A Patient Guide, Prepared by Roger P. Smith, MD.

In the 1940s, Dr. George Papanicolaou developed a simple test, called the "Pap" smear, to detect early changes of cancer in cells shed from various parts of the body. One of the major benefits of the Pap smear is that far fewer women die today from cancer of the cervix (the opening to the womb at the end of the vagina). This has ben a major advance in saving women's lives: Prior to the widespread use of the Pap smear, cervical cancer had been a major killer of women in their later reproductive years (ages 40-55). Since cervical cancer develops slowly, women who have annual Pap smears can be assured that such a cancer can be caught in the early stages when it can be successfully treated. In fact, cervical cancer is almost 100% curable if detected early.

Obtaining the smear

The Pap smear is generally done as part of a woman's routine gynecologic examination. When you have your pelvic exam, you will be asked to rest on the edge of the examining table with your hips and knees flexed and your legs supported by heel or knee stirrups. This position may seem awkward, but it is necessary so that your physician can get a clear view of the genital area with sufficient room to perform the pelvic exam and the Pap smear. Your physican or the nurse may place a drap over your legs, but some women prefer to do without the drape so they can see what's taking place. Be sure to tel your doctor your preference. You may want to ask your doctor to "talk you through" the exam and explain the steps involved in the Pap smear. These are:

1. The doctor inserts a speculum, an instrument designed to hold open the wals of the vagina and provide a view of the cervix.
2. With a cotton-tipped applicator or a specially shaped wooden spatula, the doctor gently wipes away some cells from the cervix. This procedure is not painful, but you may feel the movement of the instrument. Occasionally, if the cervix is irritated (as may happen if you have a mild infection), there may be a small amount of pink-tinged discharge immediately after the examination.
3. The cells that have been removed from the surface of your cervix are spread on a microscope slide and prepared for examination at a laboratory. There, a specially trained technician or pathologist examines the slide for abnormalities that could indicate early cancer. Although cancer detection is the most important use of the Pap smear, it can also be used to lok for signs of infection and to measure estrogen levels in vaginal and other genital areas.

Reporting the results

The Pap smear results are usually categorized and reported as falling into one of five classes. The most common is Class I, which means that there are no abnormalities and cervical cancer is unlikely. In a Class II Pap smear, very mild abnormalities are present. These are usually caused by local inflamation, such as occurs with cervical or vaginal infections. Some patients with a Class II Pap smear may require follow-up studies or more frequent Pap smears.

Class III, IV, and V Pap smears are progressively more worrisome. In a Class III smear, cancer may be suspected, whereas a Class IV or V smear indicates that cancerous cells are present. Women with these results almost always require further tests to determine the source, extent, and severity of the abnormalities seen on the smear.

Fortunately, the vast majority of Pap smears fall into Class I. If your doctor tells you that you rPap smear shows some abnormalities, don't panic. Often, a repeat Pap smear and other tests may show no problems. But if further tests show evidence of definite abnormalities, early treatment is usually curative.

When to have the Pap smear

A woman should generally have her first Pap smear sometime between the ages of 18 and 20 (or whenever she begins to be sexually active), or earlier if she requires a pelvic examination for another problem. After this first examination, the Pap smear should be repeated annually throughout a woman's life.

Doctors often recommend more frequent Pap smears for women who have previously had abnormal smears and for those who are at higher risk for cervical problems. These risk factors include early sexual activity, multiple sexual partners, and infection with certain sexually transmitted diseases (herpes or genital warts).

Summing up

The Pap smear - a simple, painless, and inexpensive test - provides you and your physician with a powerful weapon in the fight against cancer. You therefore want to be sure to have this test done regularly. Remember: Doctors believe that deaths from cervical cancer can be virtually eliminated if every woman has an annual Pap smear.

 

Disclaimer: The articles and information, while with the best effort to be accurate and up-to-date, may not be. Also, every physician and medical professional holds their own views on certain diagnosis and advice. There truly are no textbook cases. It is always best to consult with your personal physician regarding medical/health related problems. The information is to be used as a general resource and not as a substitute for trained medical advice and/or treatment.