The Pap Smear

The American Cancer Society estimates that in 2003, about 12,200 cases of invasive cervical cancer will be diagnosed in the United States. About 4,100 women will die from cervical cancer in the United States in 2003.

Cervical cancer was once one of the most common causes of cancer death for American women. Between 1955 and 1992, the number of cervical cancer deaths in the United States declined by 74%. The main reason for this change is the use of a screening test called the Pap test.

“In nearly all cases, the Pap test allows for the detection of abnormal cells. This is the precancerous stage, when the abnormal cells (dysplasia) exist only in the outer layer of the cervix and haven’t invaded deeper tissues. If untreated, the abnormal cells may convert to cancer cells, which may spread in various stages into the cervix, the upper vagina, the pelvic areas and to other parts of your body. Cancer or precancerous conditions that are caught at the pre-invasive stage are rarely life-threatening and typically require only outpatient treatment” according to the Mayo Clinic.

A Pap test and a pelvic exam are important parts of a woman’s routine health care because they can detect abnormalities that may lead to invasive cancer of the cervix. Most invasive cancers of the cervix can be prevented if women have regular Pap tests.

A Pap test is a simple, painless, quick procedure done in the doctor’s office. While a woman lies on the exam table, the clinician inserts a speculum into her vagina to widen it.

A sample of cells is obtained using a brush or wooden scraper. The specimen is placed on a slide and preserved with fixative, or the brush is rinsed off in a vial of fixative and sent to a laboratory for examination.

The American Cancer Society recommends the following guidelines for early detection of cervical cancer:

  • All women should begin cervical cancer screening about 3 years after they begin having vaginal intercourse, but no later than 21 years old. Screening should be done every year with the regular Pap test or every 2 years using the newer liquid-based Pap test.
  • Beginning at age 30, women who have had 3 normal Pap test results in a row may get screened every 2 to 3 years with either the conventional (regular) or liquid-based Pap test. Women who have certain risk factors such as diethylstilbestrol (DES) exposure before birth, HIV infection or a weakened immune system due to organ transplant, chemotherapy, or chronic steroid use should continue to be screened annually.
  • Another reasonable option for women over 30 is to get screened every 3 years (but not more frequently) with either the conventional or liquid-based Pap test, plus the HPV DNA test.
  • Women 70 years of age or older who have had 3 or more normal Pap tests in a row and no abnormal Pap test results in the last 10 years may choose to stop having cervical cancer screening. Women with a history of cervical cancer, DES exposure before birth, HIV infection or a weakened immune system should continue to have screening as long as they are in good health.
  • Women who have had a total hysterectomy may choose to stop having cervical cancer screening, unless the surgery was done as a treatment for cervical cancer or precancer. Women who have had a hysterectomy without removal of the cervix should continue to follow the guidelines above.

A Pap test should not be done when a woman is menstruating. The best time is between 10 and 20 days after the first day of the last menstrual period. For 2 days before a Pap test, she should avoid douching or using vaginal medicines, intercourse, and spermicidal foams, cream, or jellies.

In 2001, new guidelines for the interpretation of Pap results were implemented. These guidelines are based on the most up-to-date research information and specify what treatment(s) are appropriate for each Pap result.

The new terminology is used in most laboratories across the country; therefore Pap results in Illinois will be reported using the same system of classification as Pap results in any other state.

The Bethesda System requires laboratories to determine whether there are enough cells in the specimen to make a proper evaluation. Under this system, Pap test samples that have no cell abnormalities are reported as “negative for intraepithelial lesion or malignancy”.

The most common abnormal Pap test result is called ASC-US, or atypical squamous cells of undetermined significance. About 1 in 20 Pap tests are diagnosed as ASC-US and almost 1 in 4 women will have an ASC-US result in their lifetime.

Most women with ASC-US do not have a significant cervical lesion and only about 1 in 1,000 will have a cervical cancer. Women with ASC-US are at increased risk for having a high-grade cervical cancer precursor lesion and require some form of follow up.

Women with ASC-US may be managed with a variety of different treatments, which are all safe and effective. They include:

  • Repeating the Pap test at least twice in an 8-12 month period to see if the abnormality persists
  • Testing for the Human Papilloma Virus
  • Inspection of the cervix with a magnifying device called a colposcope and obtaining cervical biopsies of abnormal appearing areas
  • Estrogen cream (in women who are near or past menopause)

We believe the most important way to improve early detection of cervical cancer and save lives is to make certain that all women have Pap tests according to the American Cancer Society guidelines.

 

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