Dear Doctor,

For so many times, I have come across articles urging women to go for pap smear tests, however I have been reluctant to go for one because from what I have heard the experience is a discomforting and painful one.  How relevant is this test anyway and could there be any other tests I could opt for instead? 

Emily

Pap smear tests are used worldwide for screening of cervical cancer (cancer of the lower end of uterus). Abnormal cells indicating cancer or a precancerous stage can be detected by taking a smear from the uterine cervix.

Cervical cancer is one of the common cancers that affect women more so in developing countries.  Sex from an early age, multiple sexual partners, multiple pregnancies, HIV infection, lowered immunity due to other causes, smoking, are some of the risk factors responsible for cervical cancer. HPV (human papilloma virus) is implicated in causing it as well.

Early detection of cervical cancer by a pap smear helps in early treatment and prevents its spread to other parts like pelvic organs, backbone among others.

Doctors generally recommend pap smear screening every 3 years for women between ages of 21 to 65 years. It may or may not be combined with test for HPV infection, however if combined with HPV test, it may be repeated every 5 years.

Pap smear tests take only few minutes to be done. To make the test effective, avoid using douches or spermicidal gels, two days prior to the test. These may obscure the results. Avoid getting it done during menses as menstrual blood can also give false results. 

A pap smear may not give accurate results always. This happens in cases where the number of inflammatory cells is very small to be detected or if they are obscured by blood and/ or inflammatory cells.  If one screening fails to reveal a precancerous stage or cancer, subsequent screenings may reveal it. 

Not all cases with abnormal cells may progress to cancer. Hence such women may undergo surgery which may not be necessary. Pap smear is often combined with pelvic examination, followed by colposcopy which is cumbersome and painful.

However a woman may opt for HPV test alone and not agree for a pap smear. It does not show the abnormal cells but indicates presence of human papilloma virus, which is causative for cervical cancer.

An alternate test is to put weak acetic acid solution over the cervix, which makes it easier to see abnormal cells after taking a biopsy. It is also best avoided during menses.

A gynaecologist can give the best advice regarding screening for a woman based on presence or absence of any symptoms, sexual history and history of any sexually transmitted disease or immune depressive conditions.

Dr Rachna   Pande is a specialist in internal medicine.