Pap smear

A pap smear also known as the Pap test or cervical smear test is done to detect any possible signs of cancer of the cervix. The test was invented by Dr Georgios Papanikolaou. This test helps the doctor to predict those women who are prone to cancer and thus help avoid it. Cell samples are taken from the vagina, the endocervix (place where the cervix and the lining of the uterus joins) and the exocervix (opening of the cervix) to carry out the test. A special instrument called the speculum is inserted into the vagina thus enabling the cervix to open. A negative pap smear can prove that you are normal. A positive test result will indicate that the cells in your cervix are undergoing a number of changes. A positive pap smear can indicate:

• Inflammation or infection of the cervix which can be due to yeast or herpes virus or any other infection.
  
• Very early signs of cervical cancer or dysplasia.
  
• Severe signs of cancer.
  
• Advanced stage of cancer.

Pap smears must be undertaken by all women above the age of 18, especially those with an active sex life. If there is any strange vaginal discharge, a pap test is usually recommended. Typically the cells collected from the cervical region are placed on a slide and sent for detection of abnormality. Cells can also be transferred through a special liquid.

Colposcopy

Colposcopy is a diagnostic tool that is often followed after an abnormal Pap smear test. A Colposcope is much like a large electric microscope that allows the physician to visualize the cervix, vaginal and genital area.

Basically a Colposcope is a complex optical instrument using light and magnification to distinguish dysplasia and cervical cancer from benign cervical findings. The word Colposcope is derived from 'colpo' indicating a vagina and 'scope' which refers to 'look'.

The physician applies vinegar solution to look for Leukoplakia and abnormal vessels. Colposcopy aids in viewing the cervix for any abnormal vascular changes. A colposcopy is suggested when there is any abnormality observed in the cervix or there is evidence of HPV. With a camera attached, images can be saved for records. During this procedure, any tissue sample or cervical biopsy can be taken for further investigation. This may cause slight discomfort and cramping. This diagnostic tool can be helpful in detecting any inflammation, cancerous growth or infection.

Preparation before colposcopy: Some conditions may require some medications before a session of colposcopy. Atrophic vaginal or cervical epithelium can be treated with intravaginal estrogen for 2-4 weeks before colposcopy in order to 'normalize' the epithelium.

Primary indications for colposcopy include abnormal Pap results or an abnormal appearing cervix. Early detection of cervical cancer is possible with colposcopy. Colposcopy is done in cases where a woman has unexplained bleeding during intercourse or there is any abnormal tissue on the cervix, vagina or vulva.

The Papanicolaou smear (Pap smear or Pap test) is a common test for dysplasia and cancer of the uterine cervix. In the US alone more than 50 million Pap Smear tests are taken every year. The Pap test is a cytologic examination of cells from the cervical transformation zone. A Pap test is often used to differentiate malignant cysts from common and mostly benign cysts. For example, Nabothian cysts are common and considered as a normal feature of the adult cervix.

A pelvic examination can sometimes help detect cysts and polyps. Endocervical polyps are the most common benign neoplasms of the uterine cervix. They are usually asymptomatic (but sometimes may cause vaginal discharge or post coital spotting) and occur in the 40 - 60 years. Most polyps are benign and the incidence of malignancy is approximately 1 in 1000.

Roche DNA Test

Recently the Federal health, Food and Drug Administration regulators in the US cleared the Roche HPV test to detect the Human Papillomavirus in women aged 25 and above. Roche's is primarily a genetic test that could be done as a first-choice screening option for cervical cancer. This is an advance on the decades-old Pap smear.

Roche diagnostics conducted a study that provided the FDA with reasonable assurance of the safety and effectiveness. Roche's trial included 47,000 women who underwent cervical screening using either Pap or HPV screening. The results were checked for accuracy against final biopsy results that confirmed whether they actually had cancer.

As such doctors use DNA-based tools as a follow-up to confirm Pap smear results. Now, Roche DNA test can be used as a first-choice option for cervical cancer screening, ahead of the Pap test.

The FDA approval comes despite warning from health advocates that approving the DNA test as an alternative to Pap could lead to confusion, higher costs and over treatment of younger women who carry the virus that have little risk of developing actual cancer.

While Roche supported its study results suggesting that genetic testing is more accurate and objective at identifying cancerous growth than the Pap smear, there are no major medical guidelines that recommend HPV testing alone for cervical cancer screening. Some physicians and gynecologists advice holding off using the test until medical societies can provide guidance to some key questions which include how frequently it should be used.

Pap test was the only available screening option for cervical cancer for decades. Due to increased Pap screening, in the US, the number of reported cases of cervical cancer has decreased more than 50 percent in the past 30 years. Yet, an estimated 12,000 cases of cervical cancer are expected to be diagnosed this year. Hence Roche and other test markers developed HPV tests – although the cost of Roche's HPA is twice and even more as that of the Pap which is $ 40.

The American Cancer Society has tried to evolve latest guidelines incorporating both techniques. A Pap test is recommended every three years for those aged between 21 and 29 years of age and older women should have both a Pap test and an HPV test every five years, or only a Pap every three years. Also, according to FDA, women who test positive for HPV 16 or 18 should proceed directly to colposcopy, which is an invasive procedure in which the cervix is viewed with a magnifying device and often tissue sample is collected for testing. A positive test for one or more of the other 12 high-risk HPV strains should be followed by a Pap test to determine the need for colposcopy.

As women in their 20s could be exposed to the danger of more invasive testing that could leave the cervix less able to handle pregnancy later in their life if they undergo a HPV screening, they are advised not to do so.

Roche DNA test claims to have the superior ability to detect HPV DNA and individual types. It is also capable of detecting HPV genotypes present in multiple infections. This can occur in up to 35% patient samples. It uses standardized and quality controlled reagents to do the test. Due to co amplification primer concentrations are used. This minimizes competition.

It helps identify women at risk and optimizes treatment strategies. It helps further stratify women with normal cytology who are HPV positive into different categories. The test also provides physicians with actionable information to treat the highest risk patients immediately.