The Pap test, or Pap smear, is so named in honor of its inventor, a Greek doctor called George (Georgios) Nicholas Papanicolaou (1883–1962).
He researched abnormal mutations in the cells of the female reproductive system.
His work focused on examining smears of cervical tissue — the cervix is the lower, narrow part of a woman's uterus — to screen for potential warning signs related to gynecological health.
Papanicolaou was not the first researcher to collect cells from the cervical area, or to note that these cells could be screened for telling abnormal mutations. A Romanian doctor called Aurel Babeş had previously come up with a similar method of collecting cells from cervical tissue.
However, "[T]he two methods were viewed to be substantially different," and ultimately the credit went to Papanicolaou.
What is the Pap test for?
Through the Pap smear, cells are collected from a woman's cervix for analysis. These are screened for any unusual results, as mutations might indicate the presence of the human papillomavirus (HPV), which is a major risk factor for the development of cervical cancer.
HPV is a very common sexually transmitted infection, and it can be contracted via sexual contact (vaginal, oral, or anal) with someone who is already infected.
In many cases, HPV will be eliminated naturally by the body's immune system within 1 or 2 years from infection, without causing any further health complications. In some cases, however, it can linger in the body, causing genital warts, or leading to cervical cancer.
The Pap test is used to detect any changes that may occur at cellular level, and to determine whether or not they are indicative of precancerous lesions, which have a high probability of developing into cancerous tissue.
According to the Centers for Disease Control and Prevention (CDC), in 2014, 12,578 women were diagnosed with cervical cancer in the United States, while the American Cancer Society (ACS) estimate that approximately 13,240 new cases will be diagnosed in 2018.
There are several types of treatment and intervention available for cervical cancer, but for these to be most effective, it is crucial to spot it as early as possible. This is why getting smear tests as advised is so important.
A Pap test can detect cells in their precancerous stage, which can allow the implementation of a preventive treatment. In addition to detecting precancerous lesions, the test can also help to spot any other issues that may appear in the cervical or vaginal area, such as infections.
How is a Pap test performed?
The Pap test is performed with the help of a special medical tool called a "speculum," which allows the practitioner to open up the vaginal canal, so that the cervix can be seen. A sample of cells is then collected from the cervix with a brush or a special tool called a "scraper."
This sample-taking procedure is what women are usually most afraid of or embarrassed about. This is a natural reaction, given that a person you don't know gets to insert a cold and uncomfortable instrument into your vagina and then scrape away at your cervix.
As hair-raising as that might sound, most accounts of undergoing the Pap smear speak of some discomfort, but definitely nothing like the horrors that some of us may imagine.
A slight discomfort that's definitely worth it
When I asked my female colleagues about their experiences on the ob-gyn exam table, the stories they shared spoke of bearing a little discomfort for a couple of minutes, and reaping much larger health benefits in the long run. One colleague said:
"I've been having Pap tests since my early 20s (by request), and I'm so glad I did. I had some abnormal cells that had to be removed. I fear that if I hadn't had the test early, these cells could have become cancerous. In terms of discomfort, I don't think it's as uncomfortable as some women perceive it to be, and it's over so quickly."
Another colleague — while admitting that she "can't say that [she] look[s] forward to having a Pap test" — certainly thought that the benefits "outweigh the short period of discomfort that they cause," as the test can identify a problem even when you don't experience any symptoms.
"On one occasion," she explained, "my ob-gyn found a small patch of infection on my cervix, even though I hadn't felt any discomfort. She nipped it in the bud, it was really worth it."
Her main advice to ladies undergoing a Pap test for the first time was to try their best to relax, so as to minimize any potential discomfort.
"Having had [Pap tests] in several different countries it all boils down to staying as relaxed as possible, getting in a comfortable position, and taking a few deep breaths," she said.
After the cell sample is collected, it is sent over to the laboratory for analysis. The National Cancer Institute say that in the U.S., the conventional way of transferring the tissue sample directly onto a glass slide has largely been replaced by liquid-based cytology testing.
This method, which requires transferring the cells into a liquid preservative, is meant to be much more effective when it comes to preserving the overall sample quality. This will also reduce the possibility of a woman having to retake the test so the practitioner can obtain better samples.
How often should I get a Pap smear?
Following current guidelines, women should start getting tested from the age of 21. Up until 2012, physicians used to recommend that women undergo smear tests once per year, but the current recommendations suggest a longer time gap between Pap tests.
The CDC note that women aged between 21 and 30 should get the Pap test done once every 3 years if no points of concern are raised, and women between 30 and 65 could get tested once every 5 years.
Women over 30 years old can also get a separate HPV test done alongside their Pap smear. This is a DNA test dedicated to identifying HPV 16 and HPV 18, two high-risk types of the virus that are usually responsible for the development of cervical cancer.
After the age of 65, Pap tests should be done only if there are unusual gynecological symptoms and the physician calls for further investigations.
Remind me again, why get tested?
Many women are at risk of cervical cancer, even if they don't think that they are. A recent article by the CDC's Division of Cancer Prevention and Control Senior Service Fellow stresses that women may not necessarily feel any symptoms even if they are infected with HPV, which is the main risk factor for this type of cancer.
Moreover, a family history of cervical cancer does not predict your likelihood of developing this condition.
Other common risk factors for cervical cancer include a smoking habit, the long-term use of contraceptive pills, an active sexual life, and having given birth repeatedly.
A study published last year in the journal Cancer also showed that the rate of death due to cervical cancer among women is worryingly on the rise.
According to data reported by the authors, in recent years, there has been a 47 percent increase in the rate of death due to cervical cancer among white women aged 55 to 59 in the U.S. Among black women in that same age group, the increase was even higher, at 72 percent.
So ladies, don't put it off any longer; Pap smears won't be the most pleasant experience, but who cares — as long as they help us to go forward in good health and with confidence.