Paulina, 25, came to her gynecologist for irregular bleeding. On further questioning she confided that there was some bleeding after intercourse too. The doctor examined her cervix, which is the neck of the uterus, and recommended a Pap Smear test. Paulina was worried and wanted to know the implications of test results.
Importance of Cervical Screening
Pap Smear Test
“What is a Pap Smear test?” asked Paulina.
Pap test is done for screening of cancer in the cervix. Cervical cancer is the second most common cancer among women in India and often has no symptoms in its early stages.
“If you do have symptoms, the most common is unusual vaginal bleeding, which can occur after sex, in between periods” said Dr Rinku Sengupta.
“Abnormal bleeding doesn’t mean that you definitely have cervical cancer, but it should be investigated.”
During cervical screening, a small sample of cells is taken from the cervix and checked under a microscope for abnormalities. This is called a Pap test.
Results of a Pap Smear Test
“An abnormal cervical screening test doesn’t mean you definitely have cancer. Most abnormal results are caused by an infection or the presence of treatable precancerous cells, rather than cancer itself” explained Dr Rinku.
Precancerous cells refers to changes in the cells which may make them more likely to develop into cancerous cells.
“What do I do if my Pap test is showing a precancerous change?” asked Paulina, scared.
“You don’t need to panic. Your doctor will look at your cervix under magnification with a microscope called a colposcope and will take a biopsy to confirm the diagnosis. Precancerous changes may revert to normal on their own or may require minor surgical treatment “ Dr Rinku calmed her down.
“But what do I do if my Pap test shows Cervical Cancer?”
“When detected early, most women with cervical cancer have a good outcome with surgical treatment. Some women with advanced disease may need radiation treatment or medical treatment with chemotherapy” Dr Rinku said.
HPV is a very common virus that can be passed on through any type of sexual contact with a man or a woman. Two strains of the HPV virus (HPV 16 and HPV 18) are known to be responsible for 70% of all cases of cervical cancer.
“These types of HPV infection don’t have any symptoms, so many women won’t realise they have the infection.”
However, it’s important to be aware that these infections are relatively common and most women who have them don’t develop cervical cancer.
HPV test can be combined with a Pap Smear test from ages 30 to 65 years. The HPV test has no significance below the age of 30, as infections are common and transitory.
Frequency of Cervical Screening
Paulina had more questions. “How often should I get a cervical screening done?”
Ideally, cervical cancer screening should start at the of age 21 years if they are sexually active.
“Women aged 21–65 years should have a Pap test every 3 years” said Dr Rinku.
Women should stop getting cervical cancer screening done after 65 years if they have had three negative Pap test results and the last report is within 5 years.
Prevention of Cervical Cancer
“How can I prevent my sister from getting cervical cancer?” Paulina asked, feeling hopeful.
“We recommend taking the HPV vaccine in adolescent age as they are highly effective in preventing HPV infections” Dr Rinku advised.
Paulina’s Test Results
As it turned out, Paulina’s test results were normal. She was immensely relieved and realized the importance of routine screening and follow up.