Pap smear test, also called vaginal smear, cervical smear, cervical smear, is called smir (pronounced in our language)in daily practice and is called cervical (cervix). It is a test used to screen for cancer. In our article, we will briefly refer to this test as smear.
The main purpose of the smear test is to collect the shed cells from the cervix to be examined under the microscope. The cervix is the lower and narrow part of the uterus, located in the upper part of the vagina and providing the connection between the uterus and the vagina.
Early diagnosis of cervical cancer or its precursor findings is made with the smear test. Thus, it provides a great chance for treatment. Cervical cancer occurs after a long period of latent disease. Smear screening is very important in recognizing this period and has been found to reduce deaths due to cervical cancer by 72%. As with all cancers, early diagnosis is lifesaving in cervical cancer. Early detection of abnormal cells with smear is the first step to stop the process before cancer occurs.
Cervical cancer has become one of the preventable cancers with smear screening and is very important for women's health.
WHY IS SMEAR DONE
As mentioned above, smear is performed for the purpose of screening and preventing cervical cancer. This test can be combined with the HPV (Human Papiloma Virus) test in women over the age of 30. HPV is a virus that is most commonly transmitted sexually and some types of which can cause cervical cancer in women.
WHO SHOULD PERFORM PAP SEMAR?
Smear test is generally recommended for women over the age of 21. However, if the doctor deems necessary, this test can be repeated at earlier ages and at different frequencies.
HOW OFTEN SHOULD PAP SMEAR BE DONE? p>
Between the ages of 21-65, a smear test every 3 years is generally recommended. If it is combined with the HPV test, the frequency of the smear test can be reduced to every 5 years.
However, if there are some risk factors, smear tests can be performed more frequently, regardless of age. These risk factors are as follows;
- Presence of cells that are likely to turn into cancer in a previous smear test
- AIDS infection
- Transplantation, Weakening of the immune system due to chemotherapy or long-term steroid use.
Smear smear in pregnant women is performed safely in the first 3 months. Although there may be slight staining due to the procedure, this does not lead to miscarriage.
WHO MAY NOT HAVE SMEAR?
In some cases below, a smear test may not be performed;
- In hysterectomy, the cervix is usually removed completely together with the uterus. Women who have this surgery should ask their doctor whether they will continue to have a smear test in the future. If the uterus has been removed due to myoma or similar reasons, there is generally no need for smear follow-up. However, if surgery has been performed due to cervical cancer or precancerous processes, smear follow-up may be recommended.
- If previous smear tests are normal, smear screening is generally not recommended after the age of 65.
First There may be different practices in different countries and different clinics regarding the screening age, frequency and the population to be screened. What is important here is the doctor's decision and each patient is evaluated in terms of his/her own risk factors in terms of screening age and frequency.
HOW RELIABLE IS SMEAR?
Smear test is a very reliable method for cervical cancer screening. However, it still does not detect100%every cervical cancer. Rarely, abnormal cells may be found even though the smear result is normal.
This does not mean that a mistake has been made. In the following cases, abnormal cells may not be detected by smear
- When taking the smear, few cells enter the sample
- The number of abnormal cells is quite low
- Abnormal cells with blood or inflammatory cells Covering the items
Sometimes abnormal cells may not be detected in the smear. However, if regular follow-ups are made, time works in the patient's favor. Because cervical cancer develops over years and abnormal cells that cannot be detected in the first smear are detected in the next smear.
THINGS TO CONSIDER WHEN GOING FOR A SMEAR TEST
Increasing the accuracy of the smear test. You need to pay attention to some points before going for the test.
- It is necessary to avoid sexual intercourse, vaginal douche, vaginal suppositories and creams until 2 days before the smear test. Because these procedures reduce the possibility of detecting abnormal cells.
- Smear test should be avoided during menstrual bleeding. Because blood cells can also make it difficult to detect abnormal cells.
HOW TO TAKE A SMEAR TEST?
Smear test is a very simple and painless procedure. It can be done even in office conditions. The test is taken on the gynecological table and in the gynecological examination position. First, an instrument called a speculum is placed in the vagina and the vaginal walls are separated from each other. Thus, the cervix becomes more visible. Then, the doctor takes a swab from the cervix with a plastic brush or spatula. The cells to be examined are in that swab. There is no cutting or tearing during the procedure. Therefore, it is completely painless.
AFTER SMEAR?
After having the smear test, you can return to your daily activities. Depending on the method applied, the collected cells are either placed in a special liquid (liquid-based smear) or spread on a thin glass (classical smear) and sent to the laboratory. Samples are examined under a microscope in the laboratory to search for cells that may be cancerous or cancer precursors. These procedures do not take long and the result of the test is usually available within a few days.
HOW ARE SMEAR RESULTS REPORTED?
Smear your doctor for suspicious cases that require further examination. warns.
Normal result; It shows that there is no abnormality in the cells. This means that no treatment or further examination is required. There is no need to do anything else until the next smear time. In this situation est is called negative. However, the word “negative”here is not an expression of negativity.
Abnormal result; means that abnormal or unusual cells have been detected. In this case, the test is called positive. However, this result does not mean that the patient has cervical cancer. The result is interpreted according to the type of abnormal cells detected.
The common diagnoses you may hear in abnormal results and further investigations to be done are as follows;
ASCUS (Atypical Cell of Unknown Significance): Uterus There are superficial squamous cells, called squamous cells, that normally cover the mouth. It indicates abnormality in these cells. However, this abnormality does not mean that there are precursor cells. In this case, an additional HPV test can be performed to investigate the presence of viruses that may cause cervical cancer. If high-risk viruses are not detected, there is no need to worry and the smear is repeated after 4-6 months. However, if high-risk HPV virus types are detected, further investigation is necessary.
SIL (Squamous Intraepithelial Lesion): This diagnosis suggests that the cells collected in the smear may be precursors of cancer. and requires further examination. Based on the shape, size and other characteristics of the cells, SIL is divided into two groups as high and low grade.
- Low grade SIL, cervical cancer development over the years.
- High-grade SIL indicates that the probability of developing cervical cancer at a much earlier stage is quite high.
Atypical Glandular Cells: Glandular cells are gland cells and secrete a clear sticky fluid called mucus. These cells are located in the inner lumen of the cervix and the uterus. Changes in these cells do not mean cancer, but further investigation is necessary.
Squamous Cell Cancer or Adenocarcinoma: When these cells are seen, the diagnosis of cancer is certain. Squamous cell cancer indicates that cancer has developed from the superficial cells covering the cervix or vagina. Adenocarcinoma indicates that cancer has developed from gland cells. In these cases, examination and treatment should be started immediately.
When the smear result is abnormal, further investigation is usually performed with a procedure called colposcopy. The cervix is examined with an optical device called a colposcope, by enlarging the image and staining the tissue. A biopsy is performed from the suspicious areas and a piece of tissue is taken and this piece is examined for a definitive diagnosis.
In light of all this; Pap test is a very important screening test and saves lives. For these reasons, it is a test that must be performed without interruption.
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