Cervical Smear (Pap Smear) Test

How does cervical cancer affect women?

According to statistics, cervical cancer is one of the ten killer cancers for women in Hong Kong. More than a hundred women die of this disease every year. Women with early stage cervical cancer do not have symptoms. If the condition goes on undetected, it may become a fatal disease.

Who are more likely to have cervical cancer?

Women who are sexually active, have multiple sexual partners, smoke, have history of sexually transmitted disease, or have early sexual life in their teens will have a higher chance of having cervical cancer.

What is a cervical smear test?

Cervical smear test is also called Pap smear test. It is a simple and effective method to detect abnormal cervical cells which may progress to become cancer cells. These pre-cancer conditions are called cervical intraepithelial lesions (CIN) or squamous intraepithelial lesions (SIL). If these conditions are found early, they can be dealt with by simple treatments so as to avoid the need for hysterectomy, chemotherapy or radiotherapy, and the treatment is often very effective with a high cure rate.

Who should have the cervical smear test?

Because of the strong relationship between cervical cancer and sexual activity, women who have ever had sex should undergo testing from the age of 25. If the initial test result is normal, she should have another test 1 year later. If both consecutive tests are normal, she can have routine tests every 2 to 3 years.

How is the cervical smear test done?

The cervical smear test is a simple, fast and safe procedure. The doctor will put a speculum into the vagina during a gynaecological examination. A plastic brush will be used to take some cell samples from the cervix for examination in the laboratory.

Implication and follow up of test result

  Normal: No abnormal cells identified, routine cervical screening as advised by doctor.

  Unsatisfactory: Insufficient cells or suboptimal smear specimen, need to repeat the test.

  Normal, inflammation seen: No abnormal cells identified. Inflammation is very common and the tissue usually recovers itself, routine cervical screening as advised by doctor.

  Normal, micro-organism seen: No abnormal cells identified. Micro-organisms may cause vaginitis. If there is no sign or symptom, there is no need for treatment because the normal flora in the vagina may counter-check other micro-organisms.

  Atypical squamous cells of undetermined significance (ASCUS): There are some borderline cell changes. It may be due to vaginitis or infection by human papillomavirus (HPV). Most of the HPV infection-related ASCUS will revert to normal in 2 years. Persistent infection can lead to more serious cell changes. Advise to perform the HPV DNA test to see if colposcopy is needed, or to repeat Pap smear test in 3-6 months.

  Low grade squamous intraepithelial lesion (LGSIL): Mild cell changes. Most of the cases are due to infection by HPV. About 80% of cases will revert to normal in 2 years. Advise to undergo colposcopy and biopsy. Treatment may be necessary.

  High grade squamous intraepithelial lesion (HGSIL): Moderate or severe cell changes. 1-2% of cases will become invasive cancers. Advise to undergo colposcopy and biopsy. Treatment will be necessary.

  Cervical intraepithelial neoplasia (CIN): Cells suggestive of pre-cancer, advise colposcopy and treatment if necessary.

What to do if the cervical smear test report is abnormal?

If the smear test report is abnormal, a special examination called colposcopy and cervical biopsy will be performed to assess the severity of the abnormality. Most of these pre-cancer conditions (CIN or SIL) can be treated with a minor surgery called Large Loop Excision of Transformation Zone (LLETZ) or loop electrosurgical excision procedure (LEEP). This procedure will not affect the women’s sexual life, and she can have family after the surgery. If the examination shows the presence of cancer, she will then need surgery or radiotherapy.

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