PAP SMEAR The cervix is a cylinder-shaped neck of tissue that connects the vagina and uterus. What is a Pap smear or Pap test? A Pap smear, short term for Papanicolau smear is a screening test used to detect abnormal changes in the woman's cervix before the cancer sets in. Why is it important? Simply, early detection allows for early treatment and thus increases the chances of cure.   Prevention, early diagnosis and treatment has been shown to reduce mortality due to cervical cancer and cytological screening using the Pap smear test remains the most effective strategy for the detection of precancerous state and consequent control of cervical cancer. An internal medical examination done simultaneously during this process may also help detect other abnormal conditions or infections of the reproductive tract. Cervical Cancer Cervical cancer refers to an abnormal cell growth in the cervix.  These cells may become cancerous when exposed to certain organisms like the Human Papilloma Virus (HPV), smoking and sexually transmitted infections. Chronic inflammation in a immune-compromised individual can set the stage for pre-cancerous changes. What Are The Symptoms Of Cervical Cancer? In the early stages, there are usually no symptoms.  The only way to detect abnormal cell condition is by having a Pap smear. However, if you are having abnormal vaginal bleeding (intermittent bleeding or bleeding after sex or after menopause), abnormal or persistent vaginal discharge (bloody or offensive), or pelvic pain, you should see your doctor. How is Pap smear done? A plastic speculum is inserted into the vagina and then widening it so the doctor can examine the cervix and also to take the sample.  A small brush called a cervical brush is then inserted into the the cervix.  A sample of cells from the surface of the cervix (usually the discharge or the mucus) is then obtained by swabbing the brush on the surface of the cervix.  It is important that this process is done by properly trained and experienced personnel as accurate visualisation of the cervix is important and an appropriate sample must be taken for assessment. The sample would be then be smeared on the microscope slide for examination. The cells are examined to detect if cervical cancer is present. You may have some spotting of blood in the day following the test which is normal. What happens when the Pap smear is abnormal? Not all abnormal Pap smear findings mean the presence of cervical cancer; it could just be an infection.  Abnormal values based on test results are divided into 3 main areas:  benign (noncancerous), precancerous (showing some degree of abnormal cell changes), and malignant (possibly cancerous). When abnormal smear is detected your doctor may do the following: • Repeat the Pap smear • Prescribe medications • Do a Colposcopy • Do a Biopsy Who needs a Pap Smear test? All women aged 25 and above – particularly those who are sexually active will need a Pap smear test.  It should be done as a precautionary measure.  The recommended frequency ranges from annually to once every 3 years depending upon the clinical indications. You need not necessarily have any symptoms of cancer to have this test done. When should a test be done? A test is best done in the mid-cycle of the menstrual cycle, seven or 10 days after the start of menstruation. Since the most common form of cervical cancer starts with precancerous changes, there are 2 ways to stop this disease from developing. The first way is to prevent the precancers by avoiding possible risk factors. The second way is to have testing to detect HPV infection and precancers. Treatment of these disorders can stop cervical cancer before it is fully developed. Most invasive cervical cancers are found in women who have not had regular Pap smears. The Pap smear does not detect other forms of cancer such as those of the ovary, vagina, or uterus. Detection of these cancers may be discovered during the course of the gynecologic pelvic examination which is normally done at the same time as the Pap smear. A Pap smear is a primary screening test. While the ability to detect the cell abnormality is good, it is not perfect and some ‘false negative’ results may occur. It is not 100% accurate but it does give an idea of whether all is well within your body. Only 5% of Pap smear shows significant abnormality and only a fraction of these is due to pre-cancerous or cancerous change.