The PAP smear is a 70 year old test that has been used successfully since World War II to reduce the numbers of women who get cervical cancer. This used to be the leading cause of cancer death for American women but is now a cancer that is no longer even in the “top 10″. In order to achieve this reduction in death (and disability) from cervical cancer it is necessary to have an effective screening program.
Today we understand that cervical cancer is caused by a viral infection (HPV). Only certain strains of HPV cause cervical cancer. New tests to detect the strains of HPV which cause cervical cancer in the cervical mucous itself have tremendously improved our ability to determine which woman is actually at risk for cervical cancer. The sample taken for an HPV test is the same sample that is taken for the PAP test, but the test run on that sample is different.
In order for a woman to develop cervical cancer the HPV infection has to be present for many years, probably at least 10. Screening for cervical cancer has been improved by using the HPV test instead of a PAP smear. The PAP smear is not a very accurate test, but in times past this was the only screening tool we had available.
If the HPV test is negative future cervical cancer screening needs to be done at less frequent intervals than was necessary when the PAP smear was used as the primary screening tool. Management of these issues is highly individualized and recommendations for cervical cancer screening depends on the woman’s personal sexual histroy and other medical problems. If a woman does have increased risk for cervical cancer this often is evaluated further by a procedure known as ” colposcopy”. This procedure consists of actually inspecting the cervix under magnification using a microscope to veiw the cervical surface.
Cervical biopsies are usually taken to determine the severity of the problem and are part of the information necessary in order to make treatment recommendations. Most of the time any necessary treatment can be performed in the office and consists of freezing(cryocautery) or shaving the surface of the cervix (LOOP Excision).