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The Pap Smear |
How often should I have a Pap smear?
All women who have ever had sex need to have regular Pap smears, including those who no longer have sex. Women should have their first Pap smear around age 18 to 20 or a year or two after first having sex, whichever is the later. They should continue throughout their life until age 70. At 70, your doctor may advise that it is safe to stop having Pap smears if her previous ones have been normal. It is important that women who have had a hysterectomy talk to their doctor to find out if they need to have regular Pap smears.
The most common type of cervical cancer usually takes more than ten years to develop, so having a Pap smear every two years is quite sufficient.
Women who have any unusual symptoms, such as unexpected bleeding, bleeding or pain after sex or discharge should see their Doctor, even if their last Pap smear was normal to discuss the need for more frequent smears or other investigation.
The Pap Smear Register
Cervical cytology registries now operate in each State/Territory. All information is confidential and protected by law. Women automatically go on the register unless they specifically ask not to be included.
The registries can provide the laboratory with results of previous abnormal smears so that a more detailed evaluation can be done of the present smear if necessary and provide a reminder service if women have not had follow-up of an abnormal smear
Pap Smear Results
Many women feel anxious or worried when they have been told that their Pap smear result is not completely normal. An abnormal result however does not mean you have cancer.
About one in every ten Pap smear results will have a comment or indicate some kind of problem. These minor abnormalities while not dangerous but do require follow up so it is important to call 7 days after your Pap smear to check you result has come in and see if a follow up appointment is required. Our receptionists may also contact you to schedule an appointment so always check you contact details are updated at reception.
It is important to be aware that the details of results are not available to our reception staff only the Doctors advice. This is to ensure the confidentiality of your personal health information.
Common Pap Smear Abnormalities
Unsatisfactory Sample
An unsatisfactory sample may happen because the cells are obscured by blood or inflammation, there are insufficient cells to give an accurate assessment, the smear may not be adequately prepared or the slide may have been damaged in transport.
If any of these problems occur, you will be asked to have another Pap smear in 6-12 weeks. This allows time for the cells of the cervix to be renewed.
Inflammation
Quite often a Pap smear will show signs of inflammation. This means that the cells of the cervix are slightly irritated. Irritation may be due to an infection, even though you may not be aware of any symptoms. Sometimes the cause of the infection can be detected by the Pap smear. Your doctor will talk with you about further tests to identify the infection and what treatment is required.
Atypia
A smear reported as 'atypical' or showing 'minor atypia' simply means that there are very slight changes in the cells. For many women, the cells will return to normal over the next twelve months.
Human Papilloma Virus (HPV)
The presence of HPV or wart virus may be detected by the Pap smear.
HPV is common and you may not be aware of any symptoms. For some women HPV will disappear naturally.
There are many different types of HPV and a few have been linked with the development of cervical cancer. The Pap smear cannot identify which type of HPV is present, so all wart virus changes in the cervix need to be regularly checked.
Low and High Grade abnormalities - CIN 1, CIN 2, CIN 3
Your Pap smear result may refer to a 'low or high grade abnormality' or it may use the term 'dysplasia' or Cervical Intraepithelial Neoplasia (CIN) These terms all describe changes that may develop into cancer in the longer term.
Smears that show atypia or HPV are also regarded as low grade abnormalities
None of these abnormalities is invasive cancer but they do indicate that the cells of the cervix may be growing in an unhealthy way. The more severe the abnormality the less likely it is to go away and the more likely it is to get worse and eventually turn into invasive cancer.
For many women, especially those with low grade abnormalities, the problem will heal on its own with the cells of the cervix going back to normal. For the high grade abnormalities, if confirmed, treatment is necessary. It is impossible to predict whether the minor abnormality will return to normal or become more serious. Therefore tests are always needed to confirm the diagnosis. Depending on these test results you will be advised of the way in which your condition may be best managed.
Your Doctor will discuss with you the need for further observation or treatment. It is important that you discuss what your results mean and what treatment you should have.
What treatment may be required?
Treatment may simply mean that you will need to have more frequent Pap smears to observe the abnormality. If the changes persist you may need to have a colposcopy. Your doctor will then discuss what was found during the examination and discuss treatment options.
Colposcopy is the examination of the cervix and vagina with a magnifying instrument.
Do I need more Pap smears after an abnormal result?
The frequency of follow up smears should always be discussed directly with your Doctor but the list below is a useful guide.
Symptoms of unexpected bleeding, bleeding or pain after sex or discharge may be an indication for more frequent smears or other investigation.
Type of Abnormality and the recommended frequency of Pap Smear tests
- HPV test the Pap smear every 6 months until you have 2 normal results.
- CIN 1 After treatment, a Pap smear every 6 months for the first year then every 2 years.
- CIN 2/CIN 3 After treatment, a pap smear every 6 months for first year, then yearly for rest of life.
Do I still need to have Pap smears after a hysterectomy?
It is important that women who have had a hysterectomy talk to their doctor to find out if they need to have regular Pap smears.
A hysterectomy is the surgical removal of the uterus. This procedure is used to treat a variety of conditions including heavy or painful periods, fibroids and endometriosis. Regular Pap tests are still needed for some women following hysterectomy.
- If the hysterectomy was part of treatment for gynaecological cancer.
- If the woman has ever had a significant abnormality detected on a Pap test.
- If the woman has never had a Pap test in her life or has been screened inadequately.
Women who are unsure if they should keep having Pap tests should check with their doctor. If the doctor has no records of the operation an internal examination of a cell sample may be required.
For further information make an appointment with your Doctor.
Ref National Cervical Screening Program Commonwealth Department of Health and Ageing
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