Pap Test - Simple Test For A Complex Disease

Cancer in females is growing at an alarming rate with increased mortality, one of the major contributing factors being ignorance of the condition as well as of the diagnostic modalities.

Worldwide, cervical cancer is the fourth most common cancer in women, besides breast, colorectal and lung cancers. According to GLOBOCAN report of the International Agency for Research on Cancer (IARC), 266,000 deaths occurred from 528,000 new cases of cervical cancer diagnosed globally in 2012. Almost 85% of cervical cancer global burden are from the low and middle income countries. It is a leading gynecological malignancy among women with one in every five women suffering from cervical cancer belonging to India.

The development of cervical cancer from precancerous stage may take more than 10 years. Most of the cervical cancers are caused by specific types of Human Papilloma Virus (HPV) which is majorly transmitted sexually. Other associated risk factors include smoking, multiple sexual partners, weak immune system, sexually active at a young age, etc. It is one of the preventable gynecological cancers, with regular screening tests and follow-up. Hence, it is time to consider cervical cancer screening not as a medical procedure, but as a preventive health checkup procedure for providing better quality of life for women all over.

This article is an attempt to create awareness about this preliminary screening test for cervical cancer i.e. PAP test. This test led to significant reduction in the cervical cancer incidences and mortality in developed countries.

WHAT IS A PAP TEST?
Pap test is an abbreviation of Papanicolaou test, named after a Greek American doctor Papanicolaou, who discovered changes in appearance of the cells present in the cervix before they become cancerous. The cervix is the lower part of the uterus that opens into the vagina. This cervical canal has a protective lining known as squamous epithelial lining. The cells from this lining are regularly shed into its cavity and these are the cells which are examined during a PAP test / PAP smear / cervical smear. Thus, it is a preventive medical procedure designed for detecting early warning signs that might later develop into cervical cancer. It is used to screen healthy, asymptomatic women who might be predisposed or at risk for development of cervical cancer and also to detect vaginal or uterine infections.

SHOULD ALL WOMEN UNDERGO A PAP TEST?
It is important for all women to have a pap test done, along with a pelvic examination as a part of routine healthcare test. It is recommended that all women aged 18 - 65 years of age, and who are and have been sexually active should undergo a pap test. Even if a woman has a normal pap test with symptoms such as abnormal vaginal discharge or bleeding should undergo this test routinely as also someone with a partial hysterectomy. Women over 65 years of age with consecutive 2-3 normal pap test with no abnormal findings for the previous 10 years may discontinue this test. Also, females who have had surgical removal of cervix and with no previous history of cervical cancer can discontinue or have no necessity for this preventive screening test.

HOW OFTEN ONE SHOULD GET TESTED?
There are several different screening recommendations which vary from one country to another. The below mentioned guidelines are the most common recommendations for women world over. Personal recommendations from your attending physician can also be taken post discussion of family history, present health status, etc.

For women aged between 21 to 29 years, screening once in every 2 - 3 years is a necessity.
For women aged 30 years or older and who have had normal findings in pap test for three consecutive years,
may be screened once every 3 years alone with pap test or together with HPV test once every 5 years.
Women > 65 years of age, can be advised by their doctor regarding continuation of the regular pap screening test.
Women with certain risk factors such as weakened immune system, HIV positive statu should continue screening at regular intervals
Also, women born to mothers who were exposed to diethylstilbestrol (DES) during her pregnancy or had undergone treatment for cervical cancer or abnormal pap test in the past should continue screening as suggested by the physician.

PRECAUTIONS TO BE TAKEN BEFORE THE TEST
To eliminate inaccuracy in the results, few preventive recommendations will be charted by the attending doctor and need to be followed for 48 hours before undergoing a pap test.
They are as follows.
Avoid sexual intercourse
Avoid having test during the menstrual cycle
Avoid vaginal douching or tampons usage
Avoid using vaginal medications or birth control pills, foams, creams or gels as these can wash away the abnormal cells.

HOW PAP TEST IS DONE?
PAP smear test involves microscopic screening of cells taken from the cervix. It detects certain viral infections such as HPV and other precancerous conditions, as most of the positive cases occur due to infection of the cervical cells by the high risk types of HPV. It is a quick and simple test that requires just few minutes. Most of the women may experience discomfort followed by minor cramps or pressure during the procedure. In some rare cases, a woman may bleed a little bit after the test.

For collection of samples, a doctor or health care provider performs the test using a special plastic or metal instrument called a speculum. A speculum is inserted into the vagina which will aid in widening the area. This helps the doctor to examine the vagina and the cervix efficiently. The sample is then collected using a small spatula or brush depending upon the type (ectocervical, endocervical or transformation zone). It is important to collect the cells and mucus from the cervix and the area around it.

The direct or cell suspension sample is smeared onto the glass slide and fixed. These fixed slides are then stained and examined by a pathologist. The stained slides are examined under a microscope to note any abnormalities in the cervical cells.

WHAT DO PAP TEST RESULTS MEAN?
The absence of abnormal cells indicate normal results. Usually, abnormal pap test does not mean a woman has cancer, but there might be some problem in the cervix area. In abnormal cases, your doctor may recommend repeating the test and depending upon the pap test results, further confirmatory test is recommended to be carried out.

Pap test can detect abnormal cells and precancerous lesions in the cervix, which can later develop into cancer. Early diagnosis can prevent development or even advancement in the stage of cervical cancer. This is more so important, as cervical cancer proceeds as a silent killer and symptoms are manifested in most of the cases only at a later stage. To devise efficient treatment strategies, early stage diagnosis becomes imperative.

So, ladies start screening with pap test today, to ensure you continue to have a healthy tomorrow!