What is a Pap Smear?

Pap smears are also referred to as pap tests. The pap smear is named after Georgios Papanikolaou who developed the test in 1928 after years of research. The test characterized by the removal of cells from the vagina, uterus, and cervix. Once removed, the cells are studied under a microscope and a pathologist can determine if the cells are abnormal or not. Cell can appear to be abnormal mainly due to infection which may lead to cancer. The most common cancer discovered by a pap smear is cervical cancer. Usually, early detection of a human papilloma virus is clear sign to look out for cervical cancer. When cervical cancer or a HPV infection is found in the early stages by a doctor, the health issues can be easily treated.

Since pap smears have become widely used, deaths caused by cervical cancer have dropped over 70%. Five year survival rates are over 90% among women who discovered cervical cancer before it had a chance to enter the surrounding tissues of the vagina. Women whose pap smear results discovered an HPV infection before it became cervical cancer had a five year survival rate near 100%. Eighty percent of new cervical cancer cases are among women who have never had a pap smear or have not had a test in at least five years. Ideally, women should begin having pap tests as soon as they become sexually active, or reach age 21. HPV is a sexually transmitted disease that is passed through skin to skin contact. Therefore, using a condom during sex does not guarantee safety from HPV. Women with multiple sexual partners are more at risk for HPV and cervical cancer. Women who are at a higher risk for cervical cancer should have pap tests regularly until they have at least three normal tests in a row.

The History of the Pap Smear

The pap smear was created by Georgios Papanikolaou. Papanikolaou was born in Greece and and studied hard to become an assistant surgeon in the Greek military. He moved to America where he would land positions in the Weill College of anatomy at Cornell University and a pathology position at New York hospital. Through his research, Papanikolaou discovered vaginal fluid examined under a microscope had the ability to reveal abnormal cells. These abnormal cells sometimes contained malignant cancer cells. By examining cells found in fluid from the vagina, uterus, and cervix, Papanikolaou could determine if a woman's cells were changing. Changes among cells can lead to invasive cancer cells.

Papanikolaou teamed with Herbert Traut, a gynecologist and pathologist, and wrote and published "Diagnosis of Uterine Cancer by Vaginal Smear" in 1943. The book outlined the procedural steps for performing a pap smear. It also explained how cells can change during menstrual cycles and how precancerous cells can be discovered with a microscope. Since Papanikolaou developed the pap smear, it has evolved into one of the most useful and effective forms of cancer screening and prevention. Papanikolaou died in 1962 just before the opening of the Papanikolaou Cancer Research Institute at Miami University. He was awarded the Albert Lasker Award for Clinical Medical Research in 1950.

The Importance of the Pap Test

Pap tests have proven to be extremely important since it was created by Georgios Papanikolaou in 1928. Pap tests are quick procedures that can save a woman's life. They can discover precancerous material that would have other wise not been found. Since pap tests were introduced, cervical cancer death have dropped over 70%. Women who have gone five years or longer without the test make up for 80% of the women who are diagnosed with cervical cancer. Pap tests can also detect HPV infections. When a HPV infection is detected before it becomes cancerous, the survival rate is near 100%. When cervical cancer is discovered in it's earliest stage during a pap test, the survival rate is over 90%. If a woman is sexually active and has many sexual partners, multiple pap tests should be scheduled to protect against the sexually transmitted disease HPV, which is a leading cause of cervical cancer.

Pap Smear Procedure

Pap smears should not take place while a woman is menstruating. The blood that is released during a woman's period has the ability to mask cells that could potentially become cancerous. Women should not use any vaginal medications, creams, or jellies within two days of the exam. Doctors, practitioner nurses and other medical assistants are qualified to give pap smears.

During the pap test, a speculum is inserted in the vagina which allows the cervix to be viewed more easily. The outside of the vagina will be examined along with the inside. Tissue samples are collected from inside the cervix using wither a Aylesbury spatula or an endocervical brush. The spatula is used to gently scrape tissue samples while the brush is twirled around, collecting tissue samples as it moves throughout the reproductive organs. When enough samples have been collected, they are placed in a glass slide to be viewed under a microscope by a pathologist. The pathologist will examine the cells after mixing the cells with a special dye. The dye allows the cells to be viewed under a light microscope. Once the cells have been properly examined, the pathologist can report back the the doctor with a diagnosis.

Pap Smear Abnormalities

Pap smear abnormalities are rare. Cases where abnormalities occur do not necessarily mean there is a serious condition. Some abnormalities are left alone because doctors believe the immune system will take care of the problem. Some women who are near the age of menopause will be given an estrogen cream that help control hormones and may help cure any problems occurring in the female reproductive system. The symptoms of abnormal pap smears are described according to the terms in the Bethesda model. The Bethesda model was created during a conference in Bethesda, Maryland in 1991.

There are five main types of pap smear abnormalities as described by the Bethesda system.

Atypical Squamous Cells (ASC)- Squamous cells are thin and flat. They form on the surface of the cervix. Atypical squamous cells are divided into two categories, atypical squamous cells of an undetermined significance and atypical squamous cells cannot exclude a high-grade squamous intraepithelial lesion. These two types are abbreviated ASC-US and ASC-H, respectively. ASC-US indicated to doctors that the cells are not normal. Doctors may not be sure what is wrong with the cells when ASC-US is discovered, but HPV infection is suspected. ASC-H results are also unclear to doctors. They do know that patients with ASC-H results are at a higher risk for precancerous cells.

Atypical Glandular Cells (AGC)- Atypical glandular cells produce mucous in endocervical canal and the lining of the uterus. Doctors are not certain what the cells mean to the vagina and cervix region but they are clearly abnormal.

Endocervical Adenocarcinoma in Situ (AIS)- These cells are precancerous and can be found in the glandular tissue.

Low-Grade Squamous Intraepithelial Lesion (LSIL)- This abnormality mean there are early changes in the size and shape of cells. The cells that form the layer of cells lining the surface of the cervix contain abnormal tissue. This condition is considered mild and is caused by an HPV infection.

High-Grade Squamous Intraepithelial Lesion (HSIL)- High-grade squamous intraepithelial lesions refer to signiicant changes in the appearance of cells. HSIL cells are severe abnormalities and look very different from healthy cells. They have a high likelihood of progressing into malignant cancer.