Pap Smear
EDP column by Dr Ketan Dhatariya

“My doctor has asked me to have a smear test. He called it ‘pap smear’. What is that?”

The smear test is named ‘pap’ after the chap who first developed it, George Papanicolau, a Greek doctor who lived between 1883 and 1962.

A smear test is important because it is used as a screening test which allows doctors to predict those women who are likely to develop cancer of the neck of the womb (carcinoma of the cervix) in time to prevent it developing. In the UK, the test is targeted at those women most at risk of cancer of the cervix. That is, those who are or have been sexually active. In the UK, the NHS offers free smear tests to women between the ages of 25 and 65 at regular intervals - three yearly between 25 and 49, and five yearly between 50 and 64. In those women who have never been sexually active, the risk of cervical cancer is very low, but is known to occur, so a smear test is offered.

The smear test involves inserting a plastic or metal instrument (speculum) into the vagina, which holds the walls of the vagina open, so that they can see the neck of the womb (cervix). A wooden or plastic device (spatula) is used to take a few cells off the surface of the cervix. These cells are smeared on to a glass slide and sent to a laboratory to be examined.

9 out of 10 samples taken routinely are normal, with the remainder there are a variety of changes in the cells that are seen. It is important to emphasis that even thought the cells may be abnormal it does NOT mean that there is a cancer present. Minor changes are common and very frequently go away on their own. A follow up smear is often advised a few months later to ensure all is well.

If the repeat smear remains abnormal, then a more detailed examination is often requested called a coloposcopy. Here the cervix is examined with a special microscope and a special fluid used to show up any abnormal cells.

Because the development of cervical cancer is strongly associated with a viral infection, a new vaccine is in development that is being considered to try and prevent this disease. It is some way for being offered routinely, but hopefully will be available by the end of the decade.

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