells are absolutely normal. This is a rare complication but may lead to considerable anxiety and unnecessary follow up testing.
- Bleeding: Although bleeding is rare, some patients may have mild bleeding during or after the test, which resolves on it’s own.
- Discomfort: Pap smear is usually obtained during a pelvic exam, and is very comfortable. Some patients may feel slight discomfort during the test.
- Infection: Infection is extremely rare if standard aseptic precautions are followed during the test.
Is PAP smear test expensive?
No, PAP smear is not expensive at all. It is just a simple and inexpensive outpatient procedure.
Do I have to get admitted for a PAP smear test?
No, the PAP smear test is a simple procedure done routinely as an outpatient in the doctor’s office.
Should I get a PAP smear done even if my uterus has been removed?
It is generally presumed that PAP smear is not required after the removal of the uterus. However, your healthcare provider may or may not recommend a PAP smear, depending on whether the cervix was removed along with the uterus or not and whether the uterus was removed for cancer or some other indication. Discuss with your healthcare provider about the best option for you:
- Hysterectomy: If both the uterus and cervix have been removed, it is called Hysterectomy. After hysterectomy, you no longer need to undergo any more PAP smears.
- Subtotal Hysterectomy: When only the uterus is removed, but the cervix is left behind, it is called Subtotal hysterectomy. In this case, you have to continue having your PAP smear testing as per the regular recommendations.
- Hysterectomy for Cancer: If your uterus was removed due to uterine cancer, then you may need to keep getting your PAP smears and your healthcare provider will guide you for further testing as per your clinical situation.
Should I get the PAP smear done if I have received the full vaccination for cervical cancer?
Yes, you should get the PAP smear done as per the regular schedule, even if you have received the full course of cervical cancer vaccination. This is because no vaccine is 100% effective. Vaccination only reduces the chance of contracting a disease, so even highly efficacious vaccines have some failure rates.
What are the do’s and don’ts for a PAP smear test?
- Do not get your test during your menstrual periods as the mixing of menstrual blood may lead to a low yield of cervical cells and a false negative test.
- Do not use any vaginal creams, jellies, lotions, soaps, foams, or tampons for 2-3 days before your test as these may affect your test results and may lead to a false negative test.
- Avoid intercourse for 2-3 days prior to your test.
- You do not need to come empty stomach for this test. You can have a light breakfast on the day of your test or you can ask your healthcare provider for instructions.
How to interpret the results of a PAP smear test?
Your healthcare provider will interpret the results of your PAP smear for you. A PAP test result may be positive, negative or indeterminate:
- Positive test or abnormal test: A PAP smear is a screening test only and a positive test does not necessarily mean cancer. It means that abnormal cells were found which may be cancerous. In the event of a positive test, your healthcare provider may perform another test called Colposcopy, in which an instrument called a colposcope is used to view your cervix directly and/or obtain a biopsy of your cervix. The biopsy sample is sent for microscopic examination to confirm if there are any cancerous cells.
- Negative test or normal test: A negative test means that no precancerous or cancerous cells were detected in the PAP smear. In other words, your sample was healthy and normal.
- Indeterminate test or unclear test: Sometimes, the test sample neither clearly shows healthy cells nor completely abnormal cells. In such cases, the test results are labeled as indeterminate and your healthcare provider may schedule you for a repeat PAP test.
What happens after a PAP smear test?
After the test, you can go back to your home or to your workplace and follow your regular schedule.
The results of the tests are available in about 1-3 weeks depending on your local timelines. Your healthcare provide will schedule your follow-up visit, based on the expected date of your result.
Carry home message
PAP smear test is an extremely valuable screening test to look for early changes of cervical cancer or precancerous changes that could potentially lead to cervical cancer. Early detection and management of precancerous changes by PAP smear can prevent the development of cervical cancer. If cervical cancer is present, early diagnosis and timely initiation of treatment prevent further spread and lead to a favorable prognosis. Always remember that cervical cancer is a vaccine-preventable disease and can be detected early with a PAP smear.
So always get your PAP smears regularly as advised by your healthcare provider. Stay healthy!
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