What Is Pap Smear Test And How Is It Done

Pap smear test, also known as smear test is a medical investigation to check for cervical cancer. People assigned female at birth (AFAB) have a tunnel shaped organ situated in the lower part of the uterus. This is called the cervix and it connects the vagina with the uterus. Cervix is like a gate that can open and close, allowing fluids to pass as well as restricting foreign objects such as diaphragm or tampons from vagina to enter the uterus. 

Cervical cancer is the cancer of the cervix. It is mostly caused due to Human Papilloma Virus (HPV) which can be contracted through sex or genital contact.

It affects around 3000 people AFAB every year in the UK. 

As per World Health Organisation, cervical cancer is the fourth most common cancer in people AFAB.  

Cervical cancer affects people AFAB in the age group 30-45 years who are sexually active. If cervical cancer is diagnosed early, there are better chances of survival. 

Importance of pap smear testing

Cervical screening can help in early detection of cervical cancer. Changes in the cells of the cervix can be detected in early stages through cervical screening. It is not a treatment for cancer. The NHS sends out invitation letters to all people AFAB in the age group 25- 64 years to check for changes in the cervical cells. A small sample of cells is collected from the cervix area and sent for investigation. The cells are checked for the presence of HPV, which can be beneficial. Two strains of HPV are mostly the cause of cervical cancer - HPV 16 and HPV 18. If these are found in the cervix cells, then cells are checked for any changes. Diagnosing these changes prior to changing into cancerous cells can be a big step in prevention or treatment of cervical cancer. 

Several studies were conducted in countries of Northern and Western Europe to determine the positive effects of cervical cancer screening tests. Studies from Northern Europe showed 41-84% reduction in cervical cancer mortality rates among the women screened. Whereas, studies from Western Europe showed around 91% reduction in cervical cancer mortality rates among the women screened.¹

The NHS cervical screening programme was launched in 1988. A population based case control study was published in 2016 from the cervical screening data of England during the period of 1988-2013. Around 796 deaths occurred a year due to cervical cancer in England. This study concluded that if people AFAB attended cervical screening regularly, around 82.9% of cervical cancer deaths could be avoided. With the current screening data, around 69.7% of cervical cancer deaths are prevented.²

Procedure of pap smear test

Pap smear test is a painless procedure. You will be asked to lie down on the examination table with your knees bent. Your health care provider will use a speculum to gently open the vagina. A tiny brush or spatula is inserted to collect the cells from the cervix. This sample is sent to the laboratory for investigation. They will be checked for the presence of HPV. You will receive your results in a few weeks. If you have any questions, feel free to ask your healthcare provider.³

Results of pap smear test

The results of the pap smear test will come back in a few weeks. The different results and outcome of the test are as follows

1. HPV Negative: It's good news if the sample does not have HPV. It indicates that your risk of getting cervical cancer is very low and you will be tested next after 3-5 years depending on your age group.
2. HPV Positive: This might create some tension as HPV is found in your sample. There are two subtypes of HPV positive results.
   • Abnormal cell changes: If HPV is found and there are some abnormal cell changes in your cervix, you might be referred for another test called colposcopy. Colposcopy refers to a test where a microscope is placed in the vagina after opening it with a speculum. The cervix is examined in detail during this procedure and a biopsy sample is also collected during this examination.
   • No abnormal cell changes: If HPV is found but there are no abnormal cell changes in your cervix, then you might be invited for cervical screening after a year to check for any developments.

Pap smear recommendations

Pap smear is recommended to people AFAB or people with cervix during the age of 25-64 years. Invitation is sent out every 3 years to people in the age group 25-49 years of age. People in the age group 50-64 years receive an invitation every 5 years. 

The HPV vaccination programme was launched in 2008. But, vaccinated people AFAB should consider getting the test as the vaccine does not guarantee protection from all subtypes of HPV. 

Vaccination

The HPV vaccination programme was launched in 2008. This vaccine reduces the chances of contracting HPV which can lead to cervical cancer.

It is recommended to 

• Kids around 12 or 13 years old 
• Men who have sex with men 
• People with high risk of HPV

People under 25 years need a single dose of this vaccine. 

People in the age group 25-45 years require two doses 6 months- 2 years apart.

People with high risk are given three doses within a 12-month time.

Risks of pap smear test

Although pap smear is done to check for any cervical cell changes that can help in preventing cancer, they might carry some risks.

• You might experience slight spotting for few hours
• If abnormal cells are found, you might have to undergo treatment for changes that might have gone back on their own
• A very small chance of premature delivery in your future pregnancies

FAQ’s

Is pap smear painful?

No, it is not painful. It might feel minor discomfort for a few seconds. But, there might be spotting for some time after the exam.

What happens if you never get a pap smear test?

If you never get a pap smear test, there is a chance that you might miss being diagnosed at early stages of cervical cancer.

Can a virgin get a pap smear test?

Yes, a virgin can get a pap smear test. If you are scared or have any doubts, feel free to consult your healthcare provider. 

When do the test results come?

The results of the pap smear test come in a few weeks. You might receive a letter or you can call your GP. 

Summary

Pap smear test is conducted on all people AFAB in the age group 25-64 years old. For people in the age group 25-49, invitations are sent out every 3 years. Invitations are sent out every 5 years for people in the age group 50-64 years. Anyone with a cervix or vaccinated is still eligible for screening. 

During the procedure, you have to lie down with your knees bent. A speculum is inserted into the vagina to check the cervix. Then a tiny brush is inserted and few cervical cells are collected which are checked for the presence of HPV. If results are negative, then you get your next test invitation after 3-5 years. But, if the sample tests positive for HPV, then you might get invited for screening after a year or referred for a colposcopy.