Pap Smear Screening for Cervical Cancer: All You Need to Know

Cervical cancer is the second most common cancer among women in India, accounting for nearly 16% of all female cancer cases. Though the instances of cervical cancer are on the rise, the good news is that over 95% of the cervical cancer burden is potentially avoidable by good-quality screening programmes such as Pap smear, and vaccination against HPV16 and 18 – the latter being the causal agent for up to 70% of cervical cancer. IARC concludes that there is sufficient evidence that cervical cancer screening can reduce cervical cancer mortality by 80% or more among screened women. Unfortunately, despite the availability of Pap smear testing, many women remain unaware of its importance and benefits. That’s why in this article, we provide comprehensive information on Pap smear screening, highlighting its significance, procedure, frequency, and the critical role it plays in early detection and prevention. Let’s start by understanding the screening process.

What is a Pap Smear Test?

Pap smear is a potentially lifesaving diagnostic procedure, which serves as the key to screening and preventing cervical cancer. Having major implications for female health and the economic and mental quantum of the nation, Pap smear is a cytology-based test in which exfoliated cells from the cervix and vagina are evaluated for abnormal changes, thereby predicting future implications of HPV infection. The key point is that women should be aware that HPV infests almost every woman who has initiated sexual activity, but cancer changes accumulate gradually over the decades in women who are not able to clear HPV from the immune system. This highlights the importance of screening at an early stage by regular cytology so that we catch this virus red-handed. 

Read more -  Cervical Cancer: Understanding the Basics

Who needs a Pap Smear Test?

Pap smear tests are an essential part of women’s health care and are recommended for the following groups:

Women aged 21-65

• Women aged 21-29: It is recommended that women start receiving Pap smear tests at the age of 21 and continue every three years if the results are normal.
• Women aged 30-65: Women in this age group should have a Pap smear every three years. Alternatively, they can choose to have a Pap smear combined with an HPV test (co-testing) every five years, as this combination provides more comprehensive screening.

Women with risk factors

Certain women may need more frequent Pap smear tests due to increased risk factors, including:

• History of cervical cancer or precancerous lesions: Women who have previously been diagnosed with cervical cancer or significant precancerous lesions need regular follow-ups.
• HIV infection: Women who are HIV-positive have a higher risk of cervical cancer and should be screened more often.
• Weakened immune system: Those with weakened immune systems due to organ transplants, chemotherapy, or chronic steroid use are at increased risk.
• Exposure to Diethylstilbestrol (DES): Women whose mothers took DES during pregnancy should have more frequent screenings.

Post-hysterectomy

• Total hysterectomy for noncancerous conditions: Women who have had a total hysterectomy (removal of the uterus and cervix) for non-cancerous conditions may not need to continue Pap smear tests, but they should consult with their healthcare provider.
• Subtotal hysterectomy: Women who have had a subtotal hysterectomy (removal of the uterus but not the cervix) should continue regular screenings.

Women over 65 years

• History of normal results: Women over 65 who have had regular screenings with normal results may be able to stop having Pap smears. However, this decision should be made in consultation with their healthcare provider.
• History of abnormal results: Women over 65 with a history of cervical cancer, precancerous lesions, or abnormal Pap smear results should continue regular screenings as recommended by their healthcare provider.

Regular Pap smear tests are a crucial preventive measure for cervical cancer, helping detect abnormal cells early when they are most treatable. Women should consult with their healthcare providers to determine the appropriate screening schedule based on their individual risk factors and medical history.

When should you get a Pap Smear Test?

A pap smear has to be done at intervals every 3 years if done alone; if done with HPV, DNA can be safely screened at 5-year intervals. Conventional pap smears sampled the cells with a wooden spatula on a glass smear. Recently, liquid-based cytology has taken over as it has more uniformity and better cell procurement. The same liquid base can be used in the detection of DNA of human papillomavirus and its variants. That said, even if a woman decides to undergo a pap smear once in her lifetime between the age of 35 to 45 years, it would significantly decrease morbidity and mortality associated with cervical cancer. 

Also, Read - Know All About HPV Vaccines

What is the Purpose of a Pap Smear Test?

A Pap smear test serves multiple important purposes, including screening for cervical cancer, diagnosing abnormal cells and infections, and monitoring the health of the cervix in high-risk individuals or those who have undergone treatment. Here’s an overview of its purposes:

Screening

• Early detection: The primary purpose of a Pap smear test is to screen for cervical cancer and precancerous changes in the cervix. By detecting abnormal cells early, before they develop into cancer, Pap smears significantly reduce the risk of cervical cancer.
• Preventive measure: Regular Pap smear screenings can identify changes in cervical cells caused by human papillomavirus (HPV), which is the leading cause of cervical cancer. Early intervention can prevent the progression of these changes into cancer.

Diagnosis

• Identifying abnormalities: A Pap smear test can help diagnose the presence of abnormal or atypical cervical cells, which may indicate pre-cancerous conditions, infections, or other issues. Further diagnostic procedures, such as a colposcopy or biopsy, may be recommended if abnormal cells are found.
• HPV testing: HPV testing can be used in conjunction with Pap smears to diagnose the presence of high-risk HPV strains that are most likely to cause cervical cancer.

Monitoring

• Post-treatment follow-up: For women who have been treated for cervical cancer or precancerous lesions, regular Pap smears are crucial for monitoring the effectiveness of the treatment and ensuring that abnormal cells do not reappear.
• Managing high-risk cases: Women with a history of cervical abnormalities, those with weakened immune systems, or those exposed to diethylstilbestrol (DES) may require more frequent Pap smear tests to monitor their condition and prevent the development of cervical cancer.

Read more- Human Papillomavirus (HPV) Test: Care for Positive Detection in Cervical Smear Analysis

What are the Risks of a Pap Smear Test?

While a Pap smear test is a routine and generally safe procedure, there are some risks and 

• Discomfort: Some women may experience mild discomfort or cramping during or after the procedure. This discomfort is usually brief and subsides quickly.
• Minor bleeding: It is common to have light spotting or minor bleeding after a Pap smear, especially if the cervix is irritated during the test. This typically resolves within a day or two.

• Infection: Although rare, there is a small risk of infection following a Pap smear test. Proper technique and sterile equipment minimise this risk.

• False-positive results: A false-positive result occurs when the test indicates the presence of abnormal cells that are not truly precancerous or cancerous. This can lead to unnecessary anxiety and additional diagnostic procedures.

Despite these risks, the benefits of regular Pap smear screenings in detecting and preventing cervical cancer far outweigh the potential drawbacks. It is important to discuss any concerns or questions with a healthcare provider to ensure you are fully informed and comfortable with the procedure.

How to Prepare for a Pap Smear?

Proper preparation can help ensure the accuracy of your Pap smear test results and make the experience more comfortable. Here are some steps to take before your appointment:

Schedule at the right time

Avoid scheduling your Pap smear during your menstrual period, especially if you have heavy bleeding. The best time is usually between 10 and 20 days after the first day of your last menstrual period.

Avoid certain activities

• Intercourse: Refrain from sexual intercourse for at least 24 hours before the test.
• Vaginal products: Do not use tampons, vaginal creams, suppositories, or medications for 48 hours before the test.
• Douching: Avoid douching for at least 48 hours before the test, as it can wash away or obscure abnormal cells.

Medical information

• Medical history: Be prepared to provide your healthcare provider with your complete medical history, including any previous abnormal Pap smear results, surgeries, and any symptoms you may be experiencing.
• Medication list: Bring a list of all medications you are currently taking, including over-the-counter drugs and supplements.

Stay relaxed

• Try to stay as relaxed as possible before and during the test. Deep breathing exercises can help reduce anxiety and discomfort during the procedure.

If you have any questions or concerns about the Pap smear, don’t hesitate to discuss them with your healthcare provider before the test. Understanding the procedure can help ease any apprehension you may have.

By following these preparation steps, you can help ensure that your Pap smear test is as accurate and comfortable as possible.

What happens during a Pap Test?

A Pap test is a simple and quick procedure typically performed during a pelvic exam by a healthcare provider. Here is what you can expect during the test:

• Undressing: You will be directed to a private area to undress from the waist down and put on a gown. Some facilities may also provide a sheet to cover yourself.
• Positioning: You will lie down on an examination table with your feet placed in stirrups, which allow your legs to be spread and supported.
• Speculum insertion: The healthcare provider will gently insert a speculum into your vagina. The speculum is a medical instrument that holds the vaginal walls open, allowing the provider to see the cervix. You may feel some pressure or mild discomfort during this step.
• Cell collection: Using a small brush or spatula, the provider will gently scrape a sample of cells from the surface of your cervix. This process is quick and usually painless, though you might feel a slight scraping sensation or mild cramping.
• Removing the speculum: After collecting the cell sample, the provider will carefully remove the speculum from your vagina.

• Sample processing: The collected cell sample is placed on a glass slide or in a liquid solution and sent to a laboratory for analysis.
• Dress and departure: You will be given privacy to get dressed. After dressing, you can discuss any immediate questions or concerns with your provider.

Understanding the steps involved in a Pap test can help reduce anxiety and ensure that you feel more comfortable during the procedure. Regular Pap tests are essential for early detection and prevention of cervical cancer.

What happens after a Pap Smear Test?

After a Pap test, several steps follow to ensure that the results are accurately processed and appropriately addressed. Here's what you can expect after the procedure:

Immediate aftercare

• Mild Discomfort: Some women may experience light spotting or mild cramping after the test. This is normal and should resolve quickly. Over-the-counter pain relief, like ibuprofen, can help if needed.
• Resuming activities: You can return to your normal activities immediately after the test. There are no restrictions on exercise, bathing, or other daily routines.

Waiting for results

• Processing time: It typically takes a few days to a week for the laboratory to analyse the cell sample collected during the Pap test.
• Receiving results: Your healthcare provider will contact you with the results. This may be done via a phone call, an online patient portal, or a follow-up appointment.

Follow-Up for abnormal results

• Colposcopy: If your Pap test results are abnormal, your healthcare provider may recommend a colposcopy, which is a more detailed examination of the cervix using a special magnifying instrument.
• Biopsy: During a colposcopy, the provider may take a small sample of cervical tissue (biopsy) for further analysis if any abnormal areas are seen.
• HPV testing: Additional testing for human papillomavirus (HPV), especially high-risk strains associated with cervical cancer, may be performed.

Regular monitoring

• Repeat Pap tests: Depending on the type and severity of the abnormal cells, you may need more frequent Pap tests to monitor any changes.
• Treatment: If high-grade abnormal cells or pre-cancerous lesions are found, treatment options might include procedures to remove or destroy the abnormal cells, such as cryotherapy, laser therapy, or a loop electrosurgical excision procedure (LEEP).

Preventive Measures

• HPV vaccination: If you haven't been vaccinated against HPV, discuss with your healthcare provider whether vaccination is appropriate for you. The HPV vaccine can protect against the types of HPV that most commonly cause cervical cancer.
• Healthy lifestyle: Maintain a healthy lifestyle, including regular exercise, a balanced diet, and avoiding smoking, to support overall health and potentially reduce the risk of cervical abnormalities.

By following up appropriately on your Pap test results and adhering to your healthcare provider's recommendations, you can ensure the best possible outcomes for your cervical health.

Understanding Pap Smear Test Results

The results of a Pap smear test provide crucial information about the health of cervical cells. Here's an overview of what different results might indicate:

• No abnormal cells detected: A normal result means that no abnormal cells were found in your cervix. You should continue with regular screenings as recommended by your healthcare provider.

• Presence of abnormal cells: An abnormal result indicates that some cervical cells have changed in appearance. This does not necessarily mean cancer, but further evaluation may be needed to determine the cause and significance of the changes.
• Atypical squamous cells of undetermined significance (ASC-US): ASC-US is the most common abnormal Pap test result. It indicates that some squamous cells do not look completely normal, but the changes are not severe enough to be classified as precancerous. Further testing, such as an HPV test, may be recommended to determine if the changes are related to high-risk HPV infection.
• Low-grade squamous intraepithelial lesion (LSIL): LSIL indicates mild abnormalities in the squamous cells, often associated with HPV infection. These changes are considered low-grade and typically do not progress to cancer. Follow-up testing and monitoring are usually recommended.
• Atypical squamous cells, cannot rule out HSIL (ASC-H): ASC-H indicates that atypical squamous cells are present, and there is a concern that high-grade squamous intraepithelial lesion (HSIL) cannot be ruled out. This result requires further investigation, usually through a colposcopy and biopsy, to determine the nature of the abnormal cells.
• High-grade squamous intraepithelial lesion (HSIL): HSIL suggests more serious changes in the squamous cells that are more likely to progress to cervical cancer if left untreated. Immediate follow-up with a colposcopy and biopsy is necessary to assess the severity and decide on appropriate treatment.
• Atypical glandular cells (AGC): AGC indicates that glandular cells, which are present in the cervical canal and endometrium, appear abnormal. This result can be associated with pre-cancerous conditions or, in rare cases, cancer. Further evaluation with colposcopy, and sometimes an endometrial biopsy, is required.

• Insufficient or uninterpretable sample: An unclear result means that the sample collected was not adequate for a conclusive analysis, possibly due to insufficient cells, presence of blood or mucus, or other factors. A repeat Pap smear may be necessary to obtain a clearer sample.

Understanding your Pap smear test results and following your healthcare provider's recommendations for follow-up care is essential for maintaining cervical health and preventing cervical cancer. If you have any questions or concerns about your results, don't hesitate to discuss them with your healthcare provider.

Final Words

Regular Pap smear tests can be instrumental in early detection and prevention of cervical cancer. If you have any questions or concerns about Pap smear or need personalised guidance, consult a specialist at Max Hospitals. We, at Max Hospitals, offer comprehensive services and expert care to help you navigate your health journey. Book a consultation to ensure you are taking the best possible steps towards maintaining your cervical health and overall well-being.