The pap smear test or the pap test is a routine test done to examine the cells collected from the cervix. The cervix is the lower narrow end of the uterus. Non-cancerous conditions such as infection and inflammation, abnormal cells that may lead to cancer, or cancer of the cervix can be detected by the examination of the cells collected from the cervix. A doctor may find out from a pelvic exam whether there are any abnormalities in the uterus, ovaries, fallopian tubes, vagina, bladder, or the rectum. Such abnormalities can lead to cervical cancer.
The pap smear is named after George Papanicolaou, who first formulated this test. In the last 50 years, there has been a noteworthy drop of fatalities due to cervical cancer. This was possible because of the popularity of the pap smear test. In the U.S., about 55 million pap tests are performed every year and about 6% (3.5 million) of them are found to be abnormal. The patients, diagnosed with abnormalities require medical follow-up so that the doctor can investigate the causes of abnormalities and can design the treatment accordingly.
- Sexually transmitted diseases like herpes or gonorrhea
- Human papillomavirus (HPV) infection
- Sex with more than one partner
- Family history of cervical cancer
- Sex without using any protection
- Excessive smoking or use of tobacco
The patient may have to undergo a few more tests to determine the exact reason behind the change observed in the collected cells. A colposcopy or biopsy may be recommended to find out the cause of an abnormal result. In some cases, cryotherapy, conization, laser therapy, hysterectomy, or loop electrosurgical excision procedure (LEEP) can be recommended.
Interpretation of Abnormal Pap Smear Results
- Benign changes in cells can be a result of genital herpes, chlamydia, yeast infections, gonorrhea, and estrogen decline during menopause. These conditions may lead to inflammation on the cervix.
- The near-abnormal cells in the endocervical region or atypical glandular cells are considered benign.
- Some cells like ASCUS (atypical squamous cells of undetermined significance) appear cancerous, but they are rarely cancerous. But, some of these cells require close monitoring, as they may lead to cancer in future.
- Dysplasia means abnormal cells. It is classified as mild, moderate, severe, and carcinoma in situ, depending upon the cell abnormality. In mild dysplasia, only the superficial layer of the cervix is affected. HPV can also cause the abnormal result. In such cases, a pap smear should be repeated within 6 months. In moderate dysplasia, more numbers of abnormal cells are detected. Severe dysplasia needs further examination with other procedures, as it is spread to the deeper tissues, developing as invasive cervical cancer. In carcinoma in situ, cancerous cells are found confined to the surface of the cervix. As they are detected before they spread to the deeper tissues, it becomes easy to treat the cancer.
It should be noted that women vaccinated against HPV also need to undergo this test. Sexually active women over the age of 21 should undergo the test every year. It is an easy procedure, helpful for maintaining women's health. A significant improvement in the survival rate of the cancer patients, and an increase in the life expectancy of cervical cancer patients has been noticed, as the test helps detect the cancer at an early stage.
About 80% of the time, the results are reliable. But, as the results can be false positive or false negative in some cases, the test should be repeated within a year. This way, missing abnormalities from the previous test can be detected during the next test.