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Cervical cancer is one of the most prevalent gynecologic cancers in the world. Failure of women to have regular cancer screening makes the disease so prevalent. Regular cervical cancer screening helps detect the pre-cancerous changes –those seen before occurrence of the cancer- at early stages and take precautions before the disease progresses. Although abnormal (or positive) result of the test does not necessarily indicate a cancer, it is critical to have the results evaluated by a Gynecologist & Obstetrician who is experienced in this field. Assoc. Prof. Ömer Lütfi Tapısız, M.D., Head of the Gynecology and Obstetrics Department of Güven Hospital, informs about the Pap-Smear test used for cervical cancer screening, abnormal findings of the test and the conditions requiring colposcopic examination.
What is cervical smear test (Pap-Smear)?
Cervical smear test (Pap-Smear) is a screening test that is used commonly around the globe to detect precancerous lesions and/or cancer in cervix. The test procedure involves obtaining a smear specimen from cervix with a special scraper or brush and examining the cells under microscope. Pap-Smear test is generally reported normal (a negative result) or abnormal (a positive result) according to certain characteristics of those cells. In case of an abnormal smear, the patient should be examined by an experienced Gynecologist & Obstetrician.
How and when the smear test is performed (?). What are the considerations before the test procedure (?)
The smear test is a part of gynecologic examination and this pain-free procedure is performed easily during a routine gynecologic examination. The patient should avoid sexual intercourse for 48 hours before the procedure. In addition, vaginal shower and use of any drug/chemical substance for genital region should also be avoided in order not to interfere the results. It is not appropriate to obtain a smear specimen from a patient with vaginal bleeding. The most suitable time for the smear test is the end of the menstrual bleeding. It is rational to start cervical Pap smear test 3 years after the first sexual intercourse, irrespective of symptoms or in other words, whether the patient has any complaints or not. According to the national cancer screening standards, every woman in the age range of 30 to 60 years is screened with Human Papilloma Virus (HPV) and Pap smear tests in our country. However, it should be remembered that the algorithm is formed for screening and the women with a symptom and/or pathological finding should necessarily visit a Gynecologist & Obstetrician without waiting for the specified intervals.
Can pregnant women have smear test ? Does the test have any side effect ?
The smear test is not contraindicated for the pregnancy and it never causes miscarriage, if it is done properly. On the other hand, if results of the cervical smear screening are normal within the one-year period before the pregnancy, a smear test that is done solely for screening is unnecessary during pregnancy. The correct approach is to start the screening program minimum 12 weeks after the end of the pregnancy. However, patients followed up and treated for abnormal cervical smear results should be followed up by an experienced Gynecologist and Obstetrician throughout the pregnancy. A smear test has no side effect and it is a quite important test for preventing a serious health problem such as cervical cancer.
How is smear test evaluated? What are normal and abnormal smear results?
After the cervix is sampled, the samples are spread and smeared on a glass slide- and the cells on the slide are assessed by an experienced pathologist. If no precancerous and/or cancerous cell is identified in the examination, the test is reported negative. Most of the results are expected to be reported as normal (or negative) that implies absence of any precancerous/cancerous cells. If abnormal cells are detected in a smear test, the result is reported positive. Positive result does not mean that the patient has cancer. The abnormal smear results, most of which are secondary to HPV (Human Papilloma Virus), and their prevalence is as follows;
ASCUS (Atypical squamous cells of undetermined significance); this result is seen in 2 to 5 percent of all smear tests; approximately 50 percent of patients with this result has high-grade HPV positivity.
LGSILD (Low-grade squamous intraepithelial lesion); it accounts for approximately 2 percent of all smear tests; 75 percent of patients with this result has high-grade HPV positivity.
HGSIL (High-grade squamous intraepithelial lesion); this result is reported for approximately 0.5 percent of all smear tests; more than 90 percent of patients with this result has high-grade HPV positivity.
ASC-H (Atypical squamous cells indicating HGSIL); this result accounts for approximately 2-3 percent of all smear tests; approximately 70-85 percent of patients with this result has high-grade HPV positivity.
AGC (Atypical glandular cells [AGC-NOS or AGC-Favor Neoplasia]; this result is seen in approximately 0.2-0.5 percent of all smear tests, approximately 40 percent of patients with this result have high-grade HPV positivity.
Cervical cancer; this result is reported for approximately 0.5 percent of all smear tests.
What does abnormal (positive) cervical smear result mean?
Abnormal (or positive) cervical smear test result does not necessarily mean that the patient has cancer. Many patients experience anxiety and depressive mood due to this misconception. Majority of abnormal results is secondary to the changes caused by a HPV virus infection. Although the relation between cervical cancer and HPV is clearly known, many HPV infections spontaneously regress within 2 years without causing any problem. HPV infection, the resultant changes in cervical cells and the developmental course of the cervical cancer over years are demonstrated below.
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