Widespread screening with Cervical Cytology (study of cells of the cervix) commonly known as PAP smear examination or PAP test along with HPV testing has dramatically reduced the incidence of mortality from cervical cancer in females over the past few decades.
Q. What is Cervical Cancer?
A. It is a malignant tumor of cervix which is the lowermost part of uterus in females.
Q. What are the risk factors?
A. Cigarette smoking, multiple sexual partners, early onset of sexual activity, history of sexually transmitted infections, increasing parity, prolonged use of oral contraceptive pills, immunocompromised and HIV infection.
Q. What is the causative agent?
A. Human papilloma virus.
There are 15 to 18 subtypes. HPV 16 and 18 account for approx. 70% of all cases.
Q. What are the symptoms?
A. Bleeding per vaginal (PV), white discharge, lower back pain, lower abdominal pain. Some may have no symptoms at all.
Q. What is the method recommended for screening?
A. PAP smear examination.
Q. What is a PAP smear?
A. A PAP smear is a screening procedure for a cervical cancer. It tests precancerous and cancerous cells in the cervix.
Q. How PAP test is performed?
A. It is performed by a Gynaecologist or a Pathologist. Patient should be supine in dorsal lithotomy position, the doctor then opens the vaginal canal with a speculum collecting cells at the transformation zone where the outer squamous cervical cells meet the inner glandular endocervical cells using an Ayre spatula or a cytobrush.
Q. Who examines a PAP smear?
A. The PAP smear slide is stained and prepared in a Pathology lab where it is examined by a Pathologist under a microscope to find any abnormal cells or infections. Then a final diagnosis is made using Bethesda system.
Q. At what age screening should begin?
A. 21 years regardless of sexual activity.
Q. What are the intervals of cervical cancer screening using Pap smear?
A. Different age groups have different time intervals-
- 21-29 years- every 3 years
- 30-65 years or more with negative results on 3 consecutive cervical cytology tests may be screened with cervical cytology and HPV co-testing every 5 years.
- > 65 years do not require screening after adequate negative prior screening results.
- Women with a history of cervical intraepithelial neoplasia (CIN) 2, CIN 3 or adenocarcinoma in situ should have routine age based screening for atleast 20 years.
- Women who had hysterectomy for benign indications with previous history of advanced cervical dysplastic changes do not require screening.
Q. Why screening is necessary?
A. Screening can identify the dysplastic or precancerous cells at an early stage hence further measures can be taken sooner for preventing progression of the disease.
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