Manju is 49-years-old and she is in her perimenopause stage, the transition period from a woman’s reproductive life to her menopause. She has always taken care of her health. She watches what she eats, exercises regularly and goes for regular health check-ups. This time when she went to gynaecologist with problems like irregular bleeding between cycles and unusual vaginal discharge, the doctor advised for a Pap-smear test. Like most women today, she had no clue what the test was or what it was meant for. Luckily enough, she didn’t have to find out through a rude shock as her results were negative. However, the Pap smear test is increasingly becoming a necessity among women in their 30’s to 50’s with the alarming rise of cases of Cervical cancer.
What is Pap smear?
The Papanicolaou test (also called Pap smear or Pap test) is a screening test to detect cervical cancer in women. The disease is caused by infection with a virus called human papillomavirus (HPV) which is transmitted sexually, usually affecting women between the ages of 35 and 55 years old. A simple routine test, the pap test can detect the disease even before it develops.
Explaining the facts behind the disease which is one of most common cancers in Indian women, Dr Revathy Ramaswamy, gynaecologist and surgeon, says, “Earlier, in the Indian context, marriages used to happen at a very young age. Women used to get pregnant at relatively younger ages, as well as have multiple childbirths within shorter spans of time. What happens is that every time, a woman gives birth, her cervix is torn and then repaired. With the frequency being higher, it lead to the cervix being unstable as it wasn’t healing completely before the next childbirth. This is one of the reasons why cervical cancer is so common in Indian women. In recent times, having multiple sexual partners and intercourse without protection has added to the growing cases.”
Talking about how HPV spreads through the cervix, the consultant gynaecologist at Apollo Hospitals, explains, “During the adolescent period, the uterus goes through numerous changes like new cell formation, cell repair and various other changes in the cervix which is the lower, narrow end of your uterus. During this period, the uterus is in an unstabilised stage and usually lasts till the female is 20 years of age. At this point, if the HPV virus attacks, it starts inducing changes (mutations) in the cervix which could last from as few as two years to 20 years. This period is called the precancerous stage; not all mutations are cancerous. However, in case of a dangerous mutation, it takes ages to develop into cancer.” Hence, detecting of the disease takes time; this explains why women between the ages of 35 to 55 are most likely to show symptoms.
Taking the pap smear test at regular intervals increases the chances of cancer detection, thus increasing chances of a complete and healthy recovery. However, women seem to be acutely unaware of these facts, making this form of cancer a growing epidemic. Even the few who do know about the test, don’t seem to realise the importance of the test. “We have had patients who didn’t know a thing about the Pap test. But they suffered from excessive vaginal bleeding, back pain, abnormal white discharge and other symptoms related to cervical cancer,” the doctor adds.
Pap smear is a very general routine test like a blood test which a woman should get done post their first intercourse experience. “Pap smear is usually done for married women when they have their first sexual intercourse. However, due to changing lifestyles, one should go for pap smear regardless of the age. It is a screening test, not a diagnostic test and screening is done even if symptoms are not there. We don’t want to aggravate the situation, we want to catch the infection early,” says Dr Bhagya Laksmi.S, a consultant obstetrician and gynaecologist at Yashoda Hospital.
When should it be done
Ideally, the first pap smear test is recommended at the age of 21. Women should also go for a screening of the cervix after becoming sexually active as HPV is transmitted sexually. “In our Indian scenario, we advise women to get the test done once every year after the age of 35. For women between 20-35, once in three years is recommended. Given the rise in numbers, we are recommending the test every year for patients who are 30 year and above,” she informs.
According to Dr Lakshmi, though the recommended age is 30, she insists one should get it done after getting married. She adds, “Age criteria is not fixed for pap smear. It should be done as soon as one begins an active sexual life.”
How is it done
Pap smear is a simple, straight-forward painless test. “In this test, we take a brush and rub it against the surface of the cervix and cells come on to the brush. Then the smear is stained and tested for various stages of cancer -- normal, precancerous and cancerous,” informs Dr Revathy.
Results of the test decides the future course of action for patients. “If you get an abnormal report, there is no need to panic. Usually, women go for hysterectomy which is not the solution to the cervical cancer. If there is a slight inclination of abnormality in results, the second stage of screening, which is colposcopy, is done to confirm the cancer. In some cases, we also go for a HPV test (Human Papillomavirus test) depending on the results. Nevertheless, pap smear is the foremost requirement for a women to detect cancer,” she adds.
Tips before taking the test
About 48 hours prior to the test, it is advised that one avoids sexual intercourse, douching, using tampons and any type of vaginal spermicides. All of these can interfere with the accuracy of the test. Dr Revathy also advises against testing during your period. “Never go for a pap smear when you are bleeding. Also, when a pap smear is
to be done, internal examination is not advisable. Once we have already checked her up, conducting the smear again is not a good idea. The first priority should be the pap smear followed by the examination of the cervix.”
Symptoms of the cancer
In early stages (even in the precancerous stage), cervical cancer usually does not show any symptoms. “During the later stages of cancer, one or more of these symptoms may be noticeable. Abnormal vaginal bleeding between regular menstrual periods and after sexual intercourse, increased vaginal discharge and pain during and after sex, these are typical symptoms. However, the above symptoms can also be caused by infections or other health problems. Hence, it is very important to consult your gynaecologist,” advises Dr Laskmi.
Prevention
Prevention is always better than cure, opines Dr Bhagya Lakshmi who is in the favour of administering the vaccine to prevent cervical cancer. There are two HPV vaccines, Cervarix and Gardasil, which not only prevent the cancer but also prevent genital warts that are caused by HPV. Gardasil is a quadrivalent vaccine and protects against four dangerous strains of HPV- 6,11,16 and 18 whereas Cervarix targets HPV strains 16 and 18.
“Vaccines should be given to young girls, right after their first menarche. The earliest it is given, it will produce better antibodies against the virus,” says Dr Lakshmi. A woman can also take vaccine after her first sexual experience. “After conducting pap smear, we can also administer the vaccine irrespective of the results, be they normal or precancerous. For lactating women, vaccine can be given immediately after their first delivery,” she explains.
Importance
Women should go for Pap smear on a regular basis to avoid future complications. “We have included pap smear as a part of our routine health check-ups. With this regular screening, we pick can up the cancer at an early stage. And it is very important to get this test done as the precancerous stage of cervical cancer doesn’t show many symptoms except unusual vaginal discharge,” Dr Revathy informs.
Remember that while the pap smear is an effective screening tool for cervical cancer, it is only effective when done regularly. Be sure to ask your doctor how often you should have a Pap smear. The frequency of the test will vary from woman to woman, based on age, health, and previous pap smear findings.