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Pap Smear

Updated on March 24, 2012

The Pap Smear Test is a test for the diagnosis of cancer. It is most commonly used to detect cancer of the cervix and uterus, though it may be used to discover cancer of some other organs. The test, properly known as the Papanicolaou smear test, is named for the Greek-American physician George Nicholas Papanicolaou, who developed the technique. It is an important advance in medicine because it detects the earliest and most easily curable stage of cancer.

The Pap smear test is based on the fact that all types of cancer, even in their earliest stages, shed atypical cells. In the case of cancer of the cervix or uterus, these liberated atypical cells float singly or in groups into the secretions of the uterus, cervix, and vagina and mix with the normal cells present. The physician uses a special instrument to rub the surface of the cervix to obtain a sample of cells. Specialists stain the smear and study it microscopically to determine the nature of the cells present.

The smears are generally interpreted in five classes: class I, the absence of atypical cells; class II, the presence of some atypical cells but no evidence of cancer; class III, the presence of cells suspicious of cancer; class IV, the presence of cells strongly suggestive of cancer; and class V, the presence of cells that are definitely malignant.

Pap smears do not, however, provide a final diagnosis, and they are not 100% accurate. They are more reliable for detecting early cancer of the cervix than for cancer of the body of the uterus, largely because it is more difficult for the physician to obtain cells from the body of the uterus. If cancer is suspected, a biopsy is performed—that is, a small piece of uterine tissue is surgically removed and studied.

A Pap smear test should be made at least once a year on all women over 20 years of age, including pregnant women, and preferably twice a year on all women over 35. The procedure is easily carried out in a physician's office, and it is painless. A woman planning to have a Pap smear test should not douche the day before or the day of the test nor use a contraceptive jelly or other substance that may affect the cells or lining of the genital tract.


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      Elizabeth 7 years ago

      I disagree with some of this, the pap smear is a screening test for cervical cancer or pre-cancer (CIN) - it cannot help with any other sort of cancer.

      It is only a screening test and is unreliable, it helps less than 1% of women (around 0.65%) - it can't help more than 1% of women because it's a rare cancer, it simply doesn't occur more often than that...

      Never allow doctors to screen you if you've never been sexually active or if you're under 25 (some say 30) also if you're in a lifetime mutually monogamous relationship you're most unlikely to benefit. Don't let doctors over-screen you, it risks your general and reproductive health.

      There are risk factors for this cancer so you can assess your level of risk.

      Smears are an offer, not a law.

      Finland has the lowest rates of cc in the world and send the fewest women for colposcopy/biopsies - they offer testing 5 yearly from 30 - 5 to 7 tests in total and many women self-test.

      If you have smears before 30 and definitely 25 and have them more often than 5 yearly, you greatly increase the risk of a false positive and unnecessary and harmful over-treatment.

      I rejected pap smears 30 years ago, many of my friends and my younger sister have been harmed by unnecessary treatments.

      Make an informed decision before you agree to smears - also routine breast exams do not help, but lead to unnecessary biopsies and biopsies are regarded by some as a risk factor for breast cancer.

      See: Hands off my chest doctor.

      The last paragraph is bad advice...annual smears carry a very high risk of over-treatment for no additional benefit, Finland has proved that point. The test is painful for some women and may cause some bleeding. Pregnant women should NOT have pap smears, they are very likely to be abnormal as a result of hormonal changes, they should also be avoided for a year following delivery - once again hormonal changes and the trauma of childbirth will land you in day procedure unnecessarily along with the awful worry, fear and discomfort. Google UK cancer research - abnormal pap smears in pregnancy.

      Dr Joel Sherman's medical privacy blog has lots of references under the women's privacy issues section.