While the average woman or man on the street may not be familiar with the Papanicolaou test, many of us would have heard of or undergone this cervical cancer screening test by its more well known name – the pap smear or pap test.. While popular misconceptions and myths abound surrounding the pap test, it’s time to clear the air.
How Does it Help?
In the developing world, where screening and treatment may be limited or non-existent, cervical cancer is the leading cause of cancer death, according to the World Health Organization.
As a screening tool, the pap test determines who is at risk of developing cervical cancer by detecting precancerous changes as early as possible allowing swift intervention for treatment. It is important to note that abornomal pap test results rarely means the person has cervical cancer and further investigation is needed.
The pap test involves taking a sample of cells in a part of the cervix called the transformation zone, which is often where cells may undergo abnormal changes or growth. Cellular abnormalities are further evaluated by colposcopy and/or biopsy before a diagnosis can be made. The colposcope is a low-power magnification device that allows lesions to be seen and ascertain whether a biopsy is needed. Tissue sample from the cervix is collected in a biopsy.
What Causes Cervical Cancer?
Almost all cervical cancers are causally related to infection by the human papilloma viruses (HPV) which doesn’t go away. Only certain types of this group of viruses cause cancer, whereas a few low-risk types cause genital warts – a common sexually transmitted infection. Many sexually active people will have HPV at some point in life, but most do not notice it because these infections tend to clear up on their own, with time.
Even short term infections from high-risk types of the virus result in little or no changes to cells in the cervix even though these high risk viruses have the ability to cause cervical or anal cancer. Persistent HPV infection by cancer-causing types, however, is a risk factor for cervical cancer. Another name for abnormal lesions is cervical intraepithelial neoplasia (CIN) which can range from a minor infection to a more serious one.
Low grade abnormalities can arise due to infections or postmenopausal changes as well. The timeline for ‘high-grade’ precancerous cells to develop into an invasive carcinoma takes around eight to 12 years in most women, presenting a window of opportunity for timely screening and treatment.
Precancerous changes within the cervix usually do not cause outward symptoms, which is why pap testing is so important. When cells become invasive, abnormal vaginal bleeding between periods or after intercourse is one of the early signs of cancer.
Abnormal vaginal discharge can be yellowish and foul-smelling or tinged with blood and the fluid component of blood (serous fluid). Other advanced symptoms include anaemia, pelvic pain and weight loss.
How Regular is Regular?
How often a pap test should be undertaken varies with the individual and her risk factors, so a discussion with your doctor is essential. Generally, women who are been sexually active are recommended to start from the age of 21 and get a pap test every two years, or more frequently if they have certain risk factors.
Having been vaccinated against HPV does not replace getting regular pap tests. You will have to get it done more frequently if an abnormal result was found and go through follow-up tests like colposcopy.
Menopause does not protect against cervical cancer, which develops over many years, so older women should remain vigilant. However, if you are over the age of 65 and have had normal pap test results for the last 10 years or so, you may not need to get tested any longer.
How to Prepare
According to consultant obstetrician and gynaecologist at the OBGYN Women’s Specialist centre in Subang Jaya and senior lecturer at Monash University School of Medicine Dr. Sharad Ratna, a pap test could potentially “cause a mild degree of discomfort but not excessive pain.” Apart from arranging for the test to be performed at a time when you’re not having your period, Dr. Sharad says that there is no preparation necessary beforehand for the procedure to take place. “It makes no difference to the results.”
For those of who haven’t been inducted, the pap test is a quick procedure usually conducted during a pelvic examination. Lying on the exam table with a sheet over your stomach and legs, with your feet in the holders at the end, the doctor will insert a plastic or metal speculum and brush the inside the cervix to obtain a sample of cells.
Setting Stigma Aside
While misconceptions exist in society that unfortunately leads to social stigma on getting a pap test, this screening tool has brought about a decrease in mortality and morbidity from cervical cancer for women worldwide.
An equivalent test does not exist for many other gynaecologic cancers, such as ovarian cancer, which is more insidious and may often be picked up only in advanced stages of the disease.
- Another reason to quit lighting up: Women who smoke have an increased risk of developing cervical cancer. Smoking cessation is especially important if abnormal cells have already been detected in the cervix. Exposure to second-hand tobacco smoke increases the risk as well.
- Sexual Habits: Having multiple sexual partners, a history of sexually transmitted infections (STI’s) and not using barrier contraception such as condoms during sex increases the risk of developing cervical cancer. Women on the oral contraceptive pill should still practice barrier contraception.
- Strength of the immune system: Women with a weakened immune system, such as those who have human immunodeficiency virus (HIV) or who are taking immunosuppressant drugs, are at higher risk of developing cervical cancer, and of having the disease progress more quickly from abnormal cell changes to invasive lesions.
Apart from undergoing regular pap tests, the following helps protect you from cervical cancer.
- Not having vaginal, oral or anal sex and skin-to-skin contact.
- Getting all three doses of the HPV vaccine before becoming sexually active.
- Consulting your doctor about getting tested for HPV.
- Using a condom reduces the risk of transmitting HPV from one person to another (with correct use), though it does not provide complete protection due to possible viral infection of genital areas not covered by the condom. Condom use is however linked to reduced cervical cancer rates.
- Having a mutually monogamous relationship with your sexual partner lowers the risk of sexually transmitted infections.
The HPV Test
The HPV test is specific for the types of virus that are linked to cervical cancer incidences. HPV infection is common in women below the age of 30, when most are able to develop an immune response to eventually clear it from the body.
- Women who are 21 years old or older would therefore only need it routinely as follow-up for an abnormal pap test result, or post-treatment check-up.
- However, if you are over 30 years of age, it may be recommended as part of your regular screening because of an increased risk of cervical cancer.