PAP SMEARS

• What is a Pap smear?

  A Pap smear is a test your doctor does to check for signs of cancer of the cervix. The cervix is part of your uterus (womb). During a Pap smear, your doctor takes a sample of cells from your cervix to be tested and examined.
  
  To take the sample, your doctor will put a special instrument called a speculum into your vagina. This helps open your vagina so the sample can be taken. Your doctor will gently clean your cervix with a cotton swab and then collect a sample of cells with a small brush, a tiny spatula or a cotton swab. This sample is put on a glass slide and sent to a lab to be checked under a microscope.

  
• What is the sample checked for?

  A normal Pap smear means that all the cells in your cervix are normal and healthy.
  
  An abnormal Pap smear can be a sign of a number of changes in the cells on your cervix:
  
  - Inflammation (irritation) This can be caused by an infection of the cervix, including a yeast infection, infection with the human papillomavirus (HPV) the herpes virus or many other infections.
  - Abnormal cells These changes are called cervical dysplasia. The cells are not cancer cells, but may be precancerous (which means they could eventually turn into cancer).
  - More serious signs of cancer These changes affect the top layers of the cervix but don't go beyond the cervix.
  - More advanced cancer

• How often should I have a Pap smear?

  You should have your first Pap smear when you start having sex or by age 18.
  
  Continue having a Pap smear once a year until you've had at least 3 normal ones. After this, you should have a Pap smear at least every 3 years, unless your doctor thinks you need them more often. Keep having Pap smears throughout your life, even after you've gone through menopause.
  
  Certain things put you at higher risk of cervical cancer. Your doctor will consider these when recommending how often you should have a Pap smear.
  
  If you're older than 65, talk with your doctor about how often you need a Pap smear. If you've been having Pap smears regularly and they've been normal, you may not need to keep having them.

• How reliable is the test?

  No test is perfect, but the Pap smear is a reliable test. It has helped drastically lower the number of women who die of cervical cancer.
  
  Sometimes the test may need to be redone because there were not enough cells on the slide. The lab will tell your doctor if this happens.
  
  ThinPrep, PAPNET and FocalPoint are ways to make Pap smears more accurate. ThinPrep is a way of preparing the sample of cells that makes it easier to spot abnormalities. PAPNET and FocalPoint are computer systems that help lab technicians find abnormal cells. These options may not be available in all areas, and they may increase the cost of a Pap smear.

• What should I do before the test?

  Plan to have your test done at a time when you aren't having your menstrual period. Don't douche, use a feminine deodorant or have sex for 24 hours before the test.

• What happens if my Pap smear is abnormal?

  If the results of your Pap smear are abnormal, your doctor may want to do another Pap smear or may want you to have a colposcopy.
  
  A colposcopy gives your doctor a better look at your cervix and allows him or her to take a sample of tissue (called a biopsy). Your doctor will use an instrument called a colposcope to shine a light on your cervix and magnify it. Your doctor will explain the results and discuss treatment options with you.

• What puts me at risk for cervical cancer?

  - Starting to have sex early (before age 18)
  - Having had many sexual partners
  - Being infected with an STI or having had a sex partner who has an STI
  - Smoking
  
  The main risk factors for cervical cancer are related to sexual practices (see the box to the right). Sexually transmitted infections (STIs) may make your cells more likely to undergo changes that can lead to cancer. STIs include HPV, herpes, gonorrhea and Chlamydia. HPV is the virus that can cause genital warts. It seems to be very closely connected with these changes.

• Is there anything I can do to avoid getting cervical cancer?

  You may be able to reduce your risk of cervical cancer if you:
  
  - Delay sexual intercourse until you're 18 years of age or older.
  - Make sure both you and your partner are tested for STIs.
  - Limit your number of sex partners.
  - Always use latex condoms to protect against sexually transmitted infections (STIs). (Remember condoms aren't 100% effective.)
  - Avoid smoking.