Pap is short for Papanicolou, the name of the Greek/American doctor who developed this cervical smear test in 1932. A Pap smear is used to detect any abnormality of the cervix, including infections and erosions.
Chronic infections of the cervix of which the patient is not aware can cause infertility and other problems, and a Pap smear can enable the doctor to diagnose these and prescribe appropriate treatment. Unquestionably, the main value of the Pap smear has been its ability to detect precancerous conditions of the cervix and cervical cancer at an early stage so that it can be treated. All women of any age who are sexually active should have regular Pap smear tests – generally every two years although once every three years may be enough for women who are past menopause.
The test is quite simple. The doctor introduces a collapsible metal or plastic tube, called a speculum, into the woman’s vagina. This is painless although it may feel a bit intrusive. The speculum is shaped like a duck’s bill. When the upper and lower blades are separated, the doctor can see the cervix, and a soft plastic brush is gently inserted into the opening of the uterus in the middle of the cervix and rotated. This lifts off a superficial layer of cells. The brush is then wiped across a glass slide to form a smear and is sprayed with a solution to preserve the cells.
The slide is sent to a pathologist who examines the smeared cells under a microscope and sends a report to the doctor. Sophisticated computers, that are more accurate than human technicians, are now being used in most laboratories to scan Pap smears for abnormalities. The collecting of the cells takes only a minute or so, and the report is usually available within a week.
The results that may be reported include:
- Normal smear – repeat in two years.
- Atypical cells – smear should be repeated in 3 to 6 months.
- CIN 1 dysplasia – colposcopy (examination of the cervix through a microscope) advised with repeat smears frequently.
- CIN 2 dysplasia – colposcopy and punch biopsy (small sample of abnormal tissue cut out) followed by appropriate treatment (eg. LLETZ procedure) and follow-up.
- CIN 3 carcinoma in situ – definitive treatment necessary (eg. cutting out abnormal tissue in a cone biopsy procedure) and careful follow-up.
- Invasive carcinoma – definitive treatment essential (eg. hysterectomy, irradiation).
Vaginal infections are often also reported on Pap smears.
CIN is an index of cervical intraepithelial neoplasia (the degree of abnormality in the cervix cells sampled).
An abnormal result from a smear test does not mean that the woman necessarily has cancer, but it does mean that she should have a further test – this will usually be a colposcopy. If as a result of the colposcopy an early stage of cancer is detected, the abnormal cells may be burnt away by diathermy or laser, or a cone-shaped area of tissue may be excised. These forms of treatment will not interfere with a woman’s normal sexual functioning or her ability to fall pregnant. Only if the cancer has already spread will she need to have the uterus removed in a hysterectomy, or undergo radiation therapy.
Cancer of the cervix is one of the more common forms of cancer in women, and yet if all women had a Pap smear regularly it could be totally prevented.
At the same time as a Pap smear is done, the doctor will usually insert two gloved fingers into the woman’s vagina and feel for any abnormalities of the uterus or ovaries. The doctor may examine the rectum as well, and will probably check the breasts and blood pressure at the same visit.