What is a pap smear?

A Pap smear, also referred to as a cervical smear, is a screening test for cervical cancer or cancer at the ‘mouth of the womb.’

What is it used to detect, and why do I need one?

It is done to look for changes in the cells of the cervix. The benefit of doing a Pap smear is to detect early premalignant changes and then treat them before they become cancerous.

Who should get them?

All women who are sexually active or have been sexually active should have this test done. Some women feel that because they may have had just one sexual encounter there is no need for a Pap smear. Once you are not a virgin, a Pap smear should be performed up to the age of 65.

How often should they be done?

A Pap smear should be done annually, and if after three consecutive smears, normal results are obtained, then it can be done every two to three years.

I have heard that women who are not sexually active should get this test done once they reach the age of 21. How true is this?

The Human Papilloma Virus (HPV), which has been proven to be associated with causes of cervical cancer, is sexually transmitted. It is therefore highly unlikely that a person who has never had sex will have this virus. There is an extremely small chance (.01%) that a person will inherit HPV from a parent. If there is a family history of HPV or cervical cancer, pap smears should be done whether the person has had sex or not. Otherwise, I do not believe it is necessary until the person becomes sexually active.

How is a pap smear done?

This is an office procedure. The patient is placed lying on her back with knees bent up. An instrument called a speculum is gently inserted into the vagina. This speculum is then opened a little so that the cervix is visualised. A small sample of cells from the surface of the cervix is collected with a spatula (a fl at wooden scraper) and a cytobrush (a very small, soft brush). This sample is spread on a slide or mixed in a liquid fixative and sent to a lab to be looked at under a microscope.

Is it painful?

It is not a painful procedure. A little discomfort and pressure is all that is experienced. Being relaxed is of course helpful!

Is there anything women should do in preparation for the test (at home before the actual appointment, or during the days leading up to the test)?

In preparation, a woman should not have sexual intercourse or douche for at least 24 hours before. Definitely, she should not be menstruating or the period should have ended at least three days prior. At the doctor’s office, the bladder should be emptied just before the test is done.

How reliable is the test? What does a false positive or false negative result mean?

A Pap smear is quite reliable; it has significantly helped to lower the incidence of cervical cancer. A false negative result is when the test results fail to pick up abnormalities that are really there. A false negative result of at least 4% has been identified in studies and this accounts for missed lesions. A false negative result can occur if the sample is improperly collected or if the cytologist is inexperienced.

How soon will I get the results of my pap smear test?

Results are usually ready within two weeks.

What if the test detects something abnormal?

What is abnormal? A Pap smear can detect inflammatory cells which can be treated with antibiotics and then the smear is repeated in about six months. It can also detect HPV changes. There is no treatment for HPV. Once you get it you have it for life, but it may cause no signs or symptoms except for warts, depending on which type of HPV is present. Doing more regular Pap smears like every six months is recommended. Fortunately, a vaccine for the prevention of HPV will soon become available. If dysplasia or CIN (Cervical Intraepithelial Neoplasia), that is, premalignant cells, is detected, colposcopy or biopsy is recommended. Colposcopy involves examination of the cervix with a colposcope which magnifies the cells thereby identifying suspicious areas and taking a sample or biopsy of the tissue and sending it to the lab.

Is it treatable?

If CIN is detected, treatment by “Loop Cone Biopsy” is performed in which the lesion is completely treatable. Cauterization of the cervix can also be done. If cancer is detected, treatment and prognosis depends on the stage of the cancer.

What are the risks of not doing pap smears regularly?

If a woman does her Pap smear regularly, and it is done properly, she may never develop cancer of the cervix. All lesions that are pre-malignant are removed before turning to cancer. Hence the benefit of doing Pap smears. Cancer cells take years to develop. So if Pap smears are not done regularly, it gives the abnormal cells the opportunity to transform into cancer cells without being detected, thereby reducing survival and increasing the chance of spread.

Where can I go to get the test done?

The test can be done at any doctor’s office—general practitioner, or gynaecologist—as well as Cancer Society clinics and Family Planning institutions.

Is it an expensive procedure?

No, it is not expensive. This is to encourage more women to do it.

I have heard that once you have a baby, or a hysterectomy, you no longer need to get pap smears done. How true is this?

Oh no. You definitely have to do your Pap smears after you’ve had a baby. With regards to a hysterectomy, if you had a total hysterectomy (the cervix was removed), there is no need to have any more Pap smears, unless of course the indication for the hysterectomy was for cancer. If a subtotal hysterectomy was done, (the cervix was left inside, intact) a Pap smear must still be done.

Are there any risks during the procedure?

No, there are no risks during the procedure.

Will it harm my baby if I’m unknowingly pregnant?

If you are unknowingly pregnant, there is no harm to the baby when a Pap smear is done. In fact, since it may be the first encounter with a gynaecologist, in the pregnancy, some doctors routinely do a Pap smear at that visit. An important point to note is that Pap smears screen for cervical cancer only. If there is cancer of the uterus or womb, which is higher up inside, the Pap smear is not a reliable test for this and may not at all detect it. In cases of abnormal bleeding, a D&C (Dilatation and Cutterage) is performed.

Dr. Sherene Kalloo studied in Trinidad, Jamaica and Barbados and is presently a Fellow of the American College of Obstetricians and Gynaecologists. She has worked at both the Port of Spain General Hospital and Mt. Hope Women’s Hospital in Trinidad. Currently she runs private practices in Chaguanas and Aranguez, and performs surgery and deliveries at St. Augustine Private Hospital.