By Emily Cleveland-Job, ND, Director of Naturopathic Medicine, Natural Bio Health
What is a Pap Smear?
A Pap smear is a way to screen for cervical cancer or precancerous changes in the cervical tissue. The term “Pap smear” comes from George Papanikolaou who developed the technique of sampling cells from the cervix and the endocervix (the area leading into the uterus) to screen for cancerous cells.
Many years ago, the process involved “smearing” the cervical cells onto a slide and spraying them with a fixative. However, more recently, a liquid-based collection system has been developed to preserve the cells until they get to the lab. This liquid form allows not only for testing the cells, but it can also be used to screen for various HPV (human papillomavirus) viruses, gonorrhea, and chlamydia. Under the microscope, a pathologist can view the cells to see if there are any pre-cancerous or cancerous changes.
Why should I get a Pap smear?
About 90% of the population has been exposed to a few of the various strains of HPV. The risk of exposure correlates with the total number of sexual partners one has in their lifetime. However, the prevalence of HPV infection is 4-20% in those with only one partner. *Pap smears can detect early changes in the cells that if left untreated can lead to invasive cervical disease over many years’ time. There are 2 types of cervical cancers, squamous cell carcinoma and adenocarcinoma. Squamous cell carcinoma is more common, though both kinds of cancer are found in sexually active women. The cause of cervical cancer has been linked to a couple of strains of the Human Papilloma Virus (HPV). There are a number of strains of this virus, but the two that have been identified as high-risk for leading to cervical cancer are type 6 and type 11.
Screening is recommended for all sexually active women (see recommendations below).
What if I have an abnormal result??
Depending on the degree of abnormality, it is usually recommended that you have a repeated Pap smear, HPV testing, or a colposcopy. Colposcopy is a procedure that allows for an illuminated and enlarged view of the cervix to aid in visual determination of normal and abnormal cells. Biopsies may be taken if needed during a colposcopy exam.
Testing positive for HPV may not mean you will need treatment, at least not immediately. After a positive HPV test, your doctor may suggest only close monitoring. If the test shows that you are infected with a type of HPV that can lead to cancer, your physician may recommend frequent Pap tests (see below) to watch for signs of abnormal cell changes in the genital area. Abnormal cell changes in the cervix are a warning sign of possible cervical cancer
A Positive HPV Infection Can Be Cleared.
While there is no known cure for HPV, the good news is the infection often clears on its own. If it does not, and treatment is needed, there are many treatment options. Most women who do show a positive HPV infection will end up completely clearing the infection in 8-24 months. Progression to cervical cancer requires persistent infection for many years. Cigarette smoking increases the risk for cervical cancer.
Infection with HPV (human papillomavirus) is very common. About 20 million people in the U.S. are affected. About 30 of the 100 HPV types are transmitted sexually. This HPV transmission can cause genital warts or abnormal cell changes in the cervix and other genital areas that can lead to cancer.
How frequently should I get a Pap smear?
More than half of the women who develop cervical cancer had either never had a Pap smear, had very sporadic Pap smears, or didn’t have a Pap smear within the previous five years. Therefore, regular screening is highly recommended.
Pap smears used to be recommended annually for all sexually active women. However, guidelines have changed a little bit based on the evidence gathered from these tests. The reason these guidelines have changed is that they were finding too many women had to get more invasive testing due to their abnormal Pap smears when they ended up clearing the infection in the long run. By changing the guidelines they have greatly decreased unnecessary testing. This decrease in unnecessary testing also decreases unnecessary stress and worry.
Initial Screening & Frequency of Tests
Adolescents are more likely to become infected and have abnormal Pap smears, but most abnormalities are transient and cervical cancer is very rare in young women. Therefore, most groups recommend the initial screening be done at age 21. However, if a woman has HIV, an autoimmune condition, or has had an organ transplant that requires long-term immunosuppressive drugs, the screens should be done earlier. Usually screenings for women who fall into this latter category are initiated soon after their first sexual encounter.
Follow-up Screening Recommendations:
Ages 21-29: Pap smear every 3 years.
Ages 30-65: Pap smear and HPV screen every 3 years, though the HPV screen really only needs to be done every 5 years.
Ages 65 and over: No more Pap smears for women who have had adequate screening prior to age 65. This means that the woman has had 3 consecutive Pap smears that were normal or 2 consecutive Pap smear + HPV tests that were normal. If there is a history of cervical cancer, screening should continue for about 20 years from the diagnosis.
What Can I Expect At The Doctor’s Office?
In preparing for your pap smear, make sure that the appointment is not during your period. If you do get your period before the appointment, you will need to reschedule as blood will interfere with the test results.
In the 48 hours leading up to your appointment, make sure to avoid sexual intercourse, vaginal douches, lubricants, spermicides, and tampons. All of these things can interfere with the accuracy of the test.
At your appointment you will be asked to undress and you will be given a drape to place over your lap. Once you are all ready, you will be asked to lie back on the exam table and place your feet in stirrups. At this point, you want to focus on relaxing all of your muscles. Taking some deep breaths can help in relaxing. The doctor will inspect the outer tissues of the vagina to make sure there are no abnormalities in the skin. Then they will insert a lightly lubricated speculum into the vagina which allows for easy viewing of the cervix.
The cervical samples are taken with a small mascara-like brush. Some women will feel a very mild cramp during the sample collection while other women notice no sensation at all. Once the samples are collected, the doctor will gently remove the speculum. At this point, you are completely done!
Some women will experience very mild spotting after sample collection. This is very normal and frequently the doctor’s office will provide thin pads for you to use for just this reason.
How long until I will know the results of my test?
Generally it takes the lab anywhere from 5-7 days to process your sample. If the results are normal, you usually will not need to come in for a follow up visit. However, if there is anything abnormal on the result, you will be asked to come in for a follow up visit to discuss the next steps to be taken.
What if I haven’t had a pap smear in many years?
That is okay, make an appointment anyway. It is never too late to start or get back on track with screening. Peace of mind is worth a lot! Worrying because you don’t know the health of your cervix adds unnecessary stress to your life. If you have questions, please do not hesitate to call and talk to one of our friendly doctors or medical staff!