PAP SMEAR…The Screening Test for Cancer Cervix

Cervical cancer is one of the commonest of all female genital tract carcinomas.

For improving survival rates it is very important to screen for cervical cancer and pick up the disease at early and preinvasive stage.

PAP SMEAR:-

PAP smear involves examination of cervical and vagina scrapes in asymptomatic women.

Papsmear or surface biopsy is a time tested screening method to diagnose cervical cancer, introduced by Papanicolou and Trout in 1943 .

Under the influence of vagina, pH and hormones cells on the cervix are transformed into different types of cells by the process called metaplasia. Three times in women’s life this metaplasia is particularly active-in embryonic development, at puberty and after pregnancy. These cells are very active and may be infected by HPV in the vagina. Certain HPV types may transform these cells into abnormal growing cells; in dysplasia (early changes of cancer seen on the smear).

A Pap Smear Test – Guidelines & Procedure:

• Do not apply any vaginal cream for one week before the test.
• To abstain from coitus for 24 hours before the test.
• Should not have active infection, bleeding or obvious growth.
• Should not be done after per vaginal examination.

Method:

• It is a OPD procedure, hence does not need any admission in the hospital
• The doctor will visualise the cervix with speculum (a device)
• Ayer’s spatula to be rotated firmly against the cervix to cover the entire cervix(transformation zone)
• The doctor immediately fixes the sample on glass slide

The test can be a bit uncomfortable for women, however it is best and most inexpensive way of detecting any abnormality.

However  in order to improve the quality of specimen collection and reduce the error of misinterpretation,LBC technique has been introduced. This is also called Liquid based thin layer cytology. The added advantage of the test is that the preparation can be submitted for HPV testing in case of abnormal cells.

Advantages of Liquid based thin layer Cytology:

• OPD procedure- does not require hospital admission
• Simplicity of the procedure
• Maintenance free equipment
• Very easy
• No pre procedure preparation is required
• No post procedure care is required
• Painless procedure
• No complications

Doctors need to explain the simplicity and convenience of this procedure to the patients in detail.

Counseling for reassurance that the procedure is painless, and to ensure that patient is relaxed and comfortable during the procedure.

Total time taken for the procedure is less than five minutes .Proper information about the procedure ,counselling and relaxed sterile setting can ease the patient and make her comfortable .

Since 80% of cervical cancers take place in developing countries, 18% of all cervical cancers occur in India , it can be concluded that screening and early detection is the key.