Cervical Smear Test (Pap smear)

Cervical smear test (Pap smear)

Why undergo a smear test?

A cervical smear test, also known as a Pap smear, aims to detect pre-cancerous alterations in the cervix (the neck of the womb). These changes, termed cervical intra-epithelial neoplasia (CIN), are prevalent across all age groups and typically manifest without symptoms. Hence, women may remain unaware of CIN without undergoing a smear test.

Are pre-cancerous changes (CIN) significant?

There's a likelihood that pre-cancerous changes may progress to cervical cancer. Conversely, some pre-cancerous changes may resolve spontaneously. However, it's impossible for doctors to predict which women's pre-cancerous changes will regress untreated and which may progress to cancer.

The duration for abnormal cells to evolve into cancer isn't definitive. Without preventive measures, cancer may develop in up to 50% of cases, albeit this progression may take several years.

How is a smear test conducted?

The smear test coincides with a pelvic examination. A sample of surface cells is collected from the cervix using a small spatula or brush. This specimen is then fixed, stained, and sent to a laboratory for microscopic examination. Technicians classify the smear as normal, borderline abnormal, or displaying varying degrees of abnormality.

What if the smear result is normal?

The woman is informed and advised to undergo another smear test in three years.

What if the result is borderline or mildly abnormal?

The woman is notified and recommended to repeat the smear test in 6 or 12 months.

What if the result indicates moderate or severe abnormalities?

The woman receives notification and is invited for further assessment and treatment at a colposcopy clinic.

What is a colposcopy?

A colposcopy involves the gynecologist examining the cervix's surface using a magnifying instrument called a colposcope. Although cell changes aren't directly visible, characteristic changes in the fine blood vessels beneath the cervix indicate cellular alterations.

The gynecologist evaluates these signs and, if cell changes are confirmed, determines their extent and severity. Biopsies are taken from the identified site of cellular changes.

How are cervical cell changes treated?

If tissue alterations are confirmed, the woman is usually advised to undergo tissue removal. Various methods, such as diathermy loop or laser therapy, may be employed, often under local anesthesia. Following the procedure, minor bleeding may occur, but the cervix typically heals swiftly. The removal of pre-cancerous tissue facilitates the growth of healthier tissue.

What follows treatment?

Depending on the severity of the removed pre-cancerous changes, the woman receives guidance on the frequency of follow-up smear tests. While this treatment is highly effective, pre-cancerous changes may recur, necessitating ongoing monitoring.

How frequently should smear tests be conducted?

Women shouldn't wait for gynecological symptoms to arise before seeking examination. In the UK, a screening program targets women aged 25 to 64, with screening intervals every three years for those aged 25 to 49 and every five years for those aged 50 to 64. Women are advised to ensure their registration on this program through their GP. More frequent examinations do not enhance cervical cancer prevention outcomes.