PAP SMEARS

Dr. Lata Sharma

MD,FRANZCOG.
Consultant OBS/GYN
PAP SMEAR TEST
What is a pap smear
Screening test for Asymptomatic
Women
To detect treatble pre-invasive
squamous Abnormalities of the
Cervix
Small number of women will develop
invasive Cancer
Not diagnostic-rather screeing test to
detect early changes on the cervix.
Target Group

All women aged 18-70 yrs who have

ever had sex
Women who still have a CX after
subtotal hysterectomy
35-70 age group have a higher risk of
developing Cx Cancer.
Women who had hysterctomy for CIN
etc-Vault smears
RISK FACTORS

First sexual Intercourse at an early

Age
A Number of sex patners or sex
partner who has had a number of sex
partners
Cigarette Smoking
History of HPV, PID or Wart Virus .
How is a Pap Smear Done

Photo
Taking pap smear

Speculum is introduced in to the

vagina this allows the Cx to be clearly
seen. Small sample of Cells are taken
by passing a brush over its surface.
These cells are smeared on tho the
slide and sprayed to dry.
Why is Pap Smear necessary

Early changes in the CX may be the

first warning signs that a problem is
occouring.
Early changes of the cx are treatable
90% cases can be prevented from
progressing to Cancer of the CX
Half of the new cases diagnosed
each year are women of age 50 or
more
How Often should I have a Pap

Regular pap smears every 2 Yrs is

very effective in detecting
abnormalities that may lead to
Cancer of CX
If you had Treatment on the Cx with
laser or Loop then you require pap
smears every 6mnth until you have 2
normal pap smears
Why screen every 2 years

Cx ca usually takes a decade to

develop in to cancer, so every 2 years
can help with an early detection
3 out of 4 women who develop cancer
early have either never had a pap
smear or have not been screened for
last 5 years.
continue

If you had a Hysterectomy for

prolapse or Bleeding problems then
you don’t need any further pap
smears provided the Cx is out.
If you hysterectomy for the pre-
invasive cell in the CX then you
require Vault smears every 2 yrs.
How effective is a PAP Smear.
The smear does not obtain abnormal cells
which may have been present on the CX
Some samples are difficult to interpret .(e.g
blood, mucosa,)
Occasionally abnormal cells are missed
under the microscope, statistic—15%-
luckly these are mild variety.
Depends on technique and type of brush?
Spatula used to collect the cells form the
Cx canal
Limitations

False negative results occurs when

pap smear fails to detect an
abnormality(13-70%)
Not completely sensitive
Unsatisfactory Smears are normally
due to cervical sampling and
speciman collectin issues.
RESULTS

Takes about one to 2 weeks to get

the report
Most results are normal and you wont
have to do anything except to
remember to have another one in 2
yrs
Copies are generally sent to your GP
if test done at other organisations.
Interpreting the Results

Unsatisfactory—have repeated in 6-
12 wks
Negative or negative with reactive
changes –Repeat in 2 yrs
Low Grade epithialial abnormality
seen- Needs further testing
Minor changes in squamous cell,
Cin1 not diagnosable – need
colposcopy
Cotniue

High Grade abnormality –CIN 2 , CIN

3 CIN 3 plus Invasive cells or
carcinoma in Situe
Adenocarcinoma in Situe
Invasive Ca,Squamous cell
carcinoma,
Adenocarcinoma
Contniue

Inconclusive– needs repeat pap

Possible High grade– repeat
Endocervical cells not identified–
controversial- means the cell from the
Transformation zone are not
obtained. BUT
If you had regular pap and they were
normal then you don’t need a repeat.
Further Investigation

Colposcopy-Visual examination of the

cervix and the upper part of the
vagina using a colposcope. The
Colposcope has a magnifier to see
the cervix, a vinegar solution is
applied to the cx and if any changes
noticible from pink to whit then a
biopsy is recommended.
HPV Testing

There are more than 85 types of virus

but only 30 are associated with Cx
dysplasia
Can be detected by DNA- very
expensive test
99% Cx Dysplasia can be detected.
Some research done with PCR urine
Treatment options

Normally treated in the office

,procedures such as freezing
Laser, LEEP
More severe once require surgerical
removal either part of CX _Cone or
complete removal of the cx with the
hysterctomy.
Pap Smears in Pregnancy
Contoversial- but if had abonormal
smears prior to pregnancy then
should have pap taken
No further than 15 ks gestation and
only with a spatula
Colposcopy and Bx indicated if
suspicious looking cx.
Remember pregnant cx are highly
vascularized and can bleed heavily
CIN

May either regress to normal or

proceed to invasive
Cx Ca 1/3 to ½ of the cases of CIN 1
and CIN 2 regress
Cin 3 also have beed seen to
regress.. Depends on the Immune
systen of the individual
Prevention

Recent trial of monvalent HPV

genotype 16 vaccine received great
interest,
if proven to be successful will prevent
warts and so 70% of dysplasia and
Ca CX reduce and occurence of
abnormal pap.
Common strain HPV-16
QLD Cx Screening Program
Is the state component of the joint
Commomwealth/state national screening
Aims to reduce the incidence of cx cancer
and associated morbidity and mortality
QLD HEALTH has employed specialists
health workers as part on comprehensive
approach
QLD CROSS-CULTURAL AWARENESS
TRAINING OPRTUNITIES
QLD Registry
Operates in each state and teritoy
Confidential and protected by law
Women need to ask to be registered
Its role is to provide with DATA
collection/quality control
Collects screening histories
Provide lab with results of previos
abnormal smears
Safety net for women and reminder for f/up
KEY Message to women
All women who have had sex and who still have a
cx –need to have a pap smear
You may cease having the pap after 70 yrs of age
if all other paps were normal
Pap smear can prevent about 90% of cx dysplasia
Each year about 1,000 new cases of CA Cx are
DX
Find a health professional who you comfortable
with for your yearly pap smears
Regrster yourself with the QLD registry
Key Message to the Health
professional
90% of cx dysplasia can be prevented
Annul screening is not cost effective
and not necessay
Its only a screenig test and has its
limitations
Pa smears prevent more than 1,000
cancer of CX
GPs take about 80% of the Pap
smears each year.
Psychological /Logistical barriers

Lack of knoweledge about pap smears

Issues such as work and family responsibilites
more important than own health
Forgetting
Low perception of risk developing cancers
Embarrasment ,fear and lack of social support and
uncomfortable
Difficuilt accessing GP or health professional
Cultural and language issues
cost
.
CONCLUSION
Have a pap smear every 2 years