A Pap smear is a method of screening for the presence of abnormal and cancer cells when cells are obtained from a woman’s cervix. These samples are obtained by getting a woman to lie on her back with the hips parted so that a speculum can be inserted to part the vulva and open up the vagina. When this has been achieved, cells can then be scraped from the cervix which has got two parts to it.
The scraping is done either with a brush or spatula. This is a small but narrow part of the female genital tract that connects the vagina with the womb. It is the passageway for menstrual blood from the uterus to the outside during the monthly cycle and it provides an exit for a baby during delivery. During intercourse, the cervix provides the gateway for sperm to swim into the uterus from the vagina.
The parts of the cervix are probably known only to the healthcare experts who work constantly in that part of the body. There is the endo-cervix, which is the innermost part of the cervix and is lined by the kind of mucosa that secretes mucus which is responsible for keeping the vagina moist. Then, there is the ecto-cervix, which is where the flat cells that resemble fish scales are found. At the junction between these two types of cells is an area where most cervical cancer cells originate from and where the pre-cancerous cells are most in evidence. Pre-cancerous cells are the abnormal cell forms that usually lead to cancer.
The aim of a Pap smear, therefore, is to examine these cells for the abnormalities we have described above in an attempt to find out if they pose a risk to the patient being examined. These cells are usually examined under the microscope to check for such abnormal cells and where they are not in evidence, the person can safely be given a clean bill of health as far as that part of the body is concerned.
This test also helps to screen for the presence of the human papillomavirus. It helps to detect the specific DNA (deoxyribonucleic acid) of the HPV to determine both its presence and the type. Besides, these tests help to determine whether the person is at increased risk of developing cancer or is already harbouring the disease. It means, therefore, that if a person can get this diagnosis, she can then proceed to get treatment.
However, it is necessary to emphasise that this kind of routine screening does not always lead to both tests because what is often of greater concern to most women is the threat or presence of cervical cancer. However, a woman being screened can ask that the presence of HPV be sought for at the same time, provided the facilities are available to conduct such tests. In many advanced countries, the incidence and morbidity arising from previously undiagnosed cervical cancer decreased greatly after the introduction of the Pap smear.
Usually, it is best to avoid having a Pap smear done when a woman is menstruating, especially if the flow is heavy. This can affect the quality of the results obtained. Equally important is the fact that women should avoid douching or otherwise putting anything at all inside their vagina in an attempt to keep it clean before such a test is conducted. In fact, it needs emphasis that douching is not even recommended at any time for any woman.
The time a woman should have a Pap smear is dependent on a number of factors, such as age, immune status, especially for those who suffer from HIV/AIDS, and medical history, which should help clear up whether the patient has had multiple sexual partners, or began having sex at a tender age such as between 13 and 16 years, or they have delivered multiple times such as five or more times, or they are sexually active.
As a result of these requirements, most women above the age of 65 years will not need to have a Pap smear done. However, women aged between 21 and 29 years should get a Pap smear done every three years. Those aged between 30 and 65 years of age should have an HPV test every five years, or if they have the opportunity, have a combined HPV and Pap smear test every five years. Consequently, anyone who has had abnormal test results from any previous test and is sleeping with more than one partner should get tested more frequently on the recommendation of their doctors.
In some cases, a colposcopy is the preferred investigation because that instrument helps to access the far walls of the vagina and its roof. This procedure affords the examining doctors to gain a better view of the surroundings of the cervix and the character of the cells in the region. It greatly magnifies the cells there and sometimes, there is no need to obtain a biopsy with this equipment. Therefore, women who have had their uterus removed in a procedure called hysterectomy do not need to continue to undergo this test because there is no cervix to be tested.
If the cervix is preserved, for some reason, like in a sub-total hysterectomy, then such women are eligible for these tests to be conducted. In another twist, if a woman has had hysterectomy due to cancer or because pre-cancerous cells were found, then these routine Pap smear must continue at the suitable intervals recommended by their doctors. Most of the time, the results will be obtained within one to three weeks, depending on the part of the country and where it was performed, but this is an improvement on what it was some 30 years ago when results might not be seen for up to six weeks or even more.
In most cases, normal results are obtained and the women can feel free to live their normal lives. Occasionally, however, abnormal cells are detected and the doctors may then request more tests or wait for a suitable interval, varying from three to six months, before a repeat investigation is ordered.
Cervical cancer is a major cause of serious illness and death in our society. Many women will not realise that they have a problem until quite late in the history of the disease. At that time, they are likely to have developed a profuse vaginal discharge or bleeding.
There are many risk factors for developing cervical cancer and these include some of the factors we shall name here. Not having had the HPV vaccine is a common risk factor for this condition and so is the exposure to having many different sexual partners as we said in a paragraph above. In the same way, having HPV infection or developing a vaginal infection due to chlamydia puts any woman at an increased risk of getting the disease.
In talking about infections, the risk posed by the HIV infection is two-fold; it decreases immunity and it paves the way for other infections like chlamydia and HPV to take their chances with the person. There is also an increased risk in being overweight or even obese just as starting to have babies at under-18 years of age puts a woman at an increased risk for getting the condition. That risk also exists for those women who have used the oral contraceptive for an extended period of time such as two years or more. Women who have delivered multiple times, often called grand multiparous women, are at increased risk. Finally, as silly as it sounds, women who do not take enough fruits and vegetables in their diet are also prone to getting cervical cancer.
It is the avoidance of the deadly nature of the cervical cancer that Pap smear was designed to help address. Regrettably, despite all the efforts made in our various communities over the last 10 to 15 years in particular, this exercise largely remains one only the elite are aware of or are willing to engage in. Were it not so, many young women who have now taken to smoking as a form of status symbol would have recognised that even that social engagement carries some risk for getting cervical cancer. The way to prevent succumbing to the condition is by prevention, which means doing the Pap smear regularly.
