Michael Abrahams | The Pap smear made simple
Cervical cancer continues to be a major health issue. Worldwide, it is both the fourth-most common cause of cancer and the fourth-most common cause of death from cancer in women. But the malady is easily avoidable.
The Pap smear is a test that has saved countless lives, and can save many more if barriers to the screening method are removed and more women understand the simplicity and effectiveness of the procedure.
A Pap smear is a simple test to assess cells from the cervix (the neck of the womb) and check for abnormalities that can develop into cancer. The cervix can be found at the upper end of the vagina. If a middle finger is inserted all the way into the vagina, a firm mass with the consistency of a nose, with a depression in the centre of it, will be detected. This is the cervix. This is what blood and tissue from the lining of the uterus pass through during menstruation, and what dilates, or opens out, to enable a baby to leave the uterus during labour and delivery.
During a Pap smear, an instrument made of stainless steel or plastic called a speculum is inserted into the vagina. I have heard women call it ‘nunni jack’, ‘ice cream scoop’ and ‘spectrum’, among other things. The purpose of the speculum is to enable the person performing the Pap smear to visualise the cervix.
The front and back walls of the vagina are usually in contact, and the blades of the speculum separate them. The cervix cannot be seen unless the vaginal walls are parted. No matter how skilful or talented a woman is, if she has normal pelvic anatomy, she cannot just ‘skin out’ and present her cervix for inspection. It does not work like that.
Also, the speculum is not only used for Pap smears, but is also utilised during gynaecological examinations to inspect the vaginal walls and the cervix. So, if a speculum is inserted into your vagina, please do not assume that a Pap smear was done.
Ladies, do not hate the speculum. It is your friend. Some women have suggested to me that they should be made in the shapes of penises, making them friendlier to the vagina. An interesting concept, but some women may enjoy the procedure a bit too much, especially if the examiner is nervous and his or her hand shakes during the examination. Also, the vaginas of lesbians would protest.
Once the cervix is identified, it is time to take the specimen. Usually a small brush, a spatula (a device made of wood or plastic shaped like a hand with a pointing index finger) or a broom-shaped device, or combinations of these, are used for specimen collection. The aim is to obtain cells from the cervix.
Cells make up the tissues in our bodies in the same way that bricks make up the walls in a building. The cervix has a small opening, one that usually would accommodate the end of a Q-tip swab, and it is into this orifice that the devices are placed and rotated to obtain cervical cells. Contrary to some of the stories that I have heard, nothing is ‘pulled down’ or ‘pinched off’. My colleagues and I are not ISIS operatives. We are here to help you.
After the specimen is taken, it is smeared on a glass slide (hence the term Pap ‘smear’). Incidentally, the word ‘Pap’ does not refer to any sound effect made when the test is performed, but is named after the Greek physician, Georgios Papanikolaou, whose observations led to the test being widely used. If you see the doctor or nurse spraying something on the slide after the test is taken, please do not be offended. It is not insect spray to kill crab lice, but rather a substance known as a fixative, which is used to preserve the cells. If the specimen is left on the slide and dries after contact with air, before being fixed, the sample will be ruined.
The slide is sent to a lab where it is stained with dye and a person known as a cytologist reads it. The cytologist uses a microscope to look at the cells and reports on the findings. The Pap smear can detect cancer cells, but its main use is to detect abnormal cells that can later become cancerous. It takes an average of 11 years for a normal cervix to become cancerous, so if you are getting Pap smears done at regular intervals, you should never get cervical cancer. Also, though not intended for this purpose, the Pap smear can also detect certain infections as well. It cannot, however, detect fibroids or infertility.
If your result is abnormal, you may either be asked to repeat the test in a few months’ time or to undergo a minor procedure known as colposcopy, where the cervix is inspected in greater detail, and the abnormal areas, if any, removed, thereby preventing the development of cancer.
How do we know that the Pap smear works? Countries that have organised screening programmes have significantly lower rates of cervical cancer than countries that do not. So, if you are a woman who is over the age of 21 years and has never had a Pap smear, or your last test was more than three years ago, and you still have a cervix (it is usually removed at hysterectomy, the operation used to take out the uterus), please visit a general practitioner, gynaecologist, clinic, health centre or branch of the Jamaica Cancer Society and sort yourself out. Prevention better than cure.
Michael Abrahams is an obstetrician and gynaecologist, comedian and poet. Email feedback to firstname.lastname@example.org and email@example.com, or tweet @mikeyabrahams.