Pap Smear Test

Pap smear test is a cervical cancer screening tool that detects any abnormality in your cervical cells, allowing early detection of cancerous or precancerous growths. The mortality rate in United States due to cervical cancer has reduced significantly due to this smear test.

In pap smear test, the cervical cells are collected from the surface for detailed analysis. Former method involves the use of a slide on which smear is applied. Liquid cytology is the more advanced analytical method in which the sample is placed inside liquid containing vial. However, both methods are equally efficient and gives reliable results.

An Abnormal Pap Smear Result!

To determine any abnormalities, microscopic screening of cells is carried out by lab technicians. Some labs have computerized system to read the results. One thing to keep in mind is that an abnormal pap smear result does not necessarily mean that person has cervical cancer! There are numerous reasons for pap smear results not being normal:

• An infection in cervix
• Irritation or inflammation of cervical cells
• Changes in hormones
• Insufficient sample for proper interpretation

If not having adequate sample is the reason, doctor will ask to repeat the pap smear test. For other reasons either a second pap smear test is conducted or another test called colposcopy is suggested which provides more detailed screening.

Repeat Pap Smear Tests!

Screenings can be misinterpreted i.e. despite having cancerous or pre-cancerous growth, results are interpreted as normal. However, sometimes even if initial screening results are interpreted correctly and cervical cells appear to be normal, second time results may show presence of cancerous cells because cervical cancer expands slowly. Therefore, smart choice is to get screened time to time, at suggested intervals.

The Bethesda System Of Pap Smear Results

Bethesda system is the standardized way for categorizing the pap smear test results. Following are the categories in which the results can be placed:

• No change or normal
• Atypical squamous cells of undetermined significance (ASCUS)

Among abnormal pap smear results, ASCUS is the most common category. It means that abnormal cervical cells are detected but they are not cancerous. Usually it is due to HPV.

• Squamous intraepithelial lesion (SIL)

SIL indicates chances of early cancer. Based on severity they are further divided into low grade SILs (LSIL) and high grade SILs (HSIL). Usually HSILs are more likely to advance towards cancer.

• Atypical squamous cells, cannot exclude HSIL

The abnormal cells detected may or may not be high grades SILs.

• Atypical glandular cells

This category indicates cancer in upper cervix, as the abnormality is detected in glandular cells and not in squamous cells.

• Cancer

The pap smear results clearly indicate cervical cancer.

Different Terminologies

To discuss abnormalities, doctor might use certain terminologies such as:

• Dysplasia – possible precancerous alterations
• Cervical intraepithelial neoplasia (CIN) – this cellular change is categorized from 1-3 to indicate the intensity of cellular abnormalities. Where, 1 is low grade whereas 3 is high grade.

The HPV Pap Smear

As mentioned earlier, pap smear test can give abnormal results due to human papilloma virus (HPV). Most of the time, HPV diminishes on its own and later the pap smear results will appear normal. But, a high-risk HPV may lead to cervical cancer! Therefore, it is essential to carry out pap smear tests at determined intervals so that doctor may decide whether the abnormalities are precancerous or not.

Doctor may also conduct HPV and pap smear test simultaneously. This will help in determining the type of HPV and will help in interpreting results more accurately. Usually women aging above 30 are suggested to take HPV test.

What Pap Smear Do Not Disclose!

A pap smear test cannot screen for STDs or other reproductive cancers such as uterine, ovarian, and fallopian tube cancers.

Pap Test Recommendations

Women aging 21 and above are recommended to take pap smear test after every 2 years. After hitting 30, if three continuous pap smear results are normal, time interval can be raised to 3 years.

References

• Athinarayanan, S., & Srinath, M. V. (2016). Classification of cervical cancer cells in PAP smear screening test. ICTACT Journal on Image and Video Processing, 6(4).
• Coskun, S., Can, H., & Turan, S. (2013). Knowledge about cervical cancer risk factors and Pap smear testing behavior among female primary health care workers: a study from South Turkey. Asian Pacific Journal of Cancer Prevention, 14(11), 6389-6392.