PAP SMEARS

Dr. Lata Sharma MD,FRANZCOG. Consultant OBS/GYN

PAP SMEAR TEST
What is a pap smear Screening test for Asymptomatic Women To detect treatble pre-invasive squamous Abnormalities of the Cervix Small number of women will develop invasive Cancer Not diagnostic-rather screeing test to detect early changes on the cervix.

Target Group
All women aged 18-70 yrs who have ever had sex Women who still have a CX after subtotal hysterectomy 35-70 age group have a higher risk of developing Cx Cancer. Women who had hysterctomy for CIN etc-Vault smears

RISK FACTORS
First sexual Intercourse at an early Age A Number of sex patners or sex partner who has had a number of sex partners Cigarette Smoking History of HPV, PID or Wart Virus .

How is a Pap Smear Done
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Taking pap smear
Speculum is introduced in to the vagina this allows the Cx to be clearly seen. Small sample of Cells are taken by passing a brush over its surface. These cells are smeared on tho the slide and sprayed to dry.

Why is Pap Smear necessary
Early changes in the CX may be the first warning signs that a problem is occouring. Early changes of the cx are treatable 90% cases can be prevented from progressing to Cancer of the CX Half of the new cases diagnosed each year are women of age 50 or more

How Often should I have a Pap
Regular pap smears every 2 Yrs is very effective in detecting abnormalities that may lead to Cancer of CX If you had Treatment on the Cx with laser or Loop then you require pap smears every 6mnth until you have 2 normal pap smears

Why screen every 2 years
Cx ca usually takes a decade to develop in to cancer, so every 2 years can help with an early detection 3 out of 4 women who develop cancer early have either never had a pap smear or have not been screened for last 5 years.

continue
If you had a Hysterectomy for prolapse or Bleeding problems then you don’t need any further pap smears provided the Cx is out. If you hysterectomy for the preinvasive cell in the CX then you require Vault smears every 2 yrs.

How effective is a PAP Smear.
The smear does not obtain abnormal cells which may have been present on the CX Some samples are difficult to interpret .(e.g blood, mucosa,) Occasionally abnormal cells are missed under the microscope, statistic—15%luckly these are mild variety. Depends on technique and type of brush? Spatula used to collect the cells form the Cx canal

Limitations
False negative results occurs when pap smear fails to detect an abnormality(13-70%) Not completely sensitive Unsatisfactory Smears are normally due to cervical sampling and speciman collectin issues.

RESULTS
Takes about one to 2 weeks to get the report Most results are normal and you wont have to do anything except to remember to have another one in 2 yrs Copies are generally sent to your GP if test done at other organisations.

Interpreting the Results
Unsatisfactory—have repeated in 612 wks Negative or negative with reactive changes –Repeat in 2 yrs Low Grade epithialial abnormality seen- Needs further testing Minor changes in squamous cell, Cin1 not diagnosable – need colposcopy

Cotniue
High Grade abnormality –CIN 2 , CIN 3 CIN 3 plus Invasive cells or carcinoma in Situe Adenocarcinoma in Situe Invasive Ca,Squamous cell carcinoma, Adenocarcinoma

Contniue
Inconclusive– needs repeat pap Possible High grade– repeat Endocervical cells not identified– controversial- means the cell from the Transformation zone are not obtained. BUT If you had regular pap and they were normal then you don’t need a repeat.

Further Investigation
Colposcopy-Visual examination of the cervix and the upper part of the vagina using a colposcope. The Colposcope has a magnifier to see the cervix, a vinegar solution is applied to the cx and if any changes noticible from pink to whit then a biopsy is recommended.

HPV Testing
There are more than 85 types of virus but only 30 are associated with Cx dysplasia Can be detected by DNA- very expensive test 99% Cx Dysplasia can be detected. Some research done with PCR urine

Treatment options
Normally treated in the office ,procedures such as freezing Laser, LEEP More severe once require surgerical removal either part of CX _Cone or complete removal of the cx with the hysterctomy.

Pap Smears in Pregnancy
Contoversial- but if had abonormal smears prior to pregnancy then should have pap taken No further than 15 ks gestation and only with a spatula Colposcopy and Bx indicated if suspicious looking cx. Remember pregnant cx are highly vascularized and can bleed heavily

CIN
May either regress to normal or proceed to invasive Cx Ca 1/3 to ½ of the cases of CIN 1 and CIN 2 regress Cin 3 also have beed seen to regress.. Depends on the Immune systen of the individual

Prevention
Recent trial of monvalent HPV genotype 16 vaccine received great interest, if proven to be successful will prevent warts and so 70% of dysplasia and Ca CX reduce and occurence of abnormal pap. Common strain HPV-16

QLD Cx Screening Program
Is the state component of the joint Commomwealth/state national screening Aims to reduce the incidence of cx cancer and associated morbidity and mortality QLD HEALTH has employed specialists health workers as part on comprehensive approach QLD CROSS-CULTURAL AWARENESS TRAINING OPRTUNITIES

QLD Registry
Operates in each state and teritoy Confidential and protected by law Women need to ask to be registered Its role is to provide with DATA collection/quality control Collects screening histories Provide lab with results of previos abnormal smears Safety net for women and reminder for f/up

KEY Message to women
All women who have had sex and who still have a cx –need to have a pap smear You may cease having the pap after 70 yrs of age if all other paps were normal Pap smear can prevent about 90% of cx dysplasia Each year about 1,000 new cases of CA Cx are DX Find a health professional who you comfortable with for your yearly pap smears Regrster yourself with the QLD registry

Key Message to the Health professional
90% of cx dysplasia can be prevented Annul screening is not cost effective and not necessay Its only a screenig test and has its limitations Pa smears prevent more than 1,000 cancer of CX GPs take about 80% of the Pap smears each year.

Psychological /Logistical barriers
Lack of knoweledge about pap smears Issues such as work and family responsibilites more important than own health Forgetting Low perception of risk developing cancers Embarrasment ,fear and lack of social support and uncomfortable Difficuilt accessing GP or health professional Cultural and language issues cost

. CONCLUSION
Have a pap smear every 2 years

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