May 1 (Punjab Khabarnama) : In layman terms, cervix is the mouth of the uterus and various factors such as HPV (Human papilloma virus – causes 95% of cervical cancers), multiple sexual partners, cigarette smoking, immunodeficiency, etc. can lead to an increased incidence of cervical cancers. Cervical cancers are one of the most dangerous cancers and is currently one of the leading causes for cancer related deaths globally, with around 3.5 lakh deaths in 2022 and these cancers are seen more in low and middle socioeconomic countries like India.
In an interview with HT Lifestyle, Dr Sujit Ash, Consultant, Gynaecology and Obstetrics at PD Hinduja Hospital and MRC in Khar, shared, “Surprisingly, this cancer does have a precancerous (CIN) stage, which if detected, can help us reduce the progression of the disease at a very early stage and do prompt treatment. Hence the importance of a screening test.”
What is Pap smear and why is it done?
Dr Sujit Ash answered, “Pap smear test is done for cervical cancer screening. Unfortunately, there are not many symptoms for cervical cancer, and the existing symptoms can range from irregular vaginal bleeding to post sex bleeding or foul-smelling discharge. All these symptoms are non-specific and many a times, this cancer is detected towards the end stage which is difficult to treat. A basic Pap screening test done on a global basis to detect this cancer.”
Pre-requisites or contraindications?
Dr Sujit Ash revealed, “As per the common belief, this test is not painful at all. It can be a little uncomfortable but is easily done on an OPD basis, and it just takes a few minutes. The test can be done anytime during the cycle but is avoided during menses, active vaginal infection, and pregnancy. Ideally one is asked to refrain from vaginal sex at least a day or two prior the test. If there is any significant symptom, that has to be brought to the notice of the doctor.”
What are the types of Pap smear?
There are two types of Pap smear test. Dr Sujit Ash explained, “A basic Pap test that checks for the abnormal cervical cells. If normal, the reports of the test are valid for 3 years. There is another type of Pap smear test called the LBC (liquid-based cytology) that checks not only for the abnormal cervical cells but also for the HPV DNA. This is called the HPV Co-test, and is usually preferred after the age of 30 years. If normal, the reports of this test are valid for 5 years.”
When are you supposed to do it? How frequently are you supposed to do it?
As per the USPTF and the ACOG guidelines, the test is done for the ones who are or have ever been sexually active. Dr Sujit Ash revealed, “It starts from the age of 21 years and goes on till the age of 65 years (provided there are 2/3 normal smear reports till 65 years of age). If anyone has undergone a hysterectomy for non-cancerous reasons, then a screening test is not warranted. If a woman has never got a Pap smear test done, then she has to follow the guidelines irrespective of her age for the test to cease. Depending on the type of test, the reports are valid for either 3 or 5 years.”
Bringing his expertise to the same, Dr Tejal Kanwar, Gynaecologist and Consultant at Ujaas, said, “Current guidelines suggest Pap tests every three years for cervical cancer detection, rather than annually. However, regular OB-GYN visits are still essential for overall wellness. Co-testing for HPV and Pap may be recommended for women aged 30 to 65, offering more comprehensive screening. Women with specific risk factors may require more frequent testing, while those over 65 without abnormal Pap history might not need screening.”
The expert asserted, “Regular Pap tests are crucial for women’s health, and preparation is key for accurate results. Avoid douching, sexual intercourse, vaginal medication, and spermicidal products two days prior to the test, and schedule it away from heavy menstrual flow to prevent false negatives.”
What if the reports are abnormal?
Assuring that even if at times the reports are abnormal, one should not worry, Dr Sujit Ash said, “Some findings are usually temporary and they recover over time. Depending on the extent of abnormal reports, the doctor may either ask you to repeat the test again after a period, or do a small procedure called Colposcopy. Colposcopy is the examination of the cervix using a magnifying lens with application of two liquids to look for any abnormal areas. This can further be treated by excision using electrosurgical techniques.”
Dr Tejal Kanwar added, “An abnormal Pap test doesn’t equate to cervical cancer. Additional testing like colposcopy helps determine the severity of abnormal cells, enabling early intervention when necessary. Regular screenings aim to catch abnormalities early, ensuring timely treatment and preventing cancer development.”
Vaccine and Pap smear?
Dr Sujit Ash informed, “The HPV vaccines are a must, which can now be administered from 9 to 45 years, as per guidelines. The vaccine gives protection against the most dangerous strains of HPV, but one can be infected with the less virulent strains too. Hence a Pap smear test has to happen as described irrespective of the vaccination status. At this point, one needs to know that HPV infection is common and does not only affect people who have multiple sexual partners. Also, the good thing about HPV infection is that the body’s immunity tries to kill of HPV, so in around 90% of the cases, the virus is cleared of by the immune system.”
Other frequent queries?
Dr Sujit Ash highlighted –
- Pap smears are supposed to be repeated as per guidelines aforesaid. One normal report does not mean that no further test is ever needed.
- Even if you have a single sexual partner, Pap smear test is advised.
- Even after menopause, Pap smear tests are to be continued as recommended.
- Pap smear test is done for the screening of cervical cancers primarily. They are not meant to diagnose any other cancers or STIs (sexually transmitted infection) or ovarian cysts or fibroids.
- The thought is for you to understand the rationale behind this very important screening test. Pap smears are vital in preventing and detecting cervical cancer and thus reducing the mortality associated with it. Along with this, vaccination is, equally if not more, important and is definitely recommended for all girls from the age of 9 years. Finally, the stress on contraceptives, specifically barrier methods i.e. condoms, since they can help reduce HPV infection related cervical, vaginal, anal, oral and penile cancers.