Pap Smears

Each year tens of thousands of young women should be thinking about whether they should start having their Pap smear done. So what is this smear test, how is it done and is it really necessary now that girls are having HPV vaccinations at school?

But first a few essential facts:

• A Pap smear is performed when a nurse or doctor samples cells from the cervix. This is the lowest part of the uterus and is accessible to sampling through the vagina.




• Cancer of the cervix has fallen from being the 8th to the 18th most common cancer in women since the introduction of the Pap smear registry program. These cancers often take several years to develop and so are very amenable to early diagnosis and management.




• The Human Papilloma Virus (HPV) is thought to be one of the main triggers of this form of cancer. There are over 100 different types of HPV infections, but only a few are thought to be the major instigators of this form of cancer. The Gardisil vaccine, recently introduced into the vaccination program for young women, targets these particular viruses.




• HPV is very prevalent in the community, but as infections with the virus are not a notifiable disease, we don’t have accurate statistics, however, according to information from the Mayo Clinic in the USA, over 25 million US citizens are infected with the virus.

Who should have a Pap smear?

Local, national and international experts differ on when and how often Pap smears should be performed. So here’s my guide to when and how often:

• Start within 12 months after the onset of sexual activity and have them annually until you have had two negative Paps - then you can have them every 2 years.




• If you change your sexual partner, go back to annual testing until you’ve had 2 negative annual tests again. The more partners the greater the risk of infection.




• If there has been no sexual activity, then start at age 21.




• In a monogamous relationship, Pap smears can be done safely every two years.




• There are no specific guidelines on when to stop, some suggest after the age of 70, some 65. My suggestion is to discuss this with your GP.

You can safely stop if you have had a total hysterectomy for a non cancerous condition, as the cervix will have been removed with the uterus.

What do the results mean?

A normal test means that there have been no abnormal cells detected and it is 95% certain that there is no cancer. A positive test doesn’t mean that you have got cancer, it means that you have some abnormal cells and it’s wise to have a closer look at your cervix and more tests.

In other words, here in WA, you should see a specialist in that area who will review your findings and suggest a colposcopy and biopsy. A colposcope is an instrument that allows the specialist to get close to the cervix and magnify it greatly for more detailed inspection. Any suspicious areas can then be biopsied for examination in the laboratory.

How can we reduce the risk of developing problems with the cervix?

• Being in a monogamous relationship.




• Reducing the number of sexual partners.




• Using a latex condom may reduce transmission of most, but not all, HPV infections.

Discussing being immunised against HPV infections before the infection finds you!