PAP SMEARS

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PAP SMEARS

• Dr. Lata Sharma MD,FRANZCOG.
• Consultant OBS/GYN

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PAP SMEAR TEST

• What is a pap smear
• Screening test for Asymptomatic Women
• To detect treatble pre-invasive squamous
  Abnormalities of the Cervix
• Small number of women will develop invasive
  Cancer
• Not diagnostic-rather screeing test to detect
  early changes on the cervix.

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Target Group

• All women aged 18-70 yrs who have ever had sex
• Women who still have a CX after subtotal
  hysterectomy
• 35-70 age group have a higher risk of developing
  Cx Cancer.
• Women who had hysterctomy for CIN etc-Vault
  smears

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RISK FACTORS

• First sexual Intercourse at an early Age
• A Number of sex patners or sex partner who has
  had a number of sex partners
• Cigarette Smoking
• History of HPV, PID or Wart Virus .

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How is a Pap Smear Done

• Photo

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Taking pap smear

• Speculum is introduced in to the vagina this
  allows the Cx to be clearly seen. Small sample of
  Cells are taken by passing a brush over its
  surface.
• These cells are smeared on tho the slide and
  sprayed to dry.

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Why is Pap Smear necessary

• Early changes in the CX may be the first warning
  signs that a problem is occouring.
• Early changes of the cx are treatable
• 90 cases can be prevented from progressing to
  Cancer of the CX
• Half of the new cases diagnosed each year are
  women of age 50 or more

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How Often should I have a Pap

• Regular pap smears every 2 Yrs is very effective
  in detecting abnormalities that may lead to
  Cancer of CX
• If you had Treatment on the Cx with laser or Loop
  then you require pap smears every 6mnth until you
  have 2 normal pap smears

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Why screen every 2 years

• Cx ca usually takes a decade to develop in to
  cancer, so every 2 years can help with an early
  detection
• 3 out of 4 women who develop cancer early have
  either never had a pap smear or have not been
  screened for last 5 years.

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continue

• If you had a Hysterectomy for prolapse or
  Bleeding problems then you dont need any further
  pap smears provided the Cx is out.
• If you hysterectomy for the pre-invasive cell in
  the CX then you require Vault smears every 2 yrs.

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How effective is a PAP Smear.

• The smear does not obtain abnormal cells which
  may have been present on the CX
• Some samples are difficult to interpret .(e.g
  blood, mucosa,)
• Occasionally abnormal cells are missed under the
  microscope, statistic15-luckly these are mild
  variety.
• Depends on technique and type of brush? Spatula
  used to collect the cells form the Cx canal

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Limitations

• False negative results occurs when pap smear
  fails to detect an abnormality(13-70)
• Not completely sensitive
• Unsatisfactory Smears are normally due to
  cervical sampling and speciman collectin issues.

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RESULTS

• Takes about one to 2 weeks to get the report
• Most results are normal and you wont have to do
  anything except to remember to have another one
  in 2 yrs
• Copies are generally sent to your GP if test done
  at other organisations.

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Interpreting the Results

• Unsatisfactoryhave repeated in 6-12 wks
• Negative or negative with reactive changes
  Repeat in 2 yrs
• Low Grade epithialial abnormality seen- Needs
  further testing
• Minor changes in squamous cell, Cin1 not
  diagnosable need colposcopy

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Cotniue

• High Grade abnormality CIN 2 , CIN 3 CIN 3 plus
  Invasive cells or carcinoma in Situe
• Adenocarcinoma in Situe
• Invasive Ca,Squamous cell carcinoma,
• Adenocarcinoma

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Contniue

• Inconclusive needs repeat pap
• Possible High grade repeat
• Endocervical cells not identified controversial-
  means the cell from the Transformation zone are
  not obtained. BUT
• If you had regular pap and they were normal then
  you dont need a repeat.

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Further Investigation

• Colposcopy-Visual examination of the cervix and
  the upper part of the vagina using a colposcope.
  The Colposcope has a magnifier to see the cervix,
  a vinegar solution is applied to the cx and if
  any changes noticible from pink to whit then a
  biopsy is recommended.

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HPV Testing

• There are more than 85 types of virus but only 30
  are associated with Cx dysplasia
• Can be detected by DNA- very expensive test
• 99 Cx Dysplasia can be detected.
• Some research done with PCR urine

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Treatment options

• Normally treated in the office ,procedures such
  as freezing
• Laser, LEEP
• More severe once require surgerical removal
  either part of CX _Cone or complete removal of
  the cx with the hysterctomy.

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Pap Smears in Pregnancy

• Contoversial- but if had abonormal smears prior
  to pregnancy then should have pap taken
• No further than 15 ks gestation and only with a
  spatula
• Colposcopy and Bx indicated if suspicious looking
  cx.
• Remember pregnant cx are highly vascularized and
  can bleed heavily

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CIN

• May either regress to normal or proceed to
  invasive
• Cx Ca 1/3 to ½ of the cases of CIN 1 and CIN 2
  regress
• Cin 3 also have beed seen to regress.. Depends on
  the Immune systen of the individual

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Prevention

• Recent trial of monvalent HPV genotype 16 vaccine
  received great interest,
• if proven to be successful will prevent warts and
  so 70 of dysplasia and Ca CX reduce and
  occurence of abnormal pap.
• Common strain HPV-16

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QLD Cx Screening Program

• Is the state component of the joint
  Commomwealth/state national screening
• Aims to reduce the incidence of cx cancer and
  associated morbidity and mortality
• QLD HEALTH has employed specialists health
  workers as part on comprehensive approach
• QLD CROSS-CULTURAL AWARENESS TRAINING OPRTUNITIES

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QLD Registry

• Operates in each state and teritoy
• Confidential and protected by law
• Women need to ask to be registered
• Its role is to provide with DATA
  collection/quality control
• Collects screening histories
• Provide lab with results of previos abnormal
  smears
• Safety net for women and reminder for f/up

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KEY Message to women

• All women who have had sex and who still have a
  cx need to have a pap smear
• You may cease having the pap after 70 yrs of age
  if all other paps were normal
• Pap smear can prevent about 90 of cx dysplasia
• Each year about 1,000 new cases of CA Cx are DX
• Find a health professional who you comfortable
  with for your yearly pap smears
• Regrster yourself with the QLD registry

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Key Message to the Health professional

• 90 of cx dysplasia can be prevented
• Annul screening is not cost effective and not
  necessay
• Its only a screenig test and has its limitations
• Pa smears prevent more than 1,000 cancer of CX
• GPs take about 80 of the Pap smears each year.

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Psychological /Logistical barriers

• Lack of knoweledge about pap smears
• Issues such as work and family responsibilites
  more important than own health
• Forgetting
• Low perception of risk developing cancers
• Embarrasment ,fear and lack of social support and
  uncomfortable
• Difficuilt accessing GP or health professional
• Cultural and language issues
• cost

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.C O N C L U S I O N

• Have a pap smear every 2 years