The pap smear is a so-called test of screening used for the prevention of cervical cancer.
The uterus is an organ composed of a body and a neck, also called the uterine cervix, protruding from the bottom of the vagina and crossed by a canal, the cervical canal, which connects the cavity of the uterus with the vagina itself.
Both the mucosa and the epithelium lining the cervical canal and the external part of the uterus, respectively, can develop curable pretumor lesions which, if not identified, can turn into an invasive tumor in about 20 years. The natural history of the disease, characterized by a very slow evolution, and the availability of a test that allows to ascertain the presence of the tumor, offer the great advantage of being able to identify pre-tumor lesions when they are 100% curable. tests, in fact, as part of organized screening programs, made it possible to reduce mortality due to cervical cancer by 80% (read the Hoax). In Italy, screening programs were launched at the end of the 1990s.
Today, the exam is offered free to all women between the ages of 25 and 64 by sending a personal invitation letter, delivered to their home every 3 years. The adhesion is voluntary but it is important to consider that the execution of the pap smear can prevent the onset of the tumor and, sometimes, save life. Furthermore, ascertaining the tumor in the initial stages (early diagnosis) allows for less invasive and to ensure a better quality of life.Therefore, having to decide whether or not to carry out the pap test, it is essential to reflect on the countless benefits and, in case of doubts and perplexities, to talk to your doctor.
In Italy, the execution of the pap test has made it possible to significantly reduce the number of new cases of cancer and to bring mortality down to about 2 deaths per 100,000 women per year. In developing countries, where these screening programs do not exist , there are on average 25 deaths per year for every 100,000 women.These data show the extraordinary prevention opportunity that the pap test offers, which all women must be informed of in order to benefit from it.
The name PAP test it derives from that of Doctor Georges Papanicolaou, the Greek physician who invented it.
Simple to perform, the pap smear is inexpensive, painless, takes a few minutes and poses no risk to the woman. Like any test aimed at ascertaining the presence or absence of a disease, the Pap test can also determine false positives (abnormal results in healthy people) or false negatives (normal results in sick people). In the case of a false positive, subsequent in-depth examinations will correct the result while in the case of a false negative the long natural history of the disease, characterized by a very slow evolution, will allow it to be identified in subsequent checks, most of the time without serious consequences. For this reason, timely adherence to programs is important screening respecting the fixed intervals.
In the context of screening programs, the test is performed by the obstetrician or doctor through the application of the speculum, an instrument that allows you to slightly dilate the vagina and view the cervix.Then, with a spatula and a brush, some cells are gently collected from the cervix and the cervical canal, are placed on a slide and, subsequently, are analyzed under a microscope in laboratories that participate in screening programs and are subjected to constant quality control. .
The only contraindication for which it may be necessary to postpone the execution of the pap test is the presence of menstrual flow. To better study the collected cells, it is advisable to avoid undergoing the test even in the 3-5 days preceding, or following, the menstrual flow and / or when a "vaginal inflammation is suspected (intense burning and / or itching and / or discharge vaginal).
In the 3-5 days preceding the examination it is advisable to refrain from sexual intercourse and avoid the use of spermicidal products, douches, creams, gels, ovules or vaginal foams of any kind.
Pregnancy, the use of the pill or the IUD for contraceptive purposes do not represent a contraindication, however, it is always good to inform those who perform the examination of your condition. Occasionally, small bleeding may occur after the test, which stops spontaneously in 1 or 2 days and is not a cause for concern.
In the case of special situations, such as a previous detection (diagnosis) of cervical cancer or a Pap test that showed pretumor cells, or HIV infection, in agreement with your doctor it may be advisable to perform the pap test. with different frequency, regardless of the age of the woman.
Screening is also recommended for people who have undergone surgery to remove the uterus due to a tumor or a pretumor form. It is important to consult with your doctor to decide together what should be done in specific situations.
The pap smear should not be confused with the bacteriological vaginal smear which, while providing similar methods of execution, is intended to identify the nature of any vaginal inflammation caused, for example, by bacteria or fungi. Usually, they manifest themselves with burning and / or itching and / or discharge and can be cured with specific treatments.
Furthermore, the pap test should not be confused with the HPV test which also provides a sample, after the insertion of a speculum in the vagina, but has the purpose of identifying the presence of the human papillomavirus (HPV), the main cause of neck cancer. uterus. The material taken is not examined under a microscope but sent to a laboratory for research and typing of the virus. Cervical cancer screening programs are introducing the HPV test as a replacement for the Pap test, which continues to be used to further diagnose women who have tested positive for the HPV test.
The results of the pap test provide a classification into five classes: I and II describe a normal examination and, in this case, the woman is asked to repeat the test after three years. Class I is synonymous with optimal conditions of the cells examined, class II excludes the presence of pretumor lesions, or frankly tumors, but signals the presence of a possible local inflammation. Class III, IV or V describe cellular anomalies of increasing importance, from mild pretumor lesions, which regress in most cases spontaneously, to more important lesions reaching up to invasive cervical cancer.
A pap test classified as class III, IV or V requires in-depth examinations to be agreed with the doctor on a case-by-case basis. In general, we proceed with colposcopy which allows you to visually check the presence of a lesion of the cervix on which to perform a targeted sampling (biopsy).The collected tissue is analyzed under a microscope to confirm, or not, the suspicion and define the type of treatment to be performed.
The call for in-depth examinations, however, should not be alarming because most of the time the alterations that initially appear suspicious are excluded with subsequent investigations and most of the pre-invasive lesions regress spontaneously. The doctor will decide, case by case, whether to limit himself to a check over time, whether to remove the lesion on an outpatient basis under local anesthesia or whether to resort to more extensive surgery and / or other adjuvant therapies.
NHS. Cervical Screening (English)
Mayo Clinic. Pap smear (English)
National Cancer Institute (NCI). Pap and HPV Testing (English)
Italian Association for Cancer Research (AIRC). Cervical cancer screening
EpiCentro (ISS). HPV infections and cervicocarcinoma
EpiCentro (ISS). Survey on adherence to organized cervical cancer screening: preliminary results presented
Italian Cervicocarcinoma Screening Group (GISCi)
Ministry of Health. Cervical cancer screening
National screening observatory (Ons). Cervical screening