Cancer of the cervix (cervical cancer) is the fourth most common cause of cancer-related death among women worldwide. The best way to detect cervical cancer is by having regular Papanicolaou tests (Pap smears), or cervical cytology. (Pap is a shortened version of Dr. George Papanicolaou, the doctor who developed the screening test.) A Pap smear is a microscopic examination of cells taken from the uterine cervix.
A Pap test can detect certain viral infections such as human papillomavirus (HPV), which is known to cause cervical cancer. Early treatment of precancerous changes (cervical dysplasia) detected on the Pap smear can stop cervical cancer before it fully develops. A woman may have cervical cancer and not know it because she may not have any symptoms.
The incidence of cancer and deaths from cervical cancer has significantly declined over the years because of prevention, screening, and early detection by the Pap test. Most abnormal Pap smear results indicate the early stages of disease and need reasonable observation by a doctor.
Risk factors for cervical cancer include conditions that increase the likelihood of being infected with a cancer-causing form of human papillomavirus as well as other factors including the following:
New recommendations were published in March, 2012 by the U.S. Preventive Service Task Force with agreement by the American Cancer Society (details are described further in this article). Briefly stated, cervical cancer screening is now recommended every 3 years starting at age 21. Cervical cancer screening may be carried out every 5 years for women over age 30 if a Pap test and HPV test are performed.
No upper age limit for cervical cancer screening exists because the incidence of cancer of the cervix increases with age at a time when women may be less likely to get a Pap smear. Diagnosis of most of these cancers is in women older than 50 years. Even after menopause, a woman should continue to have regular Pap testing. Women over age 65 who have had three or more normal Pap tests in a row and no abnormal Pap test results in the last 10 years may choose to stop having Pap tests.
If a woman has had her uterus removed, she should still have yearly screening tests if there is a history of advanced precancerous changes seen on Pap smear or other lower genital tract cancer.
The Pap smear procedure is not complicated or painful. The only risk is not detecting cervical cancer in time to treat and cure it.
The best time to have a Pap smear is when the woman is not menstruating.
For two days before the Pap test, avoid the following because these might interpretation of the test more difficult:
A Pap smear is usually part of a pelvic exam and accompanied by a breast exam performed by the health care professional. It should only take about one minute to perform a Pap smear during this overall exam.
The health care professional will send a letter with test results. If there is a problem, the woman's health care professional may contact her. For peace of mind, she can also call the medical office to get the results. Before leaving after the exam, she can ask how long it takes the office to receive the lab report.
A negative or normal test finding means that the cervix looks healthy. All the cells are of a healthy size and shape.
A positive or abnormal test finding means that something unusual is in the sample. The test found abnormal cells of a different size and shape.
An abnormal Pap smear result does not always indicate cancer. Cells sometimes appear abnormal but are not cancerous. The woman will have to return to the doctor for follow-up care.
Most laboratories in the United States use a standard set of terms called the Bethesda System to report, or interpret, test results. Under the Bethesda System, Pap smear samples that have no cell abnormalities are reported as "negative for intraepithelial lesion or malignancy" (meaning the woman does not have cancer).
Samples with abnormal cells fall into the following categories (as outlined by the National Cancer Institute):
If a woman's Pap smear result is normal, she will continue routine screening.
If the Pap smear result is abnormal, the doctor will recommend repeat testing or more frequent follow-up, depending upon the exact type of abnormality and whether any infection is present. The doctor may choose to do a procedure known as a colposcopy.
Early cervical pre-cancers and cancer often have no signs or symptoms. Therefore, it is important to have regular Pap smears. Symptoms usually appear when the cancer has progressed.
The following symptoms must be reported to a health care professional right away:
These symptoms do not always indicate that someone has cancer. Other conditions may cause these symptoms, but a check-up is necessary to determine the cause.
As in many cancers, there may be no signs or symptoms of cervical cancer until it has progressed to a dangerous stage. However, if symptoms do occur they may include:
