Pap Smears

The Papanicolaou (Pap) test is the best screening test we have in medicine. Countries that perform the test, like the USA, prevent over 90% of cervical cancers. Pap tests should not detect cervical cancer, because it is the cervical cancer we want prevent. Our goal is to detect pre-cancerous changes, and treat cases in their pre-cancerous state. Earlier findings require less costly and less painful treatment. 

The cervix is the part of the uterus that extends into the vagina. Through the canal in the cervix the shedding lining of the uterus flows during the menstrual period. The cervix has two main types of cells: squamous cells on the outer portion of the cervix, like those that line the vagina, and columnar cells which line the canal of the cervix. Most of the cervical pre-cancerous changes occur in the squamous cells at the squamo-columnar junction. Cells, shed normally in the female, are collected by the physician during the Pap smear, placed on a slide and sent to the pathologist. The cells that the pathologist views on the Pap test slide are these cells. It is important to note that a Pap test is not performed every time the physician conducts an internal exam. 

Cervical cells are read as normal, cancerous, or as a progression between these margins. It can take 1.5 years to 4.5 years to transform from a normal cell to a cancerous cell. That is the reasoning for a yearly Pap exam. Not all abnormal Pap tests are cancer, nor do all abnormal Pap tests need treatment. Treatment depends on the severity of the cell abnormality, and the physician-patient relationship. All abnormal Pap tests must be followed by a physician, and not ignored.

There are factors that can promote abnormal cells on the cervix. Early ages of sexual intercourse, increased numbers of sexual partners, and cigarette smoking each increase the risk of cervical cell abnormalities. Cervical cancer is a sexually transmitted disease associated with the human papilloma virus, HPV, the same type of virus that causes genital warts. Cervical cancer does not generally have a family pattern. The incidence of cervical cancer also increases after the age of 18. We recommend to every woman a yearly Pap test once she has had sexual intercourse, or once she is 18 years old. 

The Pap test is an easy test to perform. While some women experience discomfort or embarrassment from the exam, the exam lasts just a fraction of the time as the alternative, repetitive examinations and treatment for cervical cancer.