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Pap Smear

Updated Screening Test

The Australian Government Department of Health has advised that from 1 December 2017, the standard Pap test will be replaced by more accurate Cervical Screening Test.  Currently Pap tests are recommended every two years when the results are normal.  Part of the good news about the Cervical Screening Test is that with normal results, repeat screening is recommended every five years!

Pap smears test for changed or abnormal cells in a sample taken from the cervix.  These changes can be pre-cancerous which is why Pap tests are so important.  With regular Pap tests, these changes are often caught very early and can be treated in a variety of ways (see below) to prevent them evolving into a cancerous state.  Pap tests should begin being done at 18 years of age and continue throughout life.

The Cervical Screening Test uses new and improved technology and lab testing to make the results more accurate.  A swab is taken in the same way as the current Pap test from the cervix, but instead of testing for abnormal cells, the Cervical Screening Test detects the human papillomavirus (more commonly known as HPV), which is the cause of abnormal cells.  As this means detecting changes even sooner than the current Pap test, it is more sensitive to change and more accurate, so the interval between tests can be significantly longer – five years instead of two.  Pap tests are not every woman’s favourite part of regular health checkups, so this is good news for all!   Also, instead of beginning at 18 years of age, it is recommended that the Cervical Screening Test from 25 to 69 years of age, with women aged 70 to 74 being invited to have a final “exit test”.

Abnormal Pap Smear

Pap smears are a screening tool used to detect abnormal cells in the cervix, which is the lower part of the uterus that opens into the vagina.  Abnormal cells can indicate changes that may lead to the development of serious medical conditions such as cervical cancer.  When caught early, these changes can be treated to prevent their development into cancer.  This is why regular screening is so important.

An abnormal Pap smear can also indicate the presence of infection or abnormal cells called dysplasia, which does not necessarily denote cancer.

Abnormal cellular changes sometimes resolve on their own, so your doctor will often ask you to have a repeat Pap test in 6 or 12 months to look at whether changes have resolved, remained the same, or developed further.  If the changes have not resolved after a period of time, or if they have developed, your doctor will most likely suggest that you undergo further investigation such as Colposcopy and/or treatment to remove the abnormal cells.

Causes of Abnormal Pap Smear

An abnormal Pap smear may indicate the presence of one or more of the following:

  • An infection or an inflammation
  • Herpes
  • Trichomoniasis
  • Dysplasia (abnormal cells that may be pre-cancerous)
  • HPV (Human Papilloma Virus) infection

HPV

HPV is an asymptomatic sexually transmitted virus, very common in sexually active men and women.  It is estimated that up to 80% of sexually active men and women will contract genital HPV at some point in their lives.  Whilst usually harmless and asymptomatic, HPV can lead to cervical cellular changes that can then lead to cancer.

Symptoms

Usually cervical cellular abnormalities and their root cause do not present symptomatically, which is why screening is so important.  However, in some cases there may be detectable symptoms, so if you experience any of the following it is worth visiting your GP or gynaecologist for investigation.

  • Abnormal discharge from the vagina, such as change in the amount, colour, odour or texture
  • Abnormal sensations such as pain, burning or itching in the pelvic or genital area during urination or sex
  • Sores, lumps, blisters, rashes or warts on or around the genitals

Treatment

Following an abnormal Pap smear, the next step is further testing to confirm the cause of the abnormal cells. A repeat Pap smear, Cervical Screening Test for HPV and colposcopy are all means for confirmation of abnormal cell changes.

Once changes are confirmed, treatment options are available and depend on the stage of change as well as the specific type of abnormal cells.  Some options include the following:

  • Cryosurgery: This involves freezing the abnormal cells which are then surgically removed.
  • Cone biopsy or LEEP procedure: In this procedure, a triangular segment of cervical tissue, including the abnormal cells, is removed by specially designed instrument.

Following all kinds of treatment, a repeat Pap smear will be performed to ensure that the abnormal cells were removed entirely and you will be monitored closely for a period of time to ensure that they do not return.  If there are still abnormal cells after treatment, or if the changes return, further treatment will be discussed with your doctor.

Abnormal Pap Smear during Pregnancy

A Pap smear during pregnancy is very safe.  In case of an abnormal Pap smear, a colposcopy can be performed during pregnancy.  However, further treatments are delayed until the birth of the baby.  Oftentimes the birth process washes away the abnormal cervical cells.

If Marcia is your obstetrician, she will perform a Pap smear for all patients regardless of former Pap test results at your post-natal appointment, approximately six weeks after the birth of your baby.

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