Pap smears (柏氏抹片), also known as the Pap test, Cervical Smear , are an effective preventative measure for women against cervical cancer. According to the World Health Organization, the Pap smear is the only test used in large populations that have been shown to reduce cervical cancer incidence and mortality.[1] This article aims to answer many of the common questions and concerns regarding Pap smears.
A Pap smear is a procedure that checks for the presence of cancerous and precancerous cells from the cervix.[2] It should be considered as a health screening that allows for interventions to prevent cervical cancer and not as a diagnostic test for cervical cancer.
The test is considered an efficient tool for routine cervical screening by proficiently detecting the presence of abnormalities on a woman’s cervical tissue. At OT&P, we also offer pap smear for domestic helpers.
A Pap smear shouldn’t be painful. However, it can be uncomfortable, and the sensation has often been described as a soft pinch.
The doctor or nurse will insert an instrument (called a speculum) into the vagina to visualise the cervix. A spatula or brush will then be inserted through the speculum to collect cells for further microscopic examination.[3]
To ensure that the test is most effective, it’s usually recommended that:
Your doctor will also inform you about any prior preparations required for a Pap smear examination.
Pap smears are usually done by a nurse or doctor. In an OT&P clinic, this procedure is performed by our gynaecologists and family doctors.
The entire Pap smear procedure should take less than 20 minutes. At OT&P, we schedule a 30-minute appointment for a consultation, pelvic exam and pap smear.
Pap smear results indicate the current risk of cervical cancer, and an HPV result can predict the future risk of cervical cancer. Interpreting both results together will provide a clear indication of risks and is a more effective screening method for cervical cancer.
HPV is the name for a very common group of viruses. Most people will get some HPV during their lives as it’s a common virus. It should not be something to feel ashamed or embarrassed about.
You can get HPV from any kind of skin-to-skin contact of the genital area and not just from penetrative sex. For example:
Some types of HPV (called "high risk" types) can cause cervical cancer. In most cases, your body will get rid of HPV without causing any problems. But sometimes HPV can stay in your body for a long time.
If high-risk types of HPV stay in your body, they can cause changes to the cells in your cervix. These changes can develop into cervical cancer if not treated.
If you do not have a high-risk type of HPV, it is highly unlikely you will get cervical cancer, even if you have had abnormal cell changes in your cervix before.
The Hong Kong Government has the following recommendations for Pap smears:[5]
If in doubt, please consult your doctor.
Yes, you can get HPV the first time you are sexually active. If you have the same partner or not had sex for a long time, you can still have HPV without knowing it.
Yes, you are at the risk of HPV and cervical cancer if you have had any sexual contact.
If you had a partial hysterectomy and the cervix was not removed, you will still need a pap smear.
This depends on your age and the previous results of your pap tests & HPV tests.
The general guideline follows screening at three-year intervals for pap smears and five-year intervals for a combination of pap smears and HPV tests, frequent enough to pick up changes in the cervix.[2] This is also subject to the results of previous Pap smears. It's best to consult with your doctor on a case-to-case basis for how frequent you should receive a Pap smear.
In Hong Kong, Pap smears are available through both the public or private healthcare systems. We recommend that you check with your preferred healthcare provider beforehand for availability.
A Pap smear can have one of two results: normal (negative) and abnormal (positive).
A normal Pap smear result shows that all cells collected during the examination are within the normal limits with no abnormalities present. Around 90% of pap smears result fall under normal reading.[5]
An abnormal test result shows that there are changes in the cells of your cervix, but it does not necessarily indicate cancer.[6] This result means that further testing is necessary. Anomalies sometimes occur during the Pap smear examination, and your doctor will advise on any necessary follow-ups.
An abnormal result can be due to various reasons, not necessarily from cancer. This can be from Low-Grade Squamous Intra-epithelial Lesion (LGSIL), High-Grade Squamous Intra-epithelial Lesion (HGSIL) to cervical cancer (CA Cervix).[7] Another Pap test will likely be done to verify the results[8].
If you have not had an HPV test, then your doctor may order one. They may be able to do this on the cells already taken during your pap smear test. Your doctor may also recommend a colposcopy for further investigation. This procedure is a detailed visual examination of the cervix using a microscope.
In some cases, your doctor may also want to perform a LEEP (Loop Electrosurgical Excision Procedure) when colposcopy results read abnormal to remove these atypical cells from the cervix. The doctor may also take tiny samples of tissue from the cervix, also known as a biopsy. Tissue from the biopsy will then be sent to a lab for further testing.
Although the abnormal cells are removed, it is important to continue doing smears afterwards to detect any future changes!
- Dr Zara Chan, Obstetrician and Gynaecology, OT&P Healthcare