Pap Smear

The Papanicolaou test (also called Pap smear test) is a screening testconducted to detect and identify changes in the cells of the cervix which might indicate cervical cancer or other conditions that may develop into cancer. This test was invented by and named after the prominent Greek doctor GeorgiosPapanikolaou.Cervical cancer is one of the few cancers that can be largely prevented through regular screening (Pap tests). Doctors normally advise women to undertake Pap tests every two years. It is important to keep in mind that Pap smears do not indicate the presence of gynecological problems or sexually transmitted diseases. They only indicate the presence of abnormal cells for which further testing and analysis would be required.

Pap Smear and Pregnancy

A Pap smear is a routine part of your pre-natal check up and poses no risk to the foetus. In case youintend to get a Pap test done, consult your doctor to understand if you can undertake it while pregnant or wait until after the baby is born. If you have an abnormal Pap during pregnancy, your doctor will suggest treatments which can be done during pregnancy, or delay the treatment until after the baby is born. If an internal biopsy into the endocervical canal is recommended, there may be a slight risk of a pregnancy complication keeping your best interests and your health in mind.

However, if you choose to have a Pap test after the birth of the baby, it is best to wait for about 12 weeks as there is high possibility of obtaining unsatisfactory results due to inflammatory cells collected on the Pap test that are taken soon after delivery. Early stages of pregnancy are the best time to get it done. Pap tests can usually be performed during pregnancy up to at least 28 weeks gestation.

Types of Screening

There are 2 types of screening:

Conventional Pap: Here samples are directly smeared onto a microscope slide after collection.
Liquid based cytology: The sample is put in a bottle of preservative for transport to the laboratory, where it is then smeared on the slide.

Additionally, an HPV test may be performed either as indicated for abnormal Pap results, or in some cases dual testing is done, where both a Pap smear and HPV test are done.

Ideal candidates for Pap Smear

Doctors normally recommend Pap smear testing from the age of 21 and then every two or three years. These tests are then recommended every three years or every five years for women above 30 years of age and the Pap smear is usually combined with an HPV test. Your doctor may recommend Pap smears most frequently in case of certain risk factors such as:

HIV infection
Weakened immune system due to chemotherapy, organ transplant or chronic corticosteroid use
A diagnosis of conditions like cervical cancer or a Pap smear that shows the presence of precancerous cells
Exposure to chemicals such as diethylstilbestrol (DES) before birth

Pros and cons of Pap smears

Pros: The Pap test when combined with the regular screening program can reduce deaths due to cervical cancer by about 80%.
Cons: Sometimes Pap test fails to detect and prevent cancer in certain cases, for e.g. Pap test does not indicate anyabnormality even if abnormal cells are present. This can occur due to various reasons such as:
- Not getting screened regularly
- Inadequate collection of cells
- Sampling and interpretation errors
- A very small number of abnormal cells
- Inflammatory cells or blood obscuring the abnormal cells