PAP Smear

• What is a PAP smear?
• Why should I have a PAP smear?
• What I need to know before my PAP smear?
• How often should I have a PAP smear?
• How should I prepare for a PAP smear?
• How is a PAP smear done?
• PAP smear results
• What happens after an abnormal PAP smear result?

What is a PAP smear?

A PAP smear is a test for all sexually active women that allows the examination of cells from the cervix (or lower, neck of the womb). This test detects abnormal changes in cervical cells that may indicate or be a precursor to cervical cancer.

Why should I have a PAP smear?

The importance of this test cannot be over-emphasized as there are no symptoms or visible changes in the stages before cervical cancer. Each year, PAP smears save 1200 Australian women from cervical cancer. With the latest immunisation program (Gardasil) against cervical cancer, vaccine is proven effective in women who have not been sexually active. However, it is not a replacement for screening. Women should note that immunisation against cervical cancer is not a substitute for regular PAP smear’s as immunisation does not cover all strains.

What I need to know before my PAP smear?

A PAP smear is usually performed by your GP or other trained health professional. It is simple, quick and often painless. There is slight discomfort with the procedure but this is usually tolerable. It is a minor test and you can engage in any desirable activity without any problems (drive back home, sporting or sexual) after the procedure. It should be noted that a PAP smear is a screening test only; it is not a diagnostic test and hence abnormal results require further investigation as discussed below.

How often should I have a PAP smear?

Every two years in all sexually active women from 18yrs of age.

How should I prepare for a PAP smear?

Plan a date outside your menstrual period. Avoid douching, use of vaginal creams or sex 24 hours before.

How is a PAP smear done?

It involves the collection of cells from the surface of the cervix and smearing them onto a glass slide for analysis in the laboratory. It may take 1-2 weeks for the results to get back to your doctor. The technique for a PAP smear may vary from doctor to doctor, however a common procedure is outlined as follows:

• The woman is asked to undress below the waist and asked to lie on an examination couch – she is asked to draw her knees up and gently open her legs and is given a cloth to cover herself.
• A speculum (which can be warmed up by warm water/body temperature) is lubricated with gel, then placed into the vagina and opened for full view of the cervix. A speculum looks like a hollow cylinder that opens up like a duck’s beak.
• A cotton tipped applicator and/or a specialized spatula or brush is applied to the cervix and rotated 360 degrees in order to collect cells from the neck of the womb.
• Two samples are then placed on a slide and sprayed with a preservative to prevent air drying of the sample.
• Some women may notice mild spotting on their panties after a PAP smear. This is normal and should not cause any worry.

PAP smear results

It is common for women to be concerned if their PAP smear result is not completely normal. Results typically take two weeks and your GP should discuss them with you. Different types of result include:

• Unsatisfactory: indicating the sample taken either did not collect enough cells or was not appropriate- presence of blood, or smear not well prepared.
• Negative smear: meaning no abnormality detected.
• Low grade epithelial abnormality: indicating there is a minor abnormality in the cells. This may encompass cervical intraepithelial neoplasia 1 (CIN I) which indicates there are abnormalities in the cells one-third of the thickness of the cervical wall.
• High grade abnormality: this could indicate a number of options ranging from CIN II (indicating there are abnormalities in two thirds of the thickness of the cervical wall), CIN III (full thickness abnormalities in the cervical wall) or carcinoma in-situ (which indicates cervical carcinoma confined to a specific area – i.e. has not spread) – these options are usually indications for further diagnostic tests.
• Inconclusive: usually indicates further testing is required.
• Endo-cervical component: indicating there are cells present from other areas.

What happens after an abnormal PAP smear result?

Referral to a gynaecologist for a colposcopy. A colposcopy involves staining the cells of the cervix and inspecting at a magnification using a colposcope. If there are abnormal tissues the gynecologist may do a biopsy for further examination under microscope. If the colposcopy shows abnormal cells requiring treatment; treatment is usually excision or laser therapy of the abnormal tissue.

References

1. Australia Bureau of Statistics. Year Book Australia, 2005 – Cancer. Available from: URL link
2. Australia Bureau of Statistics. Cancer in Australia: A snapshot, 2004-05. Available from: URL link
3. The Cancer Council Australia. Cervical cancer screening [Online]. 2006 [cited March 2006]. Available from: URL link
4. Impey L. Obstetrics and Gynecology: the cervix and its Disorders. 2nd ed. USA: Blackwell; 2006.
5. National health, Medical Research Council. Screening to prevent cervical cancer: Guidelines for the management of asymptomatic women with screen detected abnormalities [Online]. 2005[cited June 2005]. Available from: URL link
6. Talley NJ, O’Connor S. Clinical Examination: A systematic guide to physical diagnosis. 5th ed. Australia: Elseiver; 2006.