Pap Smear

What exactly is a pap smear? And why do I have to suffer through one each year?

I've had several patients who have told me that they dread their annual gynecological visit. "Oh, it's not you, you understand...it's the whole speculum exam thing!" I thought I should at least try to make a better case for the pap smear.

Cervical cancer has been a significant killer of young women, and continues to be world-wide. Unfortunately, most women with cervical cancer have no symptoms; the cases of cervical cancer that still occur are usually in women who have not had a pap smear for several years. Over the last 25 years, cervical cancer deaths in the U.S. have dropped, largely believed due to annual screening.

Nearly all cases of cervical cancer and dysplasia (pre-cancers) are caused by a virus--human papilloma virus, or HPV. Though this virus is sexually transmitted, we still have no good way of identifying carriers, and there is no vaccine or antiviral that can prevent transmission. 75 percent of women may be infected with HPV by age 30. For many women, the virus remains latent--no symptoms or abnormal pap smears. For others, the virus causes cervical cells to proliferate abnormally - and over months to years, dysplasia or outright cancer can develop. The best way to detect these abnormal cells (since women do not have recognizable symptoms) is to sample the cervical cells from time to time. We do this with a small spatula and brush during a speculum exam. "Pap" is short for Papanicolaou, the pathologist who developed the test and "smear" is how the cells are plated out on a slide for examination under the microscope.

So who should get screened and how frequently? All women, regardless of race or sexual preference, should get an initial pap smear by the age of 21. Frequency of follow-up paps may vary between 1 and 3 years. Abnormal pap smears usually require more frequent follow-up and sometimes cervical biopsies.

Cervical cancer can be prevented with annual pap smear screening, which is performed by most primary health care providers. It is a hassle, but a very worthwhile one.

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