Cervical Smears
Cervical smears should be taken in a proper way by an experienced person so as to avoid an inadequate material.44 Because of the phases that precede the lesion in the natural progress of invasive cervical cancer, and because they can be easily discovered and treated, the disease is well suited to screening programs. It is now recommended that all patients with abnormal cytology should undergo further investigations.4 Annual Pap smear screening has been favoured over less frequent screening in the United States to minimize the risk of cervical cancer. Although cytological screening programs using Pap smears have dramatically reduced cervical cancer incidence and mortality in developed nations, single Pap tests suffer from suboptimal sensitivity, limited reproducibility, and many equivocal results.7
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Although natural history studies have demonstrated that most HPV infections produce only transient minor lesions,8 untreated infections may persist and progress to cervical intraepithelial neoplasia (CIN) 3, a cancer precursor.
If detected early, cervical cancer is curable and the 5-year survival rate is as high as 92%.5 The idea behind the PAP-test is that cellular changes that may develop into cancer are detected at such an early stage that they can be removed through a simple operation, thus preventing the cancer.5 Thus, Papanicolaou (Pap) screening has spread, it has become common to detect pre-invasive lesions rather than invasive cancer, and so, the incidence rates have been fallen steadily.9 Evidence for the importance of the PAP-test can be found in statistics from many countries where the PAP-test is used in systematic, comprehensive screening
programs.5
Current guidelines recommend that women should have a Pap test every 3 years beginning at age 21. These guidelines further recommend that women ages 30 to 65 should have HPV and Pap co-testing every 5 years or a Pap test alone every 3 years. Women with certain risk factors may need to have more frequent screening or to continue screening beyond age 65. Women who have received the HPV vaccine still need regular cervical screening.10
Because of the phases that precede the lesion in the natural progress of invasive cervical cancer, and because they can be easily discovered and treated, the disease is well suited to screening programs. The Papanicolaou test is an established method for examining the cells collected from the cervix to determine whether they show signs of pre-neoplastic differentiation.1
A detected high grade premalignant lesion typically leads to the woman being offered a colposcopy and, if a lesion is confirmed, an operation to remove it. The detection of a low grade lesion may lead to a follow-up smear being taken after a shorter time interval than the normal 2-3 years. In principle, the screening task is straight forward.5
Although natural history studies have demonstrated that most HPV infections produce only transient minor lesions,8 untreated infections may persist and progress to cervical intraepithelial neoplasia (CIN) 3, a cancer precursor.
If detected early, cervical cancer is curable and the 5-year survival rate is as high as 92%.5 The idea behind the PAP-test is that cellular changes that may develop into cancer are detected at such an early stage that they can be removed through a simple operation, thus preventing the cancer.5 Thus, Papanicolaou (Pap) screening has spread, it has become common to detect pre-invasive lesions rather than invasive cancer, and so, the incidence rates have been fallen steadily.9 Evidence for the importance of the PAP-test can be found in statistics from many countries where the PAP-test is used in systematic, comprehensive screening
programs.5
Current guidelines recommend that women should have a Pap test every 3 years beginning at age 21. These guidelines further recommend that women ages 30 to 65 should have HPV and Pap co-testing every 5 years or a Pap test alone every 3 years. Women with certain risk factors may need to have more frequent screening or to continue screening beyond age 65. Women who have received the HPV vaccine still need regular cervical screening.10
Because of the phases that precede the lesion in the natural progress of invasive cervical cancer, and because they can be easily discovered and treated, the disease is well suited to screening programs. The Papanicolaou test is an established method for examining the cells collected from the cervix to determine whether they show signs of pre-neoplastic differentiation.1
A detected high grade premalignant lesion typically leads to the woman being offered a colposcopy and, if a lesion is confirmed, an operation to remove it. The detection of a low grade lesion may lead to a follow-up smear being taken after a shorter time interval than the normal 2-3 years. In principle, the screening task is straight forward.5