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Understanding the Pap Smear

What Is A Pap Smear?

The Pap smear is a simple, relatively painless and inexpensive method for detecting precancerous and cancerous conditions of the cervix (the lower end of the uterus). It is considered by many to be the best cancer screening tool available. The procedure was named for Dr. George Papanicolaou, who developed the test about 40 years ago.

The Pap smear is a routine part of a gynecological examination. Properly preformed, it is highly effective in detecting abnormal cervical cells before they become cancerous. In fact, since the development of the Pap smear, the number of deaths from cervical cancer has been reduced by 70%.

How Is A Pap Smear Performed?

You will be asked to lie down on your back on the gynecologic examination table with your buttocks at the edge of the table and your knees or feet supported in stirrups. The physician will place a metal or plastic instrument called a speculum into the vagina to expand its walls so the cervix can be seen. (insertion of the speculum might cause slight discomfort. You should inform the physician if you are too uncomfortable.) the physician will then collect cells from around the opening of the cervix and its inner and outer surfaces using a cotton swab, wooden spatula or cervical brush. The cells are then smeared onto a glass slide (hence the name Pap “smear”) and preserved with a chemical solution to prevent them from drying and changing appearance.

After obtaining the Pap smear, your physician will conduct a manual examination of the uterus. By placing the fingers of one hand on your abdomen and gently pushing the uterus up with two fingers placed within the vagina, the physician will check for abnormalities.

Who Evaluates A Pap Smear?

The slide, along with some personal information (your age and gynecologic and obstetric history), is sent to a laboratory. A specially trained laboratory technologist examines the slide under a microscope and searches for abnormalities among the 50,000 to 300,000 cells found on the slide.

How Is The Pap Smear Evaluated?

The Bethesda Classification System is a recently developed means of evaluating the Pap smear. It was devised at a 1988 workshop sponsored by the National Cancer Institute. This system provides three main types of information:

  • A Statement On The Adequacy Of The Specimen – Since the results of Pap tests can be confused by inadequate cervical smear samples, the adequacy of the specimen is evaluated. If it is considered unacceptable, a new sample is requested.
  • A General Categorization – the sample is categorized as being “normal” or “other”.
  • The Descriptive Diagnosis – If designated as “other” the sample is evaluated further. It is classified as infection, inflammation or different stages and forms of cancer. The evaluator is asked to describe the kinds of abnormal cells that are found. For example, if precancerous or cancerous cells are found, the evaluation categorizes the cells according to the kind of cancer that appears to be present in the specimen.
How Often Should A Woman have A Pap Smear?

The first Pap test should be preformed by age 18 of when a woman becomes sexually active. All women should have a Pap smear as part of a pelvic examination once a year. After three consecutive Pap smears are normal, your doctor may recommend that the test be preformed less frequently. However, woman at high risk for cervical cancer should continue to have annual Pap smears.

Who Is At Risk For Cervical Cancer?

A woman’s risk of cervical cancer is directly related to the number of sexual partners she has had: The risk is also increased when a woman’s sexual partner has had other partners. Recent studies show that half of all married women and from 70% - 80% of married men have had multiple sex partners. This means that nearly all women who are sexually active should have an annual Pap smear. Doctors have identified the following types of women as being at high risk for the disease:

  • Women who have had more than one sexual partner;
  • Women whose partner has had more than one sexual partner;
  • Women who become sexual active before age 18;
  • Women with a history of vaginal infections or genital warts;
  • Women whose mothers took DES, a synthetic hormone commonly used to prevent miscarriages between the years 1940 and 1971.
  • Women who had their first child before the age of 20 or who have had many pregnancies.
How Can I Improve The Accuracy Of My Pap Test?
  1. Don’t douche or use vaginal medications, lubricants or contraceptive products, such as spermicides, for 2 to 3 days prior to the test because they may wash away or hide abnormal cells.
  2. Try to schedule your Pap smear so it takes place between the 12th and 16th days of your menstrual cycle.
  3. Abstain from sexual intercourse for 1 or 2 days prior to the test.
  4. Question your physician about where your tissue sample will be sent for analysis. Ask if the laboratory is certified by a professional organization.
New Directions For The Pap Smear

Advances in technology are combining with the traditional Pap smears technique, the new Bethesda System and better sampling and interpretation guidelines to make this test more effective than ever in directing early disease.

  1. PAPNET: this is a computerized method for analyzing Pap smears. The PAPNET computer duplicates the process that the human eye and mind use to identify abnormal cells. Currently it is only being used to retest Pap smears that have been interpreted by technologists, but eventually it is hoped that it will replace much of the screening now done by hand.
  2. ViraPap: this is a test that was approved by the FDA in 1989. It is used to screen for the presence of human papillomavaris (HPV or genital warts) in Pap smear samples. HPV is linked to the incidence of cervical cancer and this test could detect the disease before cancer develops.