I'm about to say something shocking. Are you ready? I'm a big fan of pap smears. You may be thinking, "What? Why?" Because getting a pap smear may prevent cervical cancer and may save your life. The American Cancer Society estimates that approximately 14,480 new cases of cervical cancer will be diagnosed in 2021 and of those cases, 4,290 women will die of cervical cancer.
What Is A Pap Smear?
A pap smear is a test that checks for early changes in the epithelial cells in the cervix. Epithelial cells are all over the body, and the cervix is one of those places. The cervix contains squamous epithelial cells and columnar epithelial cells. The cells have similar functions but have different locations within the cervix. Their names come from how they look under a microscope. They may be remembered as squamous epithelial cells look "squashed" and columnar epithelial cells look like columns.
Pap smears usually occur at the time of the pelvic exam. Many times people will say they are getting a pap smear when they are actually getting a pelvic exam. They are not the same thing. A pelvic exam checks a patient's reproductive organs and looks for any obvious signs of abnormalities. A pap smear is a test that is specifically looking for changes in the epithelial cells. A pap smear is done by inserting an instrument called a speculum into the vagina. A speculum is a tool that holds the vagina apart so that the clinician can perform the exam better. A soft brush and a "spatula" are used to scrape the epithelial cells and place them on a slide. The cells are then sent to the lab where they are evaluated under a microscope.
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| Image by fernando zhiminaicela from Pixabay |
What Do The Results Mean?
A normal pap smear means exactly what it says. Everything is normal, and the next pap smear should be scheduled in three years. The American College of Obstetrics and Gynecology recommends that women 21-29 years old should have a pap smear every three years. Women over 29 can also have a pap smear every three years, but they can space it out to every 5 years.
An abnormal pap smear means that something did not look quite right under the microscope or that changes in the epithelial cells were found. If the results are abnormal, they may indicate that CIN1, CIN2, or CIN3 are present. This does not mean that cancer is present, unlike previously thought. It means that there are changes to epithelial cells in the cervix that may lead to cancer. These changes are usually caused by the Human Papilloma Virus (HPV). According to the Centers for Disease Control and Prevention, approximately 90% of cervical cancers are associated with HPV. People may be embarrassed to be treated or tested for HPV because it is considered a sexually transmitted disease (STD). However, in 2018, there were 43 million HPV infections, and it is estimated that almost all men and women in the United States get HPV at some point in their lives.
What Happens Next?
If CIN1, CIN2, or CIN3 is present, the patient may undergo a colposcopy. An instrument called a colposcope is used to examine the cervix. The clinician may take a biopsy of the abnormal cells and have them looked at again by the lab. This is done to verify the level of abnormality in epithelial cells. If the cells are truly abnormal (they may not always be), then other procedures may be warranted. Those procedures include cryocautery, cold knife conization, loop electrosurgical excision procedure (LEEP), and laser therapy. Treatment options should be discussed with a clinician. After the procedures to biopsy and remove the abnormal tissue, follow-up exams, including follow-up pap smears and possible continued treatment may be needed.
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