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Understanding Pap Smear for Cervical Cancer Screening and Prevention

By Dr. Kanika Gupta in Surgical Oncology

Feb 02 , 2024 | 2 min read

The eyes don’t see what the mind does not know ...

Pap smear is the key to screening and preventing the fourth most common cancer in the world, i.e. cervical cancer. It has major implications for female health and the economic and mental quantum of the nation. Pap smear is a cytology-based test in which exfoliated cells from the cervix and vagina are evaluated for abnormal changes, thereby predicting future implications of HPV infection. Over 95% of the cervical cancer burden is potentially avoidable by good-quality screening programmes and vaccination against HPV16 and 18 – the latter being the causal agent for up to 70% of cervical cancer. IARC concludes that there is sufficient evidence that cervical cancer screening can reduce cervical cancer mortality by 80% or more among screened women. The key point is that women should be aware that HPV infests almost every woman who has initiated sexual activity, but cancer changes accumulate gradually over the decades in women who are not able to clear HPV from the immune system.

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This highlights the importance of screening at an early stage by regular cytology so that we catch this virus red-handed. The World Health Organisation recommends HPV DNA as the test of choice wherever facilities are present. In remote areas, cytology and visual inspection of the cervix vision under magnification (colposcopy) are alternative modalities. A pap smear has to be done at intervals every 3 years if done alone; if done with HPV, DNA can be safely screened at 5-year intervals. Conventional pap smears sampled the cells with a wooden spatula on a glass smear. Recently, liquid-based cytology has taken over as it has more uniformity and better cell procurement. The same liquid base can be used in the detection of DNA of human papillomavirus and its variants.

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Even if a woman decides to undergo a pap smear once in her lifetime between the age of 35 – 45 years, it would significantly decrease morbidity and mortality associated with cervical cancer. The cytology is further classified based on Bethesda and Lower Anogenital squamous terminology, and precancerous lesions are treated accordingly. Newer HPV vaccines have been introduced, and these provide adequate efficacy against nine subtypes in a feasible one or two-dose schedule as recommended by WHO. These vaccines are for the target age group of 9 – 25 years, and public awareness needs to be done. 

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India has emerged victorious against the eradication of poliomyelitis through vaccines, and cervical cancer can also be fought with the same weapon. Women who are immunocompromised and are living with HIV – AIDS need an extra dose of this vaccine. 

Thus, awareness regarding cervical cancer, its screening and vaccination needs to be increased, and this transformation can be brought through sex education and cancer awareness in society.