Pap Test: what is it and when to do it?

By Cristiano Antonino On Jan 5, 2023

The Pap test is a valuable ally for women’s health. It allows early detection of abnormal cells in the cervix that can progress to cancer

How is it performed and how often should it be done?

What is the Pap Test

The Pap test is a test that allows the observation under a microscope of the cells present in mucus taken from the cervix, smear (which is why it is sometimes improperly called a smear) on a slide and then stained to make the cells visible.

The method was developed more than 80 years ago by a Greek physician, George Papanicolaou, who emigrated to the United States. Hence, the name Pap-test.

Today, a new method is used as an alternative to traditional sampling.

The collected mucus is collected in a vial containing a preservative liquid, which, once centrifuged, is placed on a slide for staining and observation.

This technique, called liquid cytology, avoids the dispersion of cells and allows a better and more homogeneous view of the preparation.

Pap test, what is it used for?

The Pap test allows the detection of abnormalities of cells from the cervix, the anatomical site most frequently the site of tumours of the lower genital tract.

How the results of the Pap test are interpreted

The abnormalities detected may be inflammatory or neoplastic in nature.

In the first case, the test signals the presence of infections due to fungi (e.g. candida albicans), bacteria (e.g. Gardnerella vaginalis), viruses and protozoa (e.g. Herpes or Trichomonas).

In the second case, the test indicates cellular atypia, also known as dysplasia.

Cellular atypia can be divided into:

mild abnormalities, called low-grade squamous intraepithelial lesions (LSIL), which include cellular changes related to the human papillomavirus (HPV)
more severe abnormalities, called high-grade squamous intraepithelial lesions (HSIL).

Some cellular abnormalities that present to the cytologist’s observation cannot be given a definitive classification: these are the so-called ASCUS (atypical cells of undetermined significance) that require clinical evaluation by the gynaecologist.

Most intraepithelial changes are not cancerous, but are susceptible to become so with time.

For this reason they should be detected early, followed up and, if necessary, treated.

The milder ones heal spontaneously: they therefore only need to be monitored.

More severe forms are treated with a minimal, outpatient operation, consisting of the removal of only the part affected by the neoplasm.

Complications are rare and the ability to procreate is fully preserved.

How the Pap test is performed

The Pap test is a simple, quick and painless test. It is performed by a gynaecologist or midwife.

The speculum is inserted gently into the vagina in order to spread the walls and thus make the cervix visible.

With the wooden or plastic spatula, cells are taken from the outer surface of the cervix; then, with the cytobrush (a stick with a small end brush), a second sample is taken from inside the cervical canal.

It is advisable to take the test during the non-menstrual period and to avoid sexual intercourse and the application of creams, ovules and vaginal douches for the previous 2-3 days.

After the test, minor bleeding is possible due to contact of the spatula or cytobrush with the mucous membranes.

Pap test: when is it performed?

According to European guidelines for the prevention of cervical cancer, the Pap test should be performed every 3 years between the ages of 25 and 65.

Many European states run organised screening programmes: with a postal notice, women are invited to come to dedicated clinics with a pre-arranged appointment.

The programme also provides for regular check-ups and management of positive cases.

The Pap test can also be performed outside the screening programmes as a diagnostic tool in the case of abnormal bleeding or inflammatory states.

As a screening test, the traditional Pap test has recently been replaced by the HPV test.

The HPV test

The HPV test makes it possible to detect the presence of an HPV infection even in the absence of cellular changes.

It is in fact a very sensitive test, capable of signalling the risk of developing the disease and of selecting women who will have to undergo frequent check-ups.

This makes it possible to promptly detect the formation of cellular abnormalities that, immediately treated, prevent progression to carcinoma.

Is the Pap test still a valid test?

The Pap test is still performed in many parts of the world as a screening test.

It continues to be used in young women under 35, in whom the presence of HPV is very frequent but, fortunately, also very fleeting.

With the use of the HPV test in this age group there is a risk of finding and, therefore, controlling many infections that will disappear spontaneously, i.e. without progression to carcinoma.

Its role as a diagnostic test remains fundamental.

In cases where the HPV test is positive, the subsequent Pap test makes it possible to detect any cellular alterations, which are not detectable with the molecular HPV test.

Why it is important to undergo screening

As reported by AIRC, it has been shown that in 99% of cases, Papillomavirus infection is the cause of cervical cancer, and that about 80% of women contract the infection at least once in their lifetime (data updated to 2020).

It is true, yes, that in most cases the infection regresses spontaneously in a short time, without causing any particular problems and above all without giving rise to ‘precancerous’ lesions.

It must be remembered, however, that in other cases the infection leads to the development of cancer.

The cancer process is usually slow, which is precisely why it is essential for women to undergo regular check-ups so that any dangerous lesions can be diagnosed early.

Early diagnosis is the most effective weapon in preventing cervical cancer.

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