On your back… Set tray … Pap (smear) !!

One of the things highlighted during the month of September is the importance of doing a pap smear. There is something about this test that sends women (those who know of it) into a state of panic. I say those who know of it because believe it or not, I still get a “what’s that” response to the question “when was your last pap smear”? This is the first of three articles I will be doing this month to inform you as much as possible on this topic.

Firstly, what is this test?

This is an age old test invented by Dr George Papanikolaou in early 1900s. The goal of the test is to check for abnormal cells and changes in the cervix (lower end of the womb/ uterus in the upper most part of the vagina). It is the gold standard in medicine for cervical cancer screening.

If you belong to a medical aid fund, check your benefits. Most funders will pay for this as an extra benefit / at no cost to you (you will not use your savings) as it is cheap for them to screen and treat minor problems than to treat cancer, for an example. The public health facilities also do this test and it is free at clinics.

Who needs a PAP smear?

As soon as a woman is sexually active, but women between the ages of 21 and 65 years of age are the primary focus. In some instances it may be necessary sooner and others even later on in life. I ENCOURAGE MEN TO READ ON. This information could save your mom’s, wife’s, daughter’s etc. life.

There are women who will not need a pap smear.

  • Older women over 65 years, who have at least 3 normal tests after menopause. Women who have menopaused but are younger than 65 still need PAP smears.
  • Women who have had a hysterectomy and no longer have a cervix (must have no previous abnormal pap smears before hysterectomy or history of cervical cancer).
  • Women who have had a hysterectomy due to cervical cancer need three normal vaginal smears before considering whether they can stop testing or not.

Always check with your health care provider if it is safe to stop regular PAP smears.

Why is it so important?

It is now as it was then, the quickest, less physically traumatic and most cost effective way of detecting cervical cell dysplasia (abnormal changes), which can be treated and cured before they become cancer that is life threatening and expensive to treat. If left undetected/ untreated; these cells can and most likely will proceed to cervical cell neoplasia (cancer).

PAP smears also detect Human Papilloma Viral infection (HPV) of the cervix, the leading cause of dysplasia and eventually cancer in women. Cervical cancer can be prevented and if found early through regular PAP examinations, can be treated successfully. A PAP smear can SAVE YOUR LIFE.

How often should a PAP smear be done?

When it comes to health decisions, a person’s age and medical history is important to take into consideration. Most can follow these guidelines:

  • Women should be screened once every year for three years initially from age 21years (or sooner if necessary).
  • After three consecutive normal smears, screening can continue at two year intervals until age 30 years.
  • Women aged 31 to 40 years (with a low risk profile) can screen every three years.
  • Women aged 41 – 65 years can screen once every 5 years. (This screening should specifically include HPV typing if positive for that infection).
  • Women over 65 years, to discuss with their health care practitioner when they can stop regular screening.

More frequent screening is necessary and advised in certain instances. This may be required every 6 to 12 months:

  • Previous abnormal smears (HPV, dysplasia/ pre-cancer cells); previously treated for cervical cancer
  • Immune compromising conditions – on chemotherapy for other cancers /steroid treatment for other conditions (post organ transplant etc.)
  • HIV infection increases risk for cervical cancer. (women with this infection need to test every 6 months for a year, then annually if the first two tests were normal)

Who does PAP smears?

  • General practitioners have all done gynaecology during undergraduate training and internship so should be able to do PAP smears. However, certain GP’s do not provide this service so check with your doctor if they do this examination.
  • Primary health professional nurses. Maybe found in private practice but most are in state facilities. They do these tests routinely at the major hospitals with gynaecology departments and have extensive experience.
  • Specialist gynaecologists. Women with abnormal PAP smear results will also be referred for further examination by the gynaecologist.

When should I go for a PAP smear?

This should be routine, just like your car service. Do not wait for symptoms / some type of indication that something could be wrong. HPV infection and dysplasia can be present for a long time and without pain before a cancer grows and spreads.

The best time to do this test is between days 10 to 20 from when your period started (in the middle of your menstrual cycle). It is best not to do it while on your periods, but bleeding is not a contradiction for testing. (Abnormal bleeding or discharges are one of the symptoms of cervical disease or cancer.)

You do not need to “wash out” (douches, manual washing with fingers etc) the vagina before the test is done. You also should not use any medicinal creams/ vaginal tablets, sanitising lotions or sprays etc. It is also advisable to abstain from sex two days before so that the cervix is not inflamed / swollen and there is no semen in the vagina.

Please note that then examination requires that underwear be removed in order to insert a speculum to see the cervix and take a sample. I have encountered patients who asked why they need to undress.

What happens after the PAP smear examination?

The results should be ready in approximately one week (in private sector, depending on laboratory used) and about six weeks in the public health care system. Some private practitioners do not give results routinely, most will contact patient in case of abnormal results. Don’t assume all is well if you have not received any feedback, be proactive and follow up. If results are normal, schedule your next exam at appropriate interval (see above for guidelines).

Abnormal results DO NOT AUTOMATICALLY MEAN CANCER so don’t be scared to follow up if asked to come in to discuss abnormal results. There could be a simple vaginal infection like Candida overgrowth (thrush) etc. which can be treated or an HPV infection which may clear.

A repeat smear may be necessary immediately if the test was inconclusive (due to inadequate sampling or presence of chemicals or infection), or in six/ 12 months time if the test results show dysplasia. In case of abnormal results showing neoplasia, you will most likely be referred to a specialist gynaecologist (if the test was done by a GP or a nurse) for further examination and testing.

In the next two articles I will address what further tests are done for further investigation of cervical dysplasia / neoplasia. I will also talk about HPV and the (not so) new HPV vaccines.

‘Till then…  Take Care and GO for your routine (or initial) PAP smear

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