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The Pap test is a way to examine cells collected from the cervix. Its main purpose is to detect abnormal cells that may lead to cervical cancer. It can also identify infection and inflammation. Cape Town-based fertility specialist, Dr Sascha Edelstein, tells us more about this medical screening and what we need to know about cervical cancer.
How does a Pap smear work?
Cervical cancer is caused by the Human Papilloma Virus (HPV), which is sexually transmitted. Chronic infection with high-risk, cancer-inducing HPV types 16 and 18, can lead to cervical cancer. The progression to cervical cancer takes about eight to 10 years and usually follows an orderly course. The Pap smear screening is designed to pick up these cervical changes before they become cancerous. A Pap test by itself, however, cannot diagnose cancer. If cancer is suspected, a tissue biopsy is required to make the diagnosis.
How is the test actually done?
The Pap test uses a spatula and brush to take a sample of cervical cells, which are then placed on a glass slide and preserved with a fixative agent. This sample is then assessed by a cytologist under a microscope. The cytologist looks at the cells to identify abnormal cell types that could be indicative of cancer. The findings are reported as normal, low-grade changes, high-grade changes or early cancer.
Are there are any factors that increase the risk for cervical cancer?
There are several epidemiological studies that have shown an increase in the risk of cervical cancer among cigarette smokers. Nicotine and tobacco-specific carcinogens have been demonstrated in cervical mucus. These carcinogens are known to cause damage to cell DNA, which may be a co-factor in the development of cellular abnormalities that can progress to cancer. Smoking is also associated with a diminished ability to mount an effective local immune response to HPV infection. So, it's possible that smoking is a co-factor in HPV-induced cervical cancer.
How common is it for women who have tested positive for HPV to develop cervical cancer?
In South Africa, cervical cancer is the second most common cancer in women. Each year approximately 6 700 women develop cervical cancer – accounting for 16 percent of all cancer in women in South Africa. Breast cancer is the most common cancer in women in South Africa, accounting for 20 percent of all cancer in women.
HPV infection is widely prevalent, but most infections are temporary and are cleared by the body’s immune system. For every one million women infected with HPV, 100 000 will develop precancerous cervical changes, but only 1 600 will develop cervical cancer.
What is the recommended frequency for a Pap test?
Women aged 21-65 should have a Pap smear every three years. Annual testing is not recommended. Women aged 65 to 70 who have had at least three normal Pap smears and no abnormal tests in the last 10 years may decide (after talking to the doctor) to stop having smears. Women who have had a hysterectomy don't need to have a Pap smear unless the surgery was done as a treatment for pre-cancer or cancer.
Where can you get a Pap smear done?
- At your gynaecologist.
- At the GP’s office.
- At a clinic or hospital.
