Don’t Fear the Smear!
With numbers of women attending their cervical cancer screening appointments in decline, we talk why it's vital to get papped - pap smeared that is! And how attending your Pap Smear appointment might just save your life.
"It's going to be soooo embarrassing!" "I just don't have the time!" "It's going to be too painful!" "It won't happen to me anyway!"
...Ladies, let's drop the excuses! Cervical cancer is the fourth most frequent cancer found in women - with an estimated 570,000 new cases found in 2018 alone (WHO), and so we just can't afford to fear the smear!
What is a PAP Smear?
PAP tests or PAP smears are tests which are conducted to identify cancers and pre-cancers in the cervix. A PAP smear will help identify any cells that are abnormal and which, if left untreated, could lead to cervical cancer.
During a Pap smear your doctor or nurse will put a tool called a speculum into your vagina. A speculum helps the doctor or nurse visualise your cervix. They will then use a swab to collect cells from the outside of your cervix which will then be sent to a laboratory for testing.
Often, HPV will also be tested for simultaneously. HPV is a sexually transmitted infection (STI) that usually goes away on its own in most people. If it does not go away, HPV can however cause abnormal cervical cells that can lead to cervical cancer. Most cases of cervical cancer are caused by infection with HPV. If a high-risk type of HPV infection lasts for a long time, it can cause more severe (“high-grade”) changes in cervical cells. High-grade changes are more likely to lead to cancer.
Human Papillomavirus (HPV): The name for a group of related viruses, some of which cause genital warts and some of which are linked to cancer of the cervix, vulva, vagina, penis, anus, mouth and throat
How often should I have cervical cancer screening and which tests should I have?
This depends on your age and health history. The American College of Obstetricians and Gynecologists guidelines say:
21–29 Pap test alone every 3 years. HPV testing is not recommended.
30–65 Pap test and an HPV test (co-testing) every 5 years (preferred). It also is acceptable to have a Pap test alone every 3 years.
Co-Testing: Use of both the Pap test and HPV test to screen for cervical cancer in women aged 30–65 years
When should I stop having cervical cancer screening?
You should stop having cervical cancer screening after age 65 years if... you do not have a history of moderate or severe abnormal cervical cells or cervical cancer, and you have had either three negative Pap test results in a row or two negative co-test results in a row within the past 10 years, with the most recent test performed within the past 5 years.
However, do not wait for your next scheduled cervical screening appointment and see your doctor promptly if you experience:
-Bleeding between periods, during or after sex, or after you have been through the menopause
-Unusual vaginal discharge
What will happen at my PAP Smear appointment?
You'll need to undress, behind a screen, from the waist down.
You'll be given a sheet to put over you.
The nurse or doctor will ask you to lie back on a bed, usually with your legs bent, feet together and knees apart.
The nurse or doctor will gently put a smooth speculum into your vagina. A small amount of lubricant may be used.
The nurse will open the speculum so they can see your cervix.
A small sample of cells will be taken from your cervix with a small brush.
The nurse will close and remove the speculum and leave you to get dressed.
After the appointment you may have some spotting or light bleeding after your cervical screening test. This is very common and should go away in a few hours.
Your Results
Results usually take 2- 3 weeks.
If you have a 'normal' result:
No further tests needed! Schedule your next PAP smear for 3-5 years (age dependent)
If you have an 'unclear' result:
Another PAP smear may be required within 3 months. This does not mean that anything is wrong but simply that the first test results were unclear.
If you have an ''abnormal' result:
There are different kinds of 'abnormal' results -
Abnormal with borderline or low-grade cell changes. If no HPV was found you will be invited for screening again in 3 or 5 years. If HPV was found, you may need to go for a colposcopy
Abnormal with high-grade cell changes You will be asked to go for a colposcopy
HPV found (HPV positive) but no cell changes You'll be invited for screening again in 1 year to make sure the HPV is gone. If you get this result 3 times in a row, you may need to go for a colposcopy
HPV found (HPV positive) with cell changes You will be asked to go for a colposcopy
In Focus: Colposcopy
A Colposcopy is usually carried out in a hospital or clinic. It takes about 15-20 minutes and you can go home the same day. The procedure is similar to a PAP smear in that a doctor or nurse will open your vagina to conduct the examination using a speculum.
It differs as a microscope with a light is used to look at your cervix – this does not touch or enter your body. Special liquids are applied to your cervix to highlight any abnormal areas. A small sample of tissue (a biopsy) may be removed for closer examination in a laboratory.
Have further questions for us about cervical screening? Feel free to subscribe to our newsletter. Alternatively, listen to our Podcast on Cervical Cancer Screening with Dr. Marcia Schmidt or join us on Instagram @thefertilitytalk.