Cervical cancer is the fourth most common cancer in women. Heavy menstrual bleeding and pelvic pain may be symptoms of cancer, calling for a pap smear immediately.

Pap Smear – A Crucial Step Towards Preventing Cervical Cancer

Introduction

After cancers of the mouth and <a href="https://merisehat.pk/disease/breast-cancer">breast cancer</a> of all age groups, cervical cancer is the third most prevalent disease in women under 50. Despite being a preventable disease, it unfortunately often does not receive due attention in Pakistan.&nbsp;Pakistan is in dire need of raising awareness in the masses on this pertinent issue while promoting screening and HPV vaccination.&nbsp; &nbsp;

This is important because invasive cervical cancer has an extremely high fatality rate. Every year, nearly 500,000 women worldwide are diagnosed annually, of which 273,000 women die.&nbsp;The majority of cervical cancer-affected females live in developing nations<a href="#accordion">[1]</a>. It&rsquo;s imperative that these countries practice the WHO policy for prevention with HPV vaccination, and set up scheduled Pap smear screening programs nationwide.&nbsp;

The Pap smear or Pap smear test, which changed how we view cervical cancer, was named after its founder Dr. Georgios Papanikolaou.

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Understanding The Importance Of A Pap Smear Test

A Pap test, also commonly known as a Pap smear, is a procedure the doctor uses to check for cervical cancer in female patients. It can also be used to check for alterations in the cervical cells that would later develop into cancer.

Your cervix&#39;s cells are gently and carefully removed during the procedure and checked for suspicious changes. This procedure takes place in a proper healthcare environment with specialized tools. Although it could be moderately painful, it typically doesn&#39;t result in any permanent pain.

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<ul>
	<li>You will feel more positive and reassured when the results of a Pap test are normal.</li>
	<li>By identifying cervical cell abnormalities, routine Pap screenings assist in prompt treatment and/or exploring reasons for the abnormal cell presentation.</li>
	<li>A Pap test aids in the early detection of cervical cancer before any symptoms even appear. The early detection of cervical cancer makes it more manageable to treat. Also, early diagnosis may result in fewer treatments and a quicker recovery.</li>
	<li>Your probability of survival improves with earlier cervical cancer detection. 
	&nbsp;</li>
</ul>

<ul>
	<li>A Pap test could indicate cervical cell abnormalities even though there are none. This is called a false positive.</li>
	<li>At the other end of the continuum, a Pap test might not find abnormal cervical cells even if they do exist. This is called a false negative.</li>
	<li>Some forms of cervical cancer do not result in death and they don&rsquo;t even impact the quality of life. This identification of cervical cells is called overdiagnosis.</li>
	<li>Several women with cervical anomalies might be recommended for additional examinations or treatment for a disease that might not have progressed to cancer.&nbsp;</li>
</ul>

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A pap smear test&#39;s primary goal is to find precancerous changes, i.e., cellular abnormalities in the cervix that might lead to cervical cancer, whereas the HPV test looks for the human papillomavirus that can cause these changes. These tests can be done separately but it is also possible to test for HPV using a sample from a pap smear. This is called co-testing.

A pap smear can identify cervical cancer cells early, so the individual can begin therapy before the disease spreads and becomes more serious. One of the leading causes of cervical cancer is HPV, which can be acquired during intercourse. While using a condom or another barrier technique when practicing intercourse reduces your risk of catching the virus, nevertheless, all sexually active women should undergo a pap smear every 3 years at least since they risk getting HPV. 
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A pap test shouldn&#39;t be done while you are menstruating. The accuracy of the test is impacted by severe bleeding. Ask your doctor if you can reschedule the test if your test date falls during that time of the month.

Experts advise following these measures 48 hours before your test for the most reliable Pap smear:

<ul>
	<li>Avoid lubrication.</li>
	<li>Abstain from sexual activity.</li>
	<li>Keep sprays and powders away from the vagina.</li>
	<li>Tampons, tablets, creams, suppositories, and other items must not be placed within the vagina.</li>
	<li>Avoid washing the genital region with any liquid, including water, vinegar, or alcohol (douche). 
	&nbsp;</li>
</ul>

The exam is completed at a clinic or your doctor&rsquo;s office. It takes 10-20 minutes. You won&#39;t feel pain during the Pap test, although you might feel a slight pinch or pressure.

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1. As you lay on a table, your feet will be firmly secured in stirrups.

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2. Your doctor will ask you to spread your legs&nbsp;

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3. Then your doctor will gently insert a metal or plastic instrument (speculum) into your vagina. This is when you might feel a sensation of pain and discomfort and it&#39;s best to relax at this stage.

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4. The speculum helps in keeping the walls of the vagina apart to enable a clear view of&nbsp; the cervix.

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5.&nbsp;Samples from your cervix will be taken and your doctor can obtain this sample in a few different ways:

<ul>
	<li>Some doctors use a spatula.</li>
	<li>Some doctors use a brush and a spatula at intervals.</li>
	<li>Some doctors use a cytobrush, which combines the functions of a spatula and a brush.</li>
	<li>Some doctors use a swab.</li>
</ul>

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6. You might experience a small push and discomfort during the sampling.

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7. Your cervix&#39;s sample of cells will be kept intact and transported to a lab to examine the presence of abnormal cells.

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8. After the exam, you might experience some minor scraping discomfort or slight cramping. Additionally, minor vaginal bleeding could occur just after the test. Let your doctor know if pain or bleeding persists beyond the test day. 
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Your test result will arrive at your doctor&#39;s office within a few days. It would either be negative (normal) or positive (abnormal).

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<h5>1. Normal Outcome</h5>

A normal outcome is actually a positive thing. According to your doctor, this indicates that there aren&#39;t any cancerous or precancerous cells on your cervix. Until your next scheduled Pap is due, you won&#39;t require another one.&nbsp;

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<h5>2. Abnormal Outcome</h5>

Your Pap smear test might show abnormal cells due to:

<ul>
	<li>Mild inflammation or minor cell changes (dysplasia)</li>
	<li>HPV or other infection</li>
	<li>Cancer or pre-cancer</li>
	<li>Lab test error</li>
</ul>

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<h5>3. Atypical Squamous Cells Of Undetermined Significance (ASCUS)</h5>

Squamous cells are thin and flat and grow on the surface of a healthy cervix. In the case of ASCUS, the Pap smear reveals slightly abnormal squamous cells, but the changes don&#39;t necessarily suggest that precancerous cells are present.

Your doctor can go for a liquid-based test to reanalyze the sample to check for the presence of viruses known to promote cancer development, such as some types of human papillomavirus (HPV). If no high-risk viruses are present, the abnormal cells found as a result of the test aren&#39;t of great concern. If worrisome viruses are present, you&#39;ll need further testing.

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<h5>4. Squamous Intraepithelial Lesion</h5>

This term indicates that the cells collected from the Pap smear may be precancerous. If the changes are low grade, it means that the cells&#39; size, shape, and other properties indicate that if a precancerous lesion is present, it would take years to develop into cancer. On the other hand, if the changes are high grade, there&#39;s a greater chance that the lesion may develop into cancer sooner; additional diagnostic testing would be necessary in this instance.

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<h5>5. Atypical Glandular Cells</h5>

Glandular cells produce mucus and grow in the opening of your cervix and within your uterus. Atypical glandular cells may appear to be slightly abnormal, but it&#39;s unclear whether they&#39;re cancerous or not. Further testing is needed to determine the abnormal cells&#39; source and significance.

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<h5>6. Squamous Cell Cancer Or Adenocarcinoma Cells</h5>

This result means the cells collected for the Pap smear appear so abnormal that the pathologist is almost certain a cancer is present. &quot;Squamous cell cancer&quot; refers to cancers arising in the flat surface cells of the vagina or cervix. &quot;Adenocarcinoma&quot; refers to cancers arising in epithelial cells. If such cells are found, your doctor will recommend a prompt evaluation.

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<h5>7. Cervical Cancer (Or Pre-Cancerous Stage) 
&nbsp;</h5>

It is important to note that not all positive tests equate to cervical cancer. Additional testing is usually done to rule out other causes before a definitive diagnosis of cervical cancer is made. For example, your doctor can decide to &quot;wait and see&quot; if you experience inflammation or moderate cell abnormalities. Or they could advise that you get a second Pap test in a few months. If the abnormal cells still exist, your doctor might suggest more tests. One of these could be a technique known as colposcopy. 
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A colposcopy is used to diagnose genital warts, cervicitis (inflammation of the cervix), and precancerous changes in the cervix, vulva, and vagina.&nbsp;Similar to the Pap test, a speculum is inserted into your vagina during a colposcopy by your doctor. The colposcope is used to examine the cervix. The device with its particular lens and a strong light enables your doctor to see your cervix more clearly. Your doctor then swabs your cervix with vinegar or another liquid substance, which highlights the suspicious regions. Your doctor can see them due to the colposcope&#39;s lens.

Samples are collected from these suspicious areas (biopsy) and are sent to a lab for additional analysis. Multiple biopsy samples can be taken if there are multiple suspicious areas.&nbsp;

After the colposcopy, if there&rsquo;s any bleeding then the doctor would swab your cervix with a chemical solution to limit the bleeding. 
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If you are anywhere between 21 and 65 years of age, the test should be taken every 3 years.&nbsp;

Starting at age 30, you can decide to get both a Pap test and an HPV test. It is recommended to repeat these combined tests every 5 years instead of 3. Alternatively, women aged 30 and above could also opt for HPV testing instead of the Pap smear, this is because HPV is a known risk factor for cervical cancer.

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Your doctor could advise more frequent Pap tests if you have certain health issues, including:

<ul>
	<li>A diagnosis of cervical cancer or an abnormal Pap smear result&nbsp;</li>
	<li>&nbsp;HIV infection</li>
	<li>&nbsp;A weakened immune system due to chemotherapy, organ transplant, or chronic use of corticosteroids</li>
	<li>&nbsp;Exposure to diethylstilbestrol (DES) before birth</li>
</ul>

Note: Inform your doctor of any of the above conditions when considering getting a Pap smear test done.&nbsp; 
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Pap tests are quite precise. Routine Pap tests decrease the incidence of cervical cancer and associated mortality by at least 80%. Although it could be difficult initially, your health will benefit from the short-time pain you endure during the procedure. The Pap smear process is safe and reliable. However, it&#39;s possible that some aberrant cells or cervical malignancies could be missed by the test (false negative).&nbsp;

Note: Discuss getting a Pap smear test done at your next visit with the doctor.&nbsp;&nbsp;

<div>&nbsp;</div>

<ul>
	<li>In addition to your yearly gynecological checkup, you can schedule a Pap smear separately by calling your gynecologist. Most insurance plans cover Pap smears, but you might have to make a co-payment.</li>
	<li>Your doctor might want to reschedule your Pap smear if you are menstruating on the day of the test because then the results would not be as reliable.</li>
	<li>The day before your test, try to avoid having sex, douching, or using spermicidal products as these could affect your results.</li>
	<li>A Pap smear is typically safe to have in the first 24 weeks of pregnancy. It becomes difficult after that. Additionally, you ought to hold it off until 12 weeks after giving birth to improve the accuracy of your findings.</li>
	<li>Maintaining your composure and breathing throughout the Pap smear procedure is crucial since your body will function more efficiently if you are comfortable.</li>
</ul>

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You and your doctor can mutually decide to discontinue Pap smears.

<ul>
	<li>Ask your doctor if you need to continue obtaining Pap smears after a total hysterectomy, which involves the surgical removal of the uterus and the cervix.</li>
	<li>You might be eligible to stop getting Pap smears regularly if your hysterectomy was done to treat uterine fibroids or another non-cancerous condition.</li>
	<li>However, your doctor could advise continuing routine Pap tests if your hysterectomy was performed because of a precancerous or cancerous disease of the cervix.</li>
	<li>Doctors generally concur that if a woman&#39;s previous tests for cervical cancer were negative, she could think about quitting regular Pap tests when she turns 65.</li>
	<li>Together, you may determine what is best for you based on your risk factors. Your doctor might advise continuous Pap testing if you engage in sexual activity with many partners. 
	&nbsp;</li>
</ul>

Cervical cancer can be screened safely by using a Pap smear. A Pap smear is not 100% accurate, though. False-negative results are possible, which means that even though you have abnormal cells, the test shows no abnormality. False-negative results don&#39;t necessarily indicate that something went wrong.

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The following variables can result in a false-negative outcome:

<ul>
	<li>An Inadequate Collection Of Cells: An insufficient amount of collected cells may give false results.</li>
	<li>A Small Number Of Abnormal Cells: Sometimes a doctor is unable to conclude the results because of an insufficient quantity of collected abnormal cells.</li>
	<li>Blood Or Inflammatory Cells Obscuring the Abnormal Cells: Unknown inflammatory conditions and blood accumulation may cause hindrances in identifying results.</li>
</ul>

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Note: Please remember that if one test doesn&#39;t detect the abnormal cells, the next test most likely will. Hence repeated testing is necessary so that if abnormal cells go undetected in the first test, they will most likely be detected in any of the subsequent tests. Repeated testing is also necessary since cervical cancer takes several years to develop and regular pap smear tests allow for early intervention. 
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Conclusion

The incidence of cervical cancer in Pakistan is lower than in other western countries, but the mortality rate is high due to scarcity of awareness, unavailability of Pap smear tests, lack of follow-up, and late presentation of cervical cancers.To curb the late-stage presentation of the disease, implementation of the screening program on the national level is imperative. This would reduce the burden of disease on the health care sector while saving the lives of countless Pakistani women.Even though some specific dos and don'ts must be followed, Pap smear is still a valuable procedure. Healthcare experts must also encourage patients to take the test by alleviating their fears and anxiety associated with the procedure.&nbsp;

Key Points

<ul><li>The Pap smear test is a quick and effective way to test for cervical cancer in women&nbsp;</li><li>Although the procedure is short, Pap smears can be a little painful and tricky.</li><li>This procedure takes place in a proper healthcare environment with specialized tools.</li><li>Pap tests decrease at least 80% of cervical cancer incidence and mortality.</li><li>Women between 21 and 65 years of age are advised to go for a pap smear every 3 years. However starting from age 30 and onwards, it is possible to get either a combined Pap smear and an HPV test OR HPV testing every 5 years.</li><li>It is important to note that not all positive tests equate to cervical cancer. Additional testing is usually done to rule out other causes before a definitive diagnosis of cervical cancer is made. </li></ul>

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