Cervical cancer is the 6th most common cancer in women and the 10th most common cause of death. Early sexual intercourse, multiple sexual partners, low socioeconomic status, herpes, HPV infection, low vitamin A levels, and smoking all increase the risk of developing cervical cancer. A Pap smear, or Pap  smear test,  is an easy-to-use test used in many countries to diagnose cervical cancer.

What is a Pap Smear Test ?

A Pap smear  is a screening test used to detect cervical cancer, cellular disorders in the cervix, abnormal precancerous cells, and infections. It can also aid in the early diagnosis of endometrial cancer, also known as cancer of the uterine lining. This test allows early detection of cellular disorders in the uterus and cervix before they develop into cancer. Early diagnosis can help patients recover fully.

How is a Pap Smear Test Done?

It's simple and painless. The best time to perform the test is 10-20 days after your period; it shouldn't be performed during your period. During the test, a speculum is inserted into the vagina to better visualize the cervix. Then, using a small brush, a sample of cells is taken from the cervix and spread on a glass slide for microscopic examination. The cells on this slide are examined by a pathologist under a microscope to detect any abnormal cell growth. The primary goal of this procedure is not only to detect potential cancer but also to identify "precancerous" lesions that are not cancerous but have a high probability of developing into cancer and are treatable. If the test is positive, your doctor may order an HPV test and colposcopy.

Before a Pap smear, sexual intercourse, vaginal douches, or intravaginal medications should be avoided for 48 hours. If a genital infection is present, it should be treated first, and a Pap smear should be taken afterward.

When Should You Start Having a Pap Smear Test ?

Screening should begin at least three years after first sexual intercourse or after age 21, at intervals. Annual Pap smear tests are recommended for women under 30, while those over 30 should have Pap smear tests every two to three years after three consecutive negative Pap smear results  . However, screening frequency should be increased for women with weakened immune systems, those who are HIV-positive, those taking estrogen hormones, those who have undergone organ transplants, or those receiving chemotherapy or corticosteroid therapy.

Who Can Have a Pap Smear Test?

• Women between the ages of 21 and 65.
• Those who have had abnormal pap smear results in the past.
• Those with HIV infection.
• Those who have had an organ transplant, chemotherapy, or are on chronic corticosteroids. 
• Those with weak immune systems.
• Women who smoke.
• Women who were exposed to a drug called DES (Diethylstilbestrol) while they were in the womb.

Which Diseases Are Diagnosed with a Pap Smear Test?

A Pap smear (also known as a Pap test) is a screening test used for the early detection of cervical cancer and other cervical diseases. Cervical cancer is a type of cancer that occurs in the cervix. It is a test performed to detect cellular changes in the cervix and identify early-stage abnormalities. Pap smear tests are performed in public hospitals and many private hospitals in Ankara.

This test can also be used to diagnose the following diseases:

• HPV (Human Papilloma Virus) infection: HPV is one of the main causes of cervical cancer and a pap smear test can be used to detect HPV infection.
• Cervical dysplasia: These are abnormal changes in the cells of the cervix and can be a precursor to cervical cancer. A Pap smear can identify dysplasia and provide early intervention for necessary treatment.
• Cervical infections: It can be used to detect infections of the cervix, such as fungal infections or bacterial infections.
• Cervical polyps: It can be used to detect cervical polyps, which are abnormal growths found on the cervix.

Pap smear tests are a recommended screening test and can improve the chances of treatment by enabling early diagnosis of diseases such as cervical cancer. Therefore, pap smear tests are standard for female patients as part of a checkup in private hospitals.

Evaluation of Smear Test Results

Today, the Bethesda system is used to evaluate smear test results.

• A negative result means that no abnormal, precancerous, or cancerous cells were seen.
• Abnormal results: This means there are many possible reasons why cervical cells may be abnormal. After evaluation, your doctor may recommend treatment for the infection, close monitoring, a colposcopy, and a biopsy.

Like every medical test, Pap smear tests carry a margin of error. Therefore, having the test done regularly reduces the likelihood of errors.

If you see the terms ARCUS, LSIL, HSIL in your pathology report, what do they mean?

 ARCUS : If the pathologist suspects the presence of cancer precursor cells in the smear material, it is reported as ARCUS. These patients should have their smear repeated every 2-3 months.

These patients undergo a colposcopy to evaluate the cervix, and if necessary, a biopsy is taken to prevent the disease from being left to chance. A human papillomavirus typing test and HPV vaccination should also be performed to control the progression of the disease.

LSIL : Patients must undergo colposcopy, the cervix must be examined in detail during colposcopy, and cervical biopsy material must be taken from suspicious areas.

Colposcopy and biopsy are required for patients with HSIL and treatment is planned according to the results.

Should I Have a Pap Smear Test Even If I Have Been Vaccinated Against HPV?

Research has shown that the HPV vaccine can largely prevent HPV infection and, consequently, cervical cancer. However, there are many different types of HPV infection, and the vaccine is not effective against some rare types. Vaccines have been developed against the most common types of HPV infection. However, lesions can occur with other types, although rare. Therefore, vaccinated individuals should also have Pap smear tests at regular intervals.

A Pap smear is a screening test used to detect vaginal diseases. Therefore, if the Pap smear yields a suspicious result, colposcopy, biopsy, and cervical curettage may be necessary. 

Colposcopy is a clinical procedure that involves a detailed examination of the vagina using a microscope similar to illuminated binoculars. First, a speculum is used to dilate the vagina. Then, the upper part of the vagina and the cervix are examined in detail using a microscope. If abnormal cells are detected in the cervix during the colposcopy, a biopsy is taken and sent to a pathologist for examination.

What is Cervical Cancer?

The cervix, also known as the cervix, is the area located at the lower part of the uterus that connects the uterus and vagina. Cervical cancer, or cervical cancer, does not appear suddenly. It develops years later following the growth of some precancerous abnormal cells in the cervix. These precancerous abnormal cells are called CIN (cervical intraepithelial neoplasia) or squamous intraepithelial lesion. In most women, these precancerous abnormal cells disappear on their own or remain unchanged. However, treatment is still a better option for preventing cancer.

These abnormal precancerous cells are treated by freezing the suspicious areas using colposcopy or by laser removal. These treatments are effective in preventing cancer formation. Afterward, the patient is followed up regularly by a doctor.

Pap smear tests  have significantly reduced the prevalence of this type of cancer and reduced mortality rates. Cervical cancer is the only gynecological cancer that can be prevented through regular checkups and screening tests. Cervical cancer is very common in countries where pap smear tests are not regularly used. Pap smear tests identify cells in the cervix that have not yet become cancerous, and cancer can be prevented through appropriate treatment.

Cervical cancer usually occurs between the ages of 35 and 55. It is rare under the age of 20. Regular Pap smear tests are recommended for all women between the ages of 20 and 65. Nearly all women diagnosed with cervical cancer have been found to have HPV. Currently, vaccines have been developed against HPV.

Risk factors for cervical cancer and precursors can be listed as follows:

• Advanced age,
• Low socioeconomic status,
• Low level of education,
• Having too many sexual partners, either himself or his spouse,
• Early first sexual experience,
• Cigarette,
• Long-term use of birth control pills,
• Diets poor in folic acid, vitamin A and vitamin C,
• Having multiple pregnancies,
• Having a first pregnancy at an early age,
• The presence of sexually transmitted herpes and HPV viruses,
• HIV infection,
• Exposure to excess estrogen hormone while in the womb,
• Not having regular  smear tests  and doctor check-ups,
• Immune system deficiency,
• Having a mother or sister with cervical cancer,
• A diet poor in vegetables and fruits,
• Excess weight.

What are the symptoms of cervical cancer?

Lesions that develop before cervical cancer often don't cause symptoms. This underscores the importance of Pap smear tests. Symptoms only appear once the disease progresses to cancer. 

These symptoms are:

• Bloody and foul-smelling vaginal discharge, 
• Abnormal bleeding during sexual intercourse or between menstrual periods, 
• Menstrual bleeding lasting longer than normal,
• Feeling pain during sexual intercourse.

The Importance of Post-Smear Test Checkup

Cervical cancer is one of the most preventable cancers thanks to a healthy diet, exercise, regular Pap smear tests, and the availability of a vaccine against the HPV virus. Cervical cancer screening tests are highly effective. Therefore, regular  Pap smear tests  are the best way to detect abnormal cells and take the necessary precautions before developing cancer.

Other precautions that can be taken are: 

• Quitting smoking, 
• Avoiding sexual intercourse at an early age, 
• Using a condom during intercourse, 
• Not being overweight, 
• A balanced diet, 
• Reducing the number of sexual partners.