The test used to determine cervical cancer is called a Pap test, named for Dr. George Papanicolaou. The Pap test detects changes in the cervix that could be a sign of cancer or precancer. It is a screening test because it detects possible signs of disease in women who do not have symptoms such as bleeding, pelvic pain, or discharge.
The Pap test has been successful in decreasing deaths from cervical cancer. Before a woman gets cervical cancer, she may go through several stages of precancer. This usually happens overa number of years. Because the precancerous cells are right on the surface of the cervix, the Pap test can pick up precancer before cancer grows. If abnormal cells are found, they can often treated with simple procedures in our office.
When Should I Have the Pap Test?
A Pap test should be done on a regular basis as a part of your overall health care. You should have your first Pap test when you become sexually active, or by the age of twenty-one. If your tests show abnormal results or if you have had cancer, you may be advised to have a pap test more often. Once begun, you should make the Pap test a habit for the rest of your life. Think of this annual exam as an important way of taking care of yourself!
Do I Need to Do Anything to Prepare for the Pap Test?
The Pap test is performed during a pelvic exam. If you are planning to have a Pap test, do not douche or use vaginal medication for 2-3 days beforehand. This may wash away or hide any changed cells. In addition, the Pap test is more accurate when you are not having your period.
How is the Pap Test Done?
During your pelvic exam, a speculum will be inserted into your vagina. This instrument gently opens the vagina so that the cervix can be seen. A small brush or swab and scraper are used to remove cells from the cervix. This is not painful. These cells, taken from inside the opening of the cervix and from the outer part of the cervix, are smeared onto a glass slide and sent to a laboratory for staining and microscopic examination. The staining highlights the abnormal cells.
What are the Results of the Pap Test?
The results are classified based on how the cells look by a system developed by the National Cancer Institute. It is called the Bethesda System and is named for the town in Maryland where NCI is located. The following diagnosis terms are used in classifying Pap test results:
- Normal: This means that only normal cells are seen.
- ASCUS, or Atypical Squamous Cells of Undetermined Significance: this result means that the cells may not be normal. It may be hard to determine exactly what is wrong with the cells, so further testing (such as a re-pap) may be needed.
- SIL, or Squamous Intraepithelial Lesion: this result means the cells that were tested show distinct changes, also called dysplasia or cervical intraepithelial neoplasia (CIN)
- Cancer: this result means that the cells have progressed beyond dysplasia (CIN) and have become invasive.
Is the Pap Test Accurate?
The pap test finds dysplasia and cancer of the cervix. It is not 100% accurate and, like any lab test, false results are possible. False-negative results are reports of normal test results when there are abnormal changes. This can occur in 10-20% of all Pap tests and can occur for many reasons, to include the following:
- Not enough cells
- Too many cells
- Cells not taken from both the inside and the outside of the cervix
- An infection "covers up" abnormal cells
- Douching or vaginal medication medicines have "washed away" abnormal cells
Diagnosis and Treatment
If your Pap test report fell within an abnormal range, we may recommend an office procedure called a colposcopy. This test is done by looking at your cervix using a special microscope, called a colposcope, to look at your cervix. A colposcope magnifies and focuses an intense light on the cervix, allowing it to be viewed in greater detail. The changes in your cervix that caused the abnormal Pap test results can be viewed. Depending on the colposcopic findings, one or more of the following diagnostic treatment procedures may be used:
- Biopsy - During the biopsy, sample tissue is taken from beneath the cervical surface. If an obvious abnormality is seen with the colposcope, a portion of tissue is removed for microscopic examination. Often, several areas are biopsied during the procedure. In some cases, no further treatment is necessary after the biopsy is performed.
- Cone Biopsy - This type of biopsy is used if a larger sample is needed. A cone-shaped wedge of tissue is removed from the cervix. All possibly abnormal cells are removed. As the cervix heals, new tissue that grows in is usually healthy. Cone biopsy can treat an abnormality as well as determine what is wrong.
- Endocervical Curettage - A sample is removed from the inside part of the cervix with a small instrument shaped like a spoon. This technique is necessary whenever the physician cannot see the transformation zone with the colposcope.
- Cryosurgery - If the endocervical curettage shows that the cervical canal is free of dysplastic cells, cryosurgery may be performed. The colposcope is used to magnify the surface of the cervix. A low temperature probe is applied briefly, freezing and destroying the involved cells. The cells that grow in during healing are usually normal and healthy.
The Thin Prep Test
The ThinPrep® Pap Test™, considered to be the first improvement to the Pap test in over 50 years, is another option for you to consider when having your annual pelvic exam. This new Pap test has been approved by the FDA as a significantly more effective replacement for the traditional Pap smear.
The traditional method for Pap testing involves smearing a portion of a woman’s cervical cell sample onto a glass slide for review by a medical professional at a lab. Only a small portion of the collected cells are actually “smeared” onto the slide. The rest of the cells —up to 80%—are thrown out with the collection device. The ThinPrep® Pap Test™ involves a different process where virtually all of the woman’s cervical cell sample is rinsed into a vial, which is then sent to a lab for slide preparation and review. All cells that are collected are reviewed, which drastically lowers the possibility of abnormal cells being tossed away before the lab has a chance to review them.
For more information on the ThinPrep® Pap Test™, visit their website.