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What is a Pap Smear?
Cancer of the cervix is the second most common cause of cancer-related disease and death among women worldwide. Cervical cancer can be diagnosed by having regular Papanicolaou tests, or Pap smears.
A Pap smear is essentially a microscopic examination of cells taken from the cervix. It is a painless, noninvasive procedure in which doctors use to screen for pre-cancerous changes of the cervix (neck of the womb).
This procedure involves
  • Sampling cells from the cervix and the vagina
  • Preparing the cell sample for evaluation under a microscope
  • Examination of the cell sample for infections and abnormal cells that may become cancerous
Although this screening test is used to detect cervical cancer or cervical abnormalities that may become cancer in women who do not have any symptoms, the pap smear cannot prove that a woman does not have cervical cancer. However, it can detect 95 percent of all cervical cancers and precancerous abnormalities.
Why are regular Pap Smears so important?
Having regular Pap smears is the most important thing a woman can do to protect herself from developing cervical cancer.
Pap smear is important because
  • It can detect early pre-cancerous cervical changes before they become cancerous. These pre-cancerous changes can be treated.
  • Women who have regular pap smears are less likely to develop cervical cancer as they are treated early during the pre-cancer stage
  • No one can predict who will develop cervical cancer

Risks factors for cancer of the cervix include:

Multiple sexual partners (or sexual partners who have had multiple partners)

Starting sexual intercourse at an early age

Viral infection, such as HPV, human immunodeficiency virus (HIV), or herpes simplex virus (HSV).

Lowered immunity

Previous cancer of the lower genital tract

Smoking

A woman who had her womb removed, should still have an annual screening if she had a previous history of abnormal smear results or other lower genital tract cancer.
How is a Pap Smear done?
A Pap Smear is usually part of a pelvic exam and accompanied by a breast exam performed by the doctor or nurse. It would normally take about 1 minute to perform a Pap smear.
  • You will be asked to lie on the examination couch on your back with your knees up and bent and your feet in stirrups (rests). While lying on the examination couch, the doctor will use a small metal or plastic instrument called a speculum to open the vagina so that the walls of the vagina and cervix can be seen clearly.
  • A sample of mucus and cells will be obtained from the cervix (neck of the womb) and endocervix (opening of the cervix) using a wooden spatula, followed by a small cervical brush.
  • The sample of cells is evenly applied to a glass slide and sprayed with a fixative. This sample is sent to the lab for close and careful examination under a microscope. At FMGC, we advise a new kind of Pap smear called a Thin-Prep test (see below). The sample is taken with a "broom-like" brush and is rinsed into a vial and sent to the lab for slide preparation and examination.
  • A cytologist (a specialist trained to look at the cells and interpret a Pap smear) reviews both types of tests.
  • You may experience some discomfort during the test. However, most women feel nothing at all or may feel pressure. If you stay relaxed, it will help stop any discomfort.
  • A Pap smear should not be painful. If you experience pain during the test, you should tell the doctor.
  • It is normal to have some vaginal spotting after the test. This should settle after a day or two.
A normal cervix Sampling cells from the cervix
How should I prepare for a Pap Smear?
  • If you are still menstruating, you should schedule the Pap smear about two weeks after the start of the menstrual period. That is when we can obtain the clearest, cleanest sample of cells from the cervix.
  • If you have reached menopause, you can schedule a Pap smear at any time.
  • In the 48 hours before having a Pap smear, you should not:
    • douche
    • have sex
    • take a tub bath
    • douche
[These activities can cause irritation to the cervix. By avoiding them, it helps ensure collection of an adequate cell sample].
Who should have a Pap Smear?
A woman should have a Pap Smear if she:
  • has reached the age of 18
  • is sexually active
  • has been sexually active
However, a woman can be screened less frequently if she had negative Pap smear results 3 years in a row or is not sexually active. This also applies to a woman > age 65 years.
There is no upper age limit for screening because the incidence of cancer of the cervix increases with age at a time when women may be less likely to have a Pap smear. Diagnosis of most of these cancers occurs in women over 50 years. Therefore, a woman should continue to have regular Pap smears even after menopause.
A Pap smear can detect certain viral infections (such as human papillomavirus [HPV]), which is associated with cervical cancer. Early treatment of HPV can stop cervical cancer before it fully develops. A woman may have cervical cancer and not know it because she may not have any symptoms.
How are Pap Smear results reported?
Our laboratory generally report Pap smear results to us a week after the test is performed. The doctor will then
  • notify you by phone or sms of your test results
  • make the results available upon request
Do not assume that the test is normal if the doctor does not inform you.
Do not assume the test was normal if the doctor doesn't call or mail the results. You should always know and understand your results. Finding out what the results are can ensure that it is not misplaced or overlooked, prevent unnecessary treatment delays and allay anxiety. Please call the clinic if you have not heard from your doctor
How accurate are Pap Smears?
The Pap smear is a very effective cancer screening method. However, even the best of laboratories sometimes classify normal cell samples as suspicious or overlook abnormalities among the half million cells on each slide.
This may be due to the fact that using the conventional Pap testing technique:
  • About 80 percent of cells sampled is discarded when the swab or spatula used in collecting it is thrown away
  • Only a small fraction of cells sample is smeared onto a glass slide. The slide that is sent to a laboratory for microscopic analysis may not include abnormal cells that are present
  • The presence of blood, mucus or inflammation makes it difficult to analyze the cells
  • Cells or slides may dry out and become distorted and therefore difficult to interpret.
What is the Thin-Prep Pap smear?
The Thin-Prep Pap smear is a new development in cervical smear testing, using new liquid based technology.
Pap smears identify pre-cancerous abnormalities of the cervix to ensure appropriate treatment is given as soon as possible. However, the conventional pap smears has not changed since 1950, and it has several limitations.
The traditional pap smear has a high failure rate, and is estimated to be about 80 percent accurate. The new Thin-Prep test has improved the accuracy by about 54 percent.
Cells are taken from the cervix and smeared onto a glass slide for examination. This traditional method of sampling is inefficient as the cells can dry or are covered by blood and mucous, therefore obscuring any abnormal cells. Furthermore, most of the cells on the brush and spatula are discarded, leaving a small proportion for analysis.
With the Thin-Prep test, however, the cells taken from the cervix (with a soft-bristled "broom") are rinsed in a small vial of special solution to preserve the cells. At the laboratory a machine separates the blood and mucus from the cervical cells which are then analyzed with a microscope for abnormalities.
Studies have shown that the Thin-Prep test significantly increases the ability of the doctor and laboratory to identify cervical abnormalities.
The Advantages of the Thin Prep smear
  • As a result of the increased sensitivity of the Thin Prep test, there is less likelihood of being recalled for testing.
  • The Thin-Prep improves the chance of detection and early treatment of pre-cancerous changes. It detects 65 percent more low-grade and more severe abnormalities in the general population. It reduces the number of inadequate cell samples by more than 50 percent
At FMGC, the Thin Prep is used for all our cervical smear tests for cervical cancer.
I have an abnormal pap smear. What does it mean?
This DOES NOT mean that you have cancer
At least half of all women (50 to 80 percent) whose Pap smears are classified as abnormal
  • do not have cervical cancer
  • do not have a condition that will progress to become cervical cancer
  • The Pap smear is a screening test. It is used to detect cervical abnormalities in women who do not have any symptoms. It is not a diagnostic test. Diagnostic tests are performed to identify the cause of the symptoms a woman may be experiencing. Therefore, in a woman with an abnormal pap smear, an additional diagnostic test may be necessary for further evaluation before treatment is given.
What happens if Pap smear shows an abnormal result?

If the pap smear indicates that abnormalities are present, the doctor may perform one of the following diagnostic procedures.
  • Colposcopy
  • Colposcopic biopsy
  • Cone biopsy
  • Endocervical curettage
Colposcopy.
The doctor examines the cervix with a lighted magnifying instrument called a colposcope after applying a vinegar-like solution. This painless office procedure has no side effects and can be safely performed during pregnancy. If the colposcopy reveal abnormal areas on the cervix, the doctor performs a biopsy (see below) to determine whether the condition is cancerous, precancerous, or non-cancerous (benign). This test is now available at FMGC.
Colposcopic biopsy.
The doctor uses forceps to remove a small piece of tissue from an area of the cervix where abnormal cells have been detected. The doctor may use local anesthetic to numb the cervix first. The woman may briefly experience pain, mild cramping or light bleeding.
Cone biopsy.
This procedure consists of removing a cone-shaped piece of cervical tissue from the border between the ectocervix and the endocervix. This area is called the transformation zone and this is the area where cancerous or precancerous conditions most often originate.
Endo-cervical curettage.
This is also called endo-cervical sampling and this procedure removes cells from the endocervix. After using local anesthetic to numb the cervix, the doctor inserts a narrow instrument called a curette into the passage between the outer part of the cervix and the inner part of the uterus.
Generally performed at the same time as colposcopic biopsy, this procedure removes cells from the part of the uterus which the colposcope cannot see. The woman may experience period-type cramps or light bleeding after the procedure.

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