The Pap test forms a regular part of a woman’s annual physical. Since this test is an important screening tool for cancer of the cervix, it’s essential to understand how the test works. Initially a woman may be afraid to have a Pap test and worried that it will hurt, but it should not be painful. Having this test performed helps safeguard a woman’s health.
The Pap test, or Pap smear, is named after Dr. Papanicolaou, the doctor who developed the test in 1943. A Pap test screens for changes in the cells of the cervix. These changes happen before cervical cancer occurs. Finding the changes early makes it easier to catch cancer in the “precancerous” stage and treat the condition before it becomes serious. It can take five to 20 years for abnormal cells to change into cancer. Treating the cells in a precancerous state makes cervical cancer almost completely preventable. This is why Pap tests can save lives.
A Pap test is done from the surface of the cervix. What is the cervix? Imagine a light bulb. The glass part of the light bulb is like the uterus, or womb, where a pregnancy develops. The very bottom metal part of the bulb is where the cervix would be. Cervix is just a special name for the end of the uterus. The cervix is visible at the very end of the vagina (birth canal) - see diagram on opposite page.
Cells of the cervix can become exposed to a virus called Human Papilloma Virus (HPV) through sexual activity. Although they sound similar, HPV has nothing to do with HIV (Human Immunodeficiency Virus). Recent research in Canada shows that about 20 to 33 per cent of women have been exposed to HPV, but these numbers are likely much higher in younger women. There are about 70 types of HPV known so far, and about 24 types are linked to cervical cancer. These strains of HPV can infect and irritate cells of the cervix, eventually leading to cervical cancer in some women. Almost all cervical cancer is related to HPV.
A doctor does the Pap test, often with the help of a nurse. The doctor uses a speculum to be able to see the cervix. A speculum is an instrument made out of plastic or metal which is gently inserted into the vagina. It holds the walls of the vagina apart so that a sample of cells can be taken from the surface of the cervix. The doctor uses a small wooden spatula and a soft-bristled brush to collect some cells from the cervix. These cells are then smeared on a glass microscope slide. A special spray is used to fix the cells on the slide, and the slide is sent to a lab. There a specialist examines the cells, looking for anything abnormal. Most women will say that having a Pap test done is uncomfortable. Having a Pap test should not be painful. If you have pain during your Pap test, you should let your doctor know.
Having a Pap test done in the middle of your cycle is best. If you are suffering from symptoms of a yeast infection, a sexually transmitted disease, or if you are having your period, it can make it difficult for your Pap test to be interpreted. For this reason, many doctors prefer not to do a Pap test if you have symptoms of an infection or abnormal discharge from the vagina.
Pap testing should be done on all women once they become sexually active. Current guidelines state that Pap tests should be done every year. If a woman has an abnormal test, she may require more frequent testing (once every six months for two years). If the Pap test shows certain changes, the woman will sometimes need a repeat Pap test done at a colposcopy clinic. This is a special clinic where the doctor can look at the cervix through a microscope while obtaining a sample of cells. Abnormal Pap tests should be discussed with your doctor so that you understand what extra testing you may require.
Women who are past menopause still need to have regular Pap tests. Women can expect to stop having Pap tests somewhere between age 65 and 70, if they have had regular Pap testing in the past and the results have been normal. It is important that women who have stopped having Pap tests still go to see their family doctor every year to make sure that the rest of their reproductive system (and body) remain healthy. Women who have had a hysterectomy (where the uterus, with or without the ovaries, are removed) can also stop having Pap testing under certain conditions. You can discuss these recommendations in detail with your doctor.
There are some circumstances when Pap testing is not the best test. Remember that the Pap test is a screening test designed to pick up abnormalities. Pap testing is meant to be done on healthy women, who do not have any symptoms of cervical cancer. It tests the cervix to see if there are cells that have become irritated and are at risk of developing into cancer. If a woman has problems that may be due to cervical cancer, a normal Pap test will not be that helpful. Symptoms like pain with intercourse, or abnormal bleeding or discharge from the vagina may mean that a Pap test may not provide useful answers. You should always see your doctor to find out what is causing these symptoms.
If a test report comes back as abnormal, this does not usually mean that there is cervical cancer present. Remember that the Pap test looks for early changes that may develop into cancer. There are other tests, such as colposcopy and cervical biopsy, which take a closer look at these abnormal cervical cells. Remember also that it can take five to 20 years for abnormal cervical cells to become cancerous. Early changes in cervical cells can be treated so that cervical cancer does not develop. Your doctor will discuss an abnormal Pap test with you. If you have questions, ask. It is important that you know when to return for further testing.
There are many things that women can do to prevent cervical cancer. Because HPV is spread mainly through sexual contact, limiting the number of sexual partners in your lifetime reduces the risk of being exposed to HPV. Other than HPV infection, the most common direct factor that increases the risk of a woman developing cervical cancer is cigarette smoking. In fact, stopping smoking decreases your risk for about 20 to 30 per cent of all types of cancer.
Pap tests are a simple way to find abnormal cells before they turn into cancer. Since testing prevents cervical cancer, saves lives, and is easy to do, having a regular Pap smear is part of protecting your health.