Understanding the Importance of Pap Smear Tests and their Associated Costs

Medically reviewed by Dr Shayesta Jahan

What is Pap Smear?

Pap Test /Pap Smear is also known as a Papanicolau test is named after George Nicholas Papanicolaou who was a pioneer in Cytopathology and invented this technique. It is done routinely on OPD basis in Gynaecological Department. It is a very simple, economical, and safe procedure. During the test procedure, a speculum is used to visualise the cervix, with the help of a brush / spatula cells are collected from the ecto and endo cervix. These cells are either preserved in a cytolyte fixative (Liquid Based Cytology) or spread directly on a glass slide (Conventional PAP Smear) and fixed and sent to the lab. Slides are then stained with PAP Stain and studied under the microscope.

What is it done for?

It is a gold standard screening tool for detecting Carcinoma cervix and precancerous cervical epithelial lesions. It is also useful in diagnosing infections and inflammation of the lower reproductive tract.

Why is PAP Smear important?

Cervical cancer is the 2nd leading cancer in women in India and 25% of all global deaths due to Cervical cancer occur in India. The main reasons being lack of timely screening and treatment. Cervical cancer has a long preinvasive stage and early detection by screening plays a crucial role in preventing the cancer development. Early cervical epithelial changes can be identified by a Pap smear test for detection of precancerous cervical intraepithelial neoplasia and the early stage of invasive cervical cancer. When detected early and managed effectively Cervical cancer is the most successfully treatable form of cancer.

Who needs a PAP Smear?

According to CDC guidelines, it is recommended that the 1st PAP Smear be done between 21 to 29 years of age. Between 30 to 65years PAP Smear should be done once every 3 years. If combined with HPV PCR test, screening can be done once every 5 years.

After the age of 65 years, there is no need of rescreening if at least three Pap tests or two HPV tests in the past 10 years were normal. If there was no history of cervical precancer or if there is a history of total hysterectomy been done for any non-cancerous condition.

If certain risk factors are present, more-frequent Pap smears, regardless of age will be needed. These include diagnosis of cervical cancer or a Pap smear which showed precancerous cells, HIV infection, history of smoking or patients with weak immune system due to organ transplant, chemotherapy or chronic steroid use.

What are the interpretations of PAP test?

If the cells examined are normal then it is reported as Negative for intraepithelial lesion or malignancy

If abnormal cells are detected microscopically then additional testing which includes follow up PAP smear or Colposcopy and biopsy will be recommended to rule out malignancy.