What does a Pap smear test show. How often should you get cervical cancer screening. What are the different cervical cancer screening options. How to prepare for a Pap smear or HPV test. What do abnormal test results mean.

The Importance of Cervical Cancer Screening

Cervical cancer screening is a crucial preventive measure that can detect early signs of cancer or precancerous conditions. Regular screening can significantly reduce the risk of developing cervical cancer by identifying and treating abnormalities before they progress. The two primary screening methods are the Pap smear test and the HPV test, both of which play essential roles in early detection and prevention.

Understanding the Pap Smear Test

The Pap smear test, also known as the Papanicolaou test, is a screening procedure that examines cells collected from the cervix. This test is designed to detect precancerous changes in cervical cells, which could potentially develop into cervical cancer if left untreated.

How is a Pap Smear Performed?

During a Pap smear, a healthcare provider uses a speculum to visualize the cervix and collects a sample of cells using a small brush or spatula. These cells are then preserved in a special liquid and sent to a laboratory for analysis under a microscope.

What Can a Pap Smear Detect?

• Precancerous cell changes (cervical dysplasia)
• Abnormal cell growth
• Signs of inflammation or infection
• Presence of human papillomavirus (HPV)

Is a Pap smear 100% accurate? While Pap smears are highly effective, they are not infallible. False negatives can occur, which is why regular screening is important. Additionally, Pap smears may not detect all types of cervical abnormalities or cancers.

The Role of HPV Testing in Cervical Cancer Screening

HPV testing is another crucial component of cervical cancer screening. This test specifically looks for the presence of high-risk strains of human papillomavirus, which are responsible for the majority of cervical cancer cases.

HPV Test vs. Pap Smear: What’s the Difference?

While both tests use samples collected from the cervix, they analyze different aspects:

• Pap smear: Examines the appearance of cervical cells
• HPV test: Detects the presence of high-risk HPV DNA

Can HPV testing replace Pap smears? In some cases, HPV testing alone (primary HPV testing) may be recommended as the preferred screening method for certain age groups. However, co-testing (combining HPV and Pap tests) is also commonly used for comprehensive screening.

Cervical Cancer Screening Guidelines: When and How Often?

Screening recommendations vary based on age and individual risk factors. Here are the general guidelines:

Ages 21-29

• Pap smear every 3 years
• HPV testing not typically recommended

Ages 30-65

• Option 1: HPV test alone every 5 years
• Option 2: Co-testing (HPV test + Pap smear) every 5 years
• Option 3: Pap smear alone every 3 years

After Age 65

Screening may be discontinued if previous results have been consistently normal and there’s no history of cervical precancer. However, individual circumstances may warrant continued screening.

Should you continue screening after a hysterectomy? If you’ve had a total hysterectomy (including removal of the cervix) for non-cancerous reasons, you may not need continued screening. However, always consult with your healthcare provider for personalized recommendations.

Preparing for Your Cervical Cancer Screening

Proper preparation can help ensure accurate test results. Here are some guidelines to follow:

For Pap Smears:

• Avoid sexual intercourse for 24-48 hours before the test
• Do not use vaginal medications, douches, or spermicides for 48 hours prior
• Try to schedule the test when you’re not menstruating

For HPV Testing:

No special preparation is typically required for HPV testing. However, following the same guidelines as for Pap smears can be beneficial if you’re having both tests done.

Is it okay to have a Pap smear during your period? While it’s best to avoid scheduling during menstruation, the test can still be performed if necessary. Always inform your healthcare provider about your cycle.

Understanding Your Cervical Cancer Screening Results

Receiving your test results can be anxiety-inducing, but understanding what they mean is crucial for proper follow-up care.

Normal Results

If your results are normal, it means no abnormal cells were detected (Pap smear) or no high-risk HPV strains were found (HPV test). Your healthcare provider will advise when to schedule your next screening based on your age and risk factors.

Abnormal Results

Abnormal results don’t necessarily mean you have cancer. They indicate that changes in cervical cells were detected or that high-risk HPV strains were present. Further testing or follow-up may be required.

What are the next steps after abnormal results? Your healthcare provider may recommend:

• Repeat testing in 6-12 months
• Colposcopy (a detailed examination of the cervix)
• Biopsy of any suspicious areas

The Link Between HPV and Cervical Cancer

Understanding the relationship between HPV and cervical cancer is crucial for comprehending the importance of screening and prevention.

What is HPV?

Human papillomavirus (HPV) is a group of viruses, some of which can cause cellular changes that may lead to cancer. There are over 100 types of HPV, but only a subset are considered high-risk for causing cervical cancer.

How Does HPV Cause Cervical Cancer?

High-risk HPV strains can infect cervical cells and cause them to change and grow abnormally. Over time, these changes can lead to precancerous lesions and, if left untreated, develop into cervical cancer.

Does having HPV mean you will get cervical cancer? Not necessarily. Most HPV infections clear on their own without causing problems. However, persistent infections with high-risk strains increase the risk of developing cervical cancer, which is why regular screening is crucial.

Prevention Beyond Screening: HPV Vaccination

While screening is essential for early detection, prevention through vaccination is equally important in the fight against cervical cancer.

Who Should Get the HPV Vaccine?

• Recommended for all genders, typically starting at age 11-12
• Can be given as early as age 9
• Catch-up vaccination recommended through age 26
• Some adults aged 27-45 may benefit from vaccination after discussing with their healthcare provider

Effectiveness of HPV Vaccination

HPV vaccines are highly effective at preventing infection with the most common high-risk HPV types that cause cervical cancer. They can prevent up to 90% of HPV-related cancers when given before exposure to the virus.

Can you still get HPV if you’ve been vaccinated? While the vaccine is very effective, it doesn’t protect against all HPV types. Regular screening is still recommended even for those who have been vaccinated.

Addressing Common Concerns and Misconceptions

There are several misconceptions surrounding cervical cancer screening that can lead to anxiety or avoidance of these crucial tests.

Pain and Discomfort

Many people worry about pain during cervical cancer screening. While some discomfort is possible, the tests are generally quick and only mildly uncomfortable. Communicating with your healthcare provider can help ease anxiety and ensure a more comfortable experience.

Privacy and Embarrassment

Feeling embarrassed about the intimate nature of these tests is common. Remember that healthcare providers are professionals who perform these screenings routinely. They are focused on your health and well-being, not judging you.

False Positives and Negatives

No test is perfect, and both false positives and false negatives can occur. This is why regular screening according to guidelines is important – it helps catch any missed abnormalities and confirms or rules out suspicious findings.

How accurate are cervical cancer screening tests? While not 100% accurate, both Pap smears and HPV tests are highly effective when used as recommended. The combination of regular screening and appropriate follow-up greatly reduces the risk of developing cervical cancer.

The Future of Cervical Cancer Screening

As medical technology advances, so do the methods for detecting and preventing cervical cancer. Researchers are continually working on improving screening techniques and developing new approaches to early detection.

Emerging Technologies

• AI-assisted analysis of Pap smear samples
• Self-sampling HPV tests for increased accessibility
• Biomarker testing for more precise risk assessment

Personalized Screening Approaches

Future screening protocols may become more tailored to individual risk factors, including genetic predisposition, lifestyle factors, and vaccination status. This personalized approach could optimize screening frequency and methods for each person.

Will cervical cancer screening eventually become obsolete? While widespread HPV vaccination could significantly reduce cervical cancer rates, screening will likely remain important for detecting cases in unvaccinated individuals and monitoring vaccine effectiveness in the long term.

Empowering Yourself Through Knowledge and Action

Understanding cervical cancer screening is the first step in taking control of your health. By staying informed about screening guidelines, communicating openly with your healthcare provider, and adhering to recommended screening schedules, you can significantly reduce your risk of cervical cancer.

Key Takeaways

• Regular screening is crucial for early detection and prevention
• Both Pap smears and HPV tests play important roles in cervical cancer screening
• Follow age-appropriate screening guidelines and discuss personalized recommendations with your healthcare provider
• HPV vaccination is a powerful tool for prevention, especially when combined with regular screening
• Don’t hesitate to ask questions or express concerns to your healthcare provider

By taking an active role in your cervical health, you’re not just protecting yourself – you’re contributing to the broader goal of eliminating cervical cancer as a public health concern. Remember, knowledge is power, and regular screening is your best defense against cervical cancer.

What Should I Know About Cervical Cancer Screening?

Español (Spanish) | Print

“If I didn’t go to that appointment, I might not be around for my kids,” says Cindy. Her cervical cancer screening test found precancerous cells. She shares her story in this video.

The HPV test and the Pap test can help prevent cervical cancer or find it early.

• The HPV test looks for the virus (human papillomavirus) that can cause cell changes on the cervix.
• The Pap test (or Pap smear) looks for precancers, cell changes on the cervix that might become cervical cancer if they are not treated appropriately.

Both tests can be done in a doctor’s office or clinic. During the Pap test, the doctor will use a plastic or metal instrument, called a speculum, to look inside your vagina. This helps the doctor examine the vagina and the cervix, and collect a few cells and mucus from the cervix and the area around it. The cells are sent to a laboratory.

• If you are getting a Pap test, the cells will be checked to see if they look normal.
• If you are getting an HPV test, the cells will be tested for HPV.

What is cervical precancer? When there are cervical cells that look abnormal but are not yet cancerous, it is called cervical precancer. These abnormal cells may be the first sign of cancer that develops years later. Cervical precancer usually doesn’t cause pain or other symptoms. It is found with a pelvic exam or a Pap test.

If you have a low income or do not have health insurance, you may be able to get a free or low-cost screening test through the National Breast and Cervical Cancer Early Detection Program.

Find out if you qualify

When to Get Screened

If You Are 21 to 29 Years Old

You should start getting Pap tests at age 21. If your Pap test result is normal, your doctor may tell you that you can wait three years until your next Pap test.

If You Are 30 to 65 Years Old

Talk to your doctor about which testing option is right for you—

• An HPV test only. This is called primary HPV testing. If your result is normal, your doctor may tell you that you can wait five years until your next screening test.
• An HPV test along with the Pap test. This is called co-testing. If both of your results are normal, your doctor may tell you that you can wait five years until your next screening test.
• A Pap test only. If your result is normal, your doctor may tell you that you can wait three years until your next Pap test.

If You Are Older Than 65

Your doctor may tell you that you don’t need to be screened anymore if—

• You have had normal screening test results for several years, and
• You have not had a cervical precancer in the past, or
• You have had your cervix removed as part of a total hysterectomy for non-cancerous conditions, like fibroids.

No special preparation is needed before you have an HPV test.

If you are getting a Pap test, you can take steps to make sure the test results are accurate. Avoid intercourse, douching, and using vaginal medicines or spermicidal foam for 2 days before the test. If you had sex before the test, go to the appointment as planned and let the doctor know.

If you have your period, don’t worry. Both tests can still be done at this time.

Test Results

It can take as long as three weeks to receive your test results. If your test shows that something might not be normal, your doctor will contact you and figure out how best to follow up. There are many reasons why test results might not be normal. It usually does not mean you have cancer.

If your test results show cells that are not normal and may become cancer, your doctor will let you know if you need to be treated. In most cases, treatment prevents cervical cancer from developing. It is important to follow up with your doctor right away to learn more about your test results and receive any treatment that may be needed.

If your test results are normal, your chance of getting cervical cancer in the next few years is very low. Your doctor may tell you that you can wait several years for your next cervical cancer screening test. But you should still go to the doctor regularly for a checkup.

What Does a Pap Test Detect?

Updated November 2022

Its real name: Papanicolaou test. There’s a good chance you know it as a Pap smear, or more appropriately, a Pap test. Discover the science behind this test ­— including what it doesn’t detect.

The Science Behind the Test

A Pap test is when a clinician takes a sample of cells from your cervix (the lower part of the uterus neck located at the top of the vagina). Then, they put the cells into small jar with a special liquid to preserve the sample so it can be tested for abnormalities under a microscope.

There are many reasons why you may have abnormal findings, such as:

• Mild inflammation
• Human papillomavirus (HPV)
• Cancer or precancer

Cervical cancer, if caught early, is highly treatable.

— Melissa A. Simon, MD

“The Pap test can detect changes in cells that could be concerning for possible cervical cancer or precancerous changes,” says Melissa A. Simon, MD, an obstetrician and gynecologist at Northwestern Medicine. 

Abnormal test results will indicate a number of atypical squamous cells, which will then be classified as low-grade or high-grade squamous intraepithelial lesions (LSIL and HSIL, respectively). LSIL indicates that the changes are mildly abnormal and usually caused by HPV infection, and they may go away on their own. HSIL suggests more serious changes.

“Cells that are determined to be atypical of undetermined significance basically reveal slightly abnormal cells, and it does not clearly mean precancer is there. Usually, these test results indicate to follow up in a year,” says Dr. Simon.

Abnormal Pap test results are typically caused by HPV. HPV is a sexually transmitted infection (STI) that enters cells and changes them. HPV can be prevented by getting the vaccine, which targets the HPV types that most commonly cause certain types of cancer and genital warts. Certain high-risk types of HPV are associated with an increased risk for the following types of cancer:

• Cervical
• Vulva
• Vagina
• Penis
• Anus
• Mouth and throat cancer

Depending on your Pap test results, your physician will determine the appropriate next steps. This can include another test, known as a colposcopy, which uses a special camera to look at your cervix. During this procedure, a biopsy of cells on your cervix may be taken for further analysis. Your physician may also opt for a loop electrosurgical excision procedure, known as LEEP, if there are more concerning findings or repeated abnormal Pap test results. A LEEP removes part of your cervix tissue for diagnosis and/or treatment.

What It Can’t Determine

Although Pap tests can help detect precancerous cells on the cervix, there are other types of gynecologic cancers that Pap tests cannot detect.  

Because your ovaries are far away from your cervix, it is extremely unlikely that a Pap test will  detect ovarian cancer. For that to happen, the cancer cells would have to travel away from your ovaries, through your fallopian tubes and uterus, and into the area surrounding your cervix.

The Pap test is also limited in detecting other types of STIs. If you are concerned you may have a STI, you should ask your clinician to screen for specific STIs.

Pap Tests Are Part of Routine Screening

The U.S. Preventive Services Task Force (USPSTF) and the American College of Obstetricians and Gynecologists (ACOG) both suggest starting screening at age 21. However, the American Cancer Society suggests that cervical cancer screening begin at age 25.

Dr. Simon explains that there are many nuances and complexities of when to start screening and how frequently screening should be done. Cervical cancer can also take a long time to develop, which could explain the varying guidelines.

Screening with a Pap test every three years during this time period is acceptable. However, other types of screening include primary HPV testing every five years. If primary HPV testing is not available, screening may be performed with co-testing that combines an HPV test with a Pap test every five years.

“If you have vaginal discharge, abnormal bleeding or are feeling pain, schedule a visit with your healthcare clinician to discuss these symptoms,” says Dr. Simon. “It’s important that if you are ever in any doubt of what you are feeling or experiencing, and are questioning if you need screening or a test, always reach out to your care team so you can have that conversation.”

The USPSTF, ACOG and American Cancer Society agree that people older than 65 do not need to be screened if adequate prior screening has been completed with normal results and if there is no history or high risk of cervical cancer. Dr. Simon recommends talking to your primary care clinician about your individual risks and recommendations for screening.

Bottom Line

The Pap test is a screening tool that can help detect abnormal cells on your cervix. This early detection can be important in stopping precancerous cells from progressing to cervical cancer.  

“Cervical cancer, if caught early, is highly treatable. And that’s why engaging in routine screening is very important,” says Dr. Simon. “Between the HPV vaccine and routine testing, this type of cancer really should be nonexistent.”

Cytological examination of smears (scrapings) from the surface of the cervix (external uterine os) and cervical canal

Cytological examination using a special method of staining the material, which makes it possible to detect atypical cells in a smear with high sensitivity and diagnose early precancerous changes in the epithelium and cervical cancer .

Synonyms Russian

Papanicolaou smear, Pap test, smear for oncocytology.

Synonyms English

Pap smear, Papanicolaou Smear; Cervical Smear; Cervical Oncocytology.

Research method

Cytological method.

What biomaterial can be used for research?

Smear from the outer surface of the cervix, swab from the inner surface of the cervix (from the cervical canal).

General information about the study

Cervical cancer (CC) is the 3rd most common malignant tumor in women (after breast cancer and colon cancer). The incidence of invasive cervical cancer in the world is 15-25 per 100,000 women. Neoplasms of the cervix occur mainly in middle-aged women (35-55 years), are rarely diagnosed under 20 years of age and in 20% of cases are detected over the age of 65 years.

The 5-year survival rate for localized (local, in situ) cervical cancer is 88%, while the survival rate for advanced cancer does not exceed 13%.

Risk factors for cervical cancer include infection with the human papillomavirus (oncogenic serotypes HPV16, HPV18, HPV31, HPV33, HPV45, etc. ), smoking, chlamydial or herpetic infection, chronic inflammatory gynecological diseases, long-term use of contraceptives, repeated births , cases of cervical cancer in the family, early onset of sexual activity, frequent change of sexual partners, insufficient dietary intake of vitamins A and C, immunodeficiencies and HIV infection.

According to international recommendations, all women should be screened (pre-symptomatic) for cervical cancer 3 years after the onset of sexual activity, but no later than 21 years. Starting at age 30, patients who have had 3 consecutive negative cervical smear results may be screened every 2-3 years. Women with risk factors (human papillomavirus infection, immunocompromised conditions) should continue annual screening. Women 65 years of age or older with 3 or more normal cervical smear results in the last 10 years may not be screened. For those who have recovered from cervical cancer, who have a papillomavirus infection or who have a weakened immune system, it is advisable to continue screening. Women who have had their uterus and cervix removed may not have this test if the operation was not due to cancer or a pre-cancerous condition of the cervix. Those who have had uterine-only surgery without cervical removal should continue to participate in screening.

Cytological examination of material from the cervix and external uterine os, stained according to the Papanicolaou method in compliance with the test procedure and conditions for preparing for analysis, allows with high sensitivity and reliability to identify atypical cells in the material, precancerous conditions (dysplasia, intraepithelial neoplasia of the cervix) . Most often, biomaterial obtained using a special cytobrush from two points (endocervix and exocervix epithelium) and fixed on a glass slide is examined 96% alcohol. Material from the transformation zone should get into the smear, since about 90% of neoplastic conditions come from the junction zone of the squamous and columnar epithelium, and only 10% from the columnar. In this study, signs of the presence of infection, pathology of the endocervix and endometrium can also be detected.

Screening and early diagnosis of precancerous conditions and early stages of cervical cancer allows for timely effective treatment and prevention of dangerous consequences.

What is research used for?

• For screening and diagnosis of cervical precancerous lesions.
• For screening and diagnosis of cervical cancer.

When is the test ordered?

• When periodically examining girls and women 3 years after the onset of sexual activity, but no later than 21 years (it is recommended to take an analysis annually and at least every 3 years).
• Every 2-3 years from age 30 to age 65 with three consecutive negative results.
• Yearly in the presence of human papillomavirus (HPV), immune system weakened by transplantation, chemotherapy, or long-term use of steroid hormones.

What do the results mean?

Bethesda ” The 2001 Bethesda System termin ology ”

1. Material quantity

• Complete material (adequate) – a good quality smear containing a sufficient amount of the appropriate cell types is considered a complete material.
• The material is insufficiently complete (insufficiently adequate) – there are no endocervix cells and/or metaplastic cells in the material, squamous epithelial cells are in sufficient quantity, or the cellular composition is poor.
• The material is defective (inadequate) – it is impossible to judge the presence or absence of pathological changes in the cervix from the material.

2. Interpretation of results:

• Negative Pap test – epithelial cells are within normal limits, the cytogram corresponds to age, normal.
• Benign changes – the presence of non-tumor cells, signs of inflammation (increased number of leukocytes), infection (a significant number of cocci, rods). It is possible to detect infectious agents (indicating the pathogen), for example Trichomonas, yeast.
• Changes in squamous epithelial cells (require increased attention, additional examination and treatment if precancer or cancer is detected):

• • Atypical squamous cells undertermined significance (ASC-US)
  • Atypical squamous cells cannot exclude (HSIL ASC-H)
  • Squamous intraepithelial lesion (SIL)
  • Low grade squamous intraepithelial lesion (LSIL)
  • High grade squamous intraepithelial lesion (HSIL)
  • Cervical intraepithelial neoplasia grade 1, 2 or 3, CIN 1, 2, 3
  • Carcinoma in situ (CIS)
  • Squamous cell carcinoma – invasive cancer

• Changes in glandular cells (require increased attention, additional examination and treatment if precancer or cancer is detected):

• • Atypical glandular cells (AGC)
  • Atypical glandular cells, favor neoplastic, AGC, favor neoplastic
  • Adenocarcinoma

Testing for oncogenic human papillomavirus serotypes is recommended if minimal changes or atypical cells of unclear significance are detected.

What can influence the result?

In girls younger than 20 years, false-positive results are possible due to the presence of changes in the epithelium against the background of transient hormonal disorders.

Important Notes

• There is a possibility of a negative test result with changes in the epithelium in the cervix, so it is important to have regular re-examinations.

Also recommended

• Cytological examination of smears (scrapings) from the surface of the cervix (external uterine os) and cervical canal for atypia
• Squamous cell carcinoma antigen (SCCA)
• Human Papillomavirus of high carcinogenic risk (types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59), DNA genotyping [real-time PCR]
• Human Papillomavirus of high carcinogenic risk (types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59), DNA quantification, no typing [real-time PCR]

Who orders the examination?

Gynecologist, oncologist.

Literature

• Apgar BS, Zoschnick L, Wright TC (November 2003). “The 2001 Bethesda System terminology”. Am Fam Physician 68(10): 1992-8. PMID 14655809.
• Arbyn M. et al. (2010). “European Guidelines for Quality Assurance in Cervical Cancer Screening. Second Edition – Summary Document”. Annals of Oncology 21(3): 448–458.
• American College of Obstetricians and Gynecologists, “ACOG Committee Opinion No. 483: Primary and Preventive Care: Periodic Assessments,” 2011, Obstet Gynecol, 2011, 117(4):1008-15. PubMed 21422880.
• Novik VI Epidemiology of cervical cancer, risk factors, screening.

Pap smear for HPV in Moscow – Prices for Pap test – Cost of a smear for HPV cytology

Pap smear for HPV in Moscow – Prices for a Pap test – The cost of a smear for HPV cytology

12/11/2020

Pap smear for HPV (Pap test) in gynecology

HPV oncocytology smear (Pap smear, Pap test in gynecology, Pap test, screening for cervical cancer, smear for cytology, smear for atypical cells) is the leading screening method for diagnosing diseases of the cervix, allowing to assess the condition of its mucous membrane , the presence of background changes in the epithelium, as well as atypical, precancerous cells and cervical cancer.

The “gold standard” of cytological diagnosis of cervical cancer in the world is liquid oncocytology – a modified method of cytological smear, when the biomaterial is transferred not to glass, as was done before, but entirely, together with a cytobrush, into a container with a liquid medium. After that, the composition is washed off by a special method from elements that impede cytological diagnosis (mucus, leukocytes, erythrocytes, detritus, inflammation elements), and the sample is subjected to microscopic examination.

It is important that the cytologist receives 100% of the collected material! This makes the study more accurate. Improving the accuracy of cytological diagnosis when performing a liquid Pap test for HPV is achieved by overcoming all the errors associated with the preparation of a smear.

Pap smear benefits

The advantages of this method are that its sensitivity is much higher than the traditional smear on glass and is 98%. All this makes the cytological examination of smears according to the Papanicolaou method more informative, and the conclusion reliable. As a result, the proportion of false-negative results of the cytological examination, which is carried out at the H-Clinic, is reduced, and the reliability of diagnosing diseases of the cervix in general is significantly increased.

The leading factor in the development of cervical cancer is the presence of oncogenic types of human papillomavirus in the cervical epithelium (in 99.7% of cases of cervical cancer, papillomavirus DNA was isolated from tumor samples). In this regard, currently used combined liquid Pap test for HPV , which allows you to assess not only the condition of the cervix at the cellular level, but also to identify the presence of papillomaviruses, indicating their type and viral load, because the activity of the virus and the degree of risk depend on it.

With the help of molecular biological methods, more than 100 serotypes of human papillomaviruses are identified, but at least 19 types are currently classified as oncogenic risk viruses:

• 16, 18 types are the most oncogenic, 70% of all cases of diagnosed oncology;
• 31, 33 – also belong to high-risk papillomaviruses;
• 30, 35, 39, 45, 52, 53, 56, 58 types – medium risk;
• 6, 11, 40, 42, 43, 44, 61 types – low risk.

For a long time, cervical cancer has consistently ranked 5th in the structure of oncological morbidity among women in Russia. In 2018, 17,766 cases were identified. Moreover, over the years, the growth rate of cases of this oncology is only gaining momentum. For 10 years, the indicator increased by 4.47% percent and the average growth rate was about 2.19% in year. In the same 2018, 6,392 women died of cervical cancer. Moreover, there is a clear increase in mortality in the age group among women 35-59 years old.

Thus, the picture is more than sad: every day we lose 17 young women from cervical cancer. The entire civilized world has been vaccinating its population against HPV for more than 15 years, critically reducing the risks of developing this disease (vaccination against the human papillomavirus in more than 100 countries is included in the national vaccination schedule).

In Russia, the vaccine is administered at the request of the patient (or the consent of the girl’s mother), in the list of mandatory vaccination (it is not yet included in the national Immunization Calendar.

Given the etiological factor of cervical cancer, the incidence and mortality figures in Russia, it is difficult to overestimate the vaccination of human papillomavirus infection. Vaccination eliminates the root cause, and screening reduces not only mortality, but also the incidence of cervical cancer, since thanks to modern diagnostic methods, the doctor can identify not only background processes that can lead to cancer, but also diagnose precancerous conditions and carry out the necessary treatment of an infectious disease in time .

Indications for Pap test in gynecology

According to current recommendations, screening for cervical cancer should begin within the first year after the onset of sexual activity, but no later than 21 years.

Women aged 21 to 29 should be screened at least once every 3 years by cytology alone (assuming 3 consecutive smears are free of atypical and intraepithelial changes). Women aged 30 to 65 years should have combined cytology plus HPV screening – typing at least every 1-5 years, or at least every 1-3 years if screening includes only cytology (also if there are 3 x consecutive negative smears for cytology (Pap test) and for HPV).

Screening in women over 65 may be discontinued as recommended:

• if there are three or more reported consecutive negative results in the last 10 years;
• with a negative HPV test;
• no aggravating factors:
  – a history of cervical disease;
  – immunocompromising diseases or conditions, for example, the presence of HIV infection, severe autoimmune diseases;
  – history of transplantation or chemotherapy.

Women who are HIV positive should have a Pap test as soon as possible after diagnosis. Also, screening for women with HIV infection should begin within the first year after the onset of sexual activity, regardless of the mode of transmission of HIV infection, but no later than 21 years.

Further, with a negative Pap test (absence of intraepithelial and / or malignant changes), the next Pap test with a transcript of the test results should be carried out at least 6-12 months later.

If the results of 3 registered consecutive smears are without atypical and epithelial changes, repeated cytological smears should be performed at least after 3 years.

Further, with a negative Pap test (absence of intraepithelial and / or malignant changes), the next Pap smear should be performed at least 6-12 months later.

If the results of 3 registered consecutive smears are without atypical and epithelial changes, repeated cytological smears should be performed at least after 3 years.

Combined HPV-PAP testing, according to current recommendations, should be carried out in women from 30 years of age and older.

Also, according to the recommendations, with a negative PAP test and an analysis for HPV infection, women over 30 years old are allowed to undergo an HPV-PAP test every 3 years.

With a negative PAP test, but the presence of human papillomavirus infection (with the exception of 16 or 16/18 types), women with HIV-positive status should undergo a liquid HPV-PAP test at least once every 12 months.

HIV-positive women should be screened for oncocytology and HPV typing throughout their lives.

If HPV types 16 or 18 and / or atypical epithelial changes are detected, colposcopy is necessary – visually examine the epithelium of the cervix at a 7.5–40-fold increase. A correctly assessed colposcopic picture allows you to identify the affected area and perform a targeted biopsy of the suspicious area of ​​​​the cervix. In the future, after receiving a histological result, the doctor decides on further tactics and algorithm for the management and treatment of HPV and / or cancer.

Papanicolaou stain

How to prepare for testing

Preparing for a Pap smear from the cervix is ​​simple and easy:

• It is not recommended to take a Pap test during menstruation and no later than 5 days before it;
• Avoid sexual activity for 48 hours prior to study;
• Do not perform within 24 hours prior to vaginal ultrasound examination;
• Do not use vaginal forms of drugs/remedies within 24-48 hours prior to the study;
• It is not recommended to take a Pap test in the presence of sexually transmitted infections, microflora disorders and inflammation of the vaginal mucosa, as well as during the treatment of these diseases.