A Pap smear is a type of test used to screen for cell changes that have the potential to lead to cervical cancer in women.

Its name originates from a prominent Greek doctor named Georgios Papanikolaou. He began researching cell changes that lead to cervical cancer in 1923 and created the movement that eventually led to the widespread use of Pap smears to screen women today.

Who should be screened?

It is recommended that all women aged over 18 years old that have ever been sexually active be screened for abnormal cell changes in the cervix using a Pap smear. For women 65 years or older, it may no longer be necessary to be tested provided there is a long history of normal screening tests. However, this depends greatly on individual circumstances and the risk of cancer.

Even women who have had a hysterectomy may continue to require regular Pap smears, depending on the type of surgery used.

Efficacy

Cervical cancer is relatively common and is the fourth most common cancer for women throughout the world, with an estimated number of 266,000 deaths worldwide due to the disease in 2012.

Approximately 90% of these occur in less developed countries where there is often a lack of screening programs and Pap smear tests. When the screening was introduced, the number of women diagnosed with cervical cancer dropped significantly and continues to drop by about 4.5% each year. This is likely as a result of the ability to detect early changes and prevent the progression to cancer.

Test Procedure

The screening test is quite simple to do and should not take very long to obtain the cell sample.

1. Opening up of the vaginal wall with a speculum to allow access to the cervix
2. Collection of the cell sample from the cervix using a spatula that scrapes along with the outer opening.
3. Cells are smeared onto a glass slide and sent away to a laboratory to be tested for any abnormalities.
4. If an abnormality is detected, follow-up consultations are necessary to discuss further tests if needed.

Test Results

The Pap smears screening test usually detects changes to the cells in the cervix and only rarely indicates cervical cancer, as it is usually detected earlier.

The results from the laboratory are usually classed as normal, unclear, or abnormal.

Normal results refer to cells that have no notable changes that could lead to the progression of cervical cancer. Women that receive this result may be advised to return for standard screening in two years.

Unclear results are when the screening test did not show obvious signs of cell changes but was not completely normal either. This result may justify further testing immediately, or a follow-up Pap smear earlier than usual after 6 or 12 months to monitor changes.

Abnormal results display signs of cell changes that could potentially lead to cervical cancer if they are not treated. There are different classifications of abnormal cells, with varying degrees of severity.

In most cases, further tests are required immediately to determine how the cells are changing and their HPV status.

The Pap smear is a useful screening tool that allows women to test if they have cell changes that may be dangerous before they experience any symptoms, where it would not otherwise have been possible.