What is a Pap smear?

In 1928, Dr Papanicolaou discovered that cells in the cervix change in appearance before they become cancerous. The Pap smear, named after the doctor, is used to check changes in the cervix (the neck of the womb) at the top of the vagina. It is a screening tool to find early warning signs that cancer might develop in the future.

The Pap smear is a simple procedure. Cells are collected from the cervix and placed (smeared) onto a slide. The slide is sent to a laboratory where the cells are tested for anything unusual. If abnormal changes are found at screening, further tests will be done to see if treatment is needed.

The Pap smear is not for diagnosing cancer, but rather, for finding early changes which might become cancer.

A Pap smear only takes a few minutes. No drugs or anaesthetics are required and it can be done by a general practitioner, nurse or women's health worker.

The Pap smear does not check for other problems in the reproductive system. It is not a check for sexually transmitted infections. Women who are worried that they may have a sexually transmitted infection should talk to their general practitioner about the tests and treatments available.

What are the symptoms of cervical cancer?

In the early stages of cervical cancer, there are usually no symptoms. The only way to detect changes is if you have a Pap smear.

If you have any abnormal vaginal bleeding (such as intermittent bleeding, bleeding after sex or after menopause), abnormal or persistent vaginal discharge (bloody or offensive), or pelvic pain, you should see your general practitioner.

Who is at risk?

The risk of developing cervical cancer increases with age. All women with a cervix who have ever had sex at some time in their life are at risk of cervical cancer. About half the new cases of cervical cancer diagnosed each year are in women over 50 years of age. Women in this age group are less likely than younger women to have regular Pap smears. More women over 50 years of age die from cervical cancer because their cancer is diagnosed later when treatment is more difficult.

What is the cause of cervical cancer?

Human Papilloma Virus (HPV), a sexually transmitted infection which in most cases (80%) is cleared by the body’s immune system in 8-14 months. The presence of HPV may be detected by the Pap smear. Some women who have persistent infections may develop abnormalities of the cervix. This is why it is important to have a regular Pap smears.

How effective is the Pap smear?

Regular Pap smears every two years can help prevent up to 90 per cent of the most common type of cervical cancer.

Like all screening procedures, the Pap smear has limitations. Sometimes it will not detect early cell changes because the smear did not contain enough abnormal cells. Sometimes samples are difficult to interpret due to blood or mucus on the slide.

How often should I have a Pap smear?

All women over 18 who have ever had sex are advised to have a Pap smear every two years, even if they no longer have sex. If a woman starts sexual activity at a younger age, screening should start within two years of first sexual intercourse.

As the most common type of cervical cancer usually takes up to 10 years to develop, there is little advantage in having a Pap smear more frequently than every two years.

Your general practitioner may recommend more frequent Pap smears if a previous smear showed significant cell changes or you experience problems, such as bleeding or pain after sex.

I’ve been through menopause; do I still need to have a Pap smear?

Yes, the risk of getting cervical cancer increases with age so it is important to keep having Pap smears every two years, even after menopause.

Should I have a Pap smear if I have had a hysterectomy?

If your hysterectomy was only partial, and your cervix was not removed, you will still need to have a Pap smear every two years. If you have had a total hysterectomy, that is, your uterus and cervix have been removed, you may still need to have a Pap smear. Check with your doctor to be absolutely sure.

Should women with a disability have Pap smears?

Yes, all women with a cervix who have ever had sex are at risk of cervical cancer. One of the key objectives of the Glenrock Country practice Cervical Screening Program is that its services are accessible to all women. We ensure that women with disabilities can be directed to a practitioner who is best able to meet their individual needs. other strategies have been put in place to address the needs of women with disabilities who wish to have a Pap smear, including:

• purchase of adjustable examination couches;
• referral to Pap smear providers who can meet women’s special needs in terms of physical and intellectual disabilities.

When should I stop having Pap smears?

If you are 70 years or over and have had two normal Pap smears in the last five years, you do not have to keep having Pap smears, unless you wish to do so. Women who are over 70 years who have never had a Pap smear, or those who request a Pap smear, can make an appointment to be screened.

How much does it cost?

There are two costs involved in having a Pap smear the Doctor consultation fee and the Pap smear pathology test. The normal fee in Glenrock Country Practice is a long consultation for your doctor while pathology provider (laboratory) fees are bulk billed . In most of the cases you may be asked to pay the full doctors fee and then claim a rebate from Medicare.
If you cant afford the full fee, discuss with your doctor the possibility of bulk billing, in which case there is no cost for the Pap smear or the consultation.
Ask for information about the cost when you make an appointment.

Useful Links

NSW Cervical Screening Program
Tel: (02) 8374 5757 Fax: (02) 8374 5700

The Cancer Council

More information

New Cervical Cancer vaccine

HPV (human papilloma virus)

If your doctor has told you that your abnormal Pap smear result may be due to an infection with HPV, you be may wondering what it is, how you got it and what it means for your health.

HPV is a very common virus, with four out of five people having it at some stage of their lives. In some cases, it can increase a woman's risk of cervical cancer. However, most women with HPV do not develop cervical cancer.

About HPV

There are over 100 different types of HPV, including some that affect the genitals. Genital HPV is similar to the virus which causes warts on other parts of the body.

Genital HPV is so common that it could be considered a normal part of being a sexually active person. Most people will have HPV at some time in their lives and never know it. You may become aware of HPV if you have an abnormal Pap smear result, or if genital warts appear.

HPV infection is very common and in most people it clears up naturally in about 8-14 months.

What does HPV have to do with cervical cancer?

A few of the many types of HPV have been linked with causing abnormalities of the cervix and in some cases the development of cancer of the cervix.

It is important to remember that most women who have HPV clear the virus naturally and do not go on to develop cervical cancer.

In a small number of women, the HPV stays in the cells of the cervix. When the infection is not cleared, there is an increased risk of developing abnormalities. In very rare cases, these abnormalities of the cervix can progress to cancer. When cervical cancer develops, HPV is found in almost all cases. Having regular Pap smears is the best way to ensure that any changes are monitored and managed to protect your health.

If you have early cell changes due to HPV, there is a strong likelihood that these changes will clear up naturally in 8 to 14 months. Because of this, and the fact that cancer of the cervix takes around 10 years to develop, your doctor may recommend simply having another Pap smear in 12 months time.

How did I get HPV?

Genital HPV is spread through genital skin contact during sexual activity. As viruses are microscopic, HPV can pass through tiny breaks in the skin. HPV is not spread in blood or other body fluids. While condoms are an important barrier to many sexually transmitted infections, they offer limited protection against HPV as they do not cover all of the genital skin.

Because the virus can be hidden in a person's cells for months or years, having a diagnosis of HPV does not necessarily mean that you or your partner has been unfaithful. For most people it is probably impossible to determine when and from whom HPV was contracted.

Can HPV be cured or treated?

There is no cure or treatment for HPV. It will, in most cases, be cleared up by your immune system. However, the effects of the virus, such as any warts that appear, or changes to the cells of the cervix, can be treated.

Consult your doctor or health practitioner if you are concerned about genital warts because of their appearance, or if they are causing you discomfort. There are a range of treatment options for warts.

If your Pap smear indicates that cells have been affected by HPV, you should have more frequent Pap smears until these cells return to normal. If the changes continue, further tests and treatment may be needed.

Should I have a special test for HPV?

There is an HPV test available which can identify strains of HPV. This is not a test for cancer. HPV tests are available in Australia but are only subsidised by the government in a limited number of cases. Because most HPV infections usually resolve naturally, and there is no cure, there is little reason to have an HPV test.

Experts now recommend that HPV testing be used for women who have been treated for a high grade abnormality. The HPV test is done to make sure the virus has gone from your body. An HPV test done for this reason will be subsidised through a Medicare rebate. Your GP can advise you if the test would be useful in your particular case.

While a Pap smear cannot identify which type of HPV is present, regular Pap smears will make sure any changes that occur are identified early and managed effectively.

What about a vaccine for HPV?

Starting in April 2007, the Australian Government is providing a vaccine, Gardasil®, free to girls aged between 12 and 13 years through the National HPV Vaccination Program on an ongoing basis.

Over two years, the vaccine will be provided free for girls and young women aged between 14-26 years.

• For girls in school, the program started in April 2007. Parents are asked to give consent for their daughters to participate in the program. By the end of 2008, all girls currently aged between 12-18 years will have had access to the vaccine in school. In some states, the vaccination program may be staggered, so that some schoolgirls are vaccinated in 2007 and the rest in 2008.
• For young women who are not in school and are under 27 years, GPs and community immunisation clinics will provide the free vaccine from July 2007 until the end of June 2009.

The vaccine will be given in a series of three injections, over a six-month period.

Gardasil® does not protect against all strains of HPV that cause cervical cancer. That is why it is still important for women to keep up to date with regular Pap smears, so early changes caused by HPV can be monitored and/or treated to prevent cancer.

 Most women understand the importance of regular Pap smears once they are sexually active, to detect the early signs of cervical cancer. Now, there's another way women can protect themselves, because there is a new vaccine that can prevent most cervical cancers.

The vaccine works by immunising women against certain strains of the human papillomavirus (HPV) that are known to cause 7 out of 10 cervical cancers. The vaccine also guards against the strains of HPV that cause 9 out of 10 cases of genital warts.

HPV is very common - it affects men and women, and 4 out of 5 people will have it at some point in their lifetime. The virus lives on the skin, so it can be spread through intimate skin-to-skin contact. That means women can still get it even if they practice safe sex, or only ever have one sexual partner. Usually the body clears the virus by itself but in some cases cervical cancer can develop.

If you are under 27, you can participate in the National HPV Vaccination Program. From July 2007 to June 2009, you can get the vaccine free from your local GP or community immunisation clinic.

Even if you are already sexually active, speak to your GP about getting immunised. You may still benefit from the vaccine because there is still a good chance you have not yet been exposed to the specific HPV types that can cause cervical cancer.

Unfortunately, the vaccine doesn't prevent all cervical cancers. That's why it's still very important for all women to keep up to date with regular Pap smears. You should have a Pap smear every two years from the age of 18, or two years after having sex, whichever is later.

For more information on the HPV vaccine, please visit the National HPV Vaccination Program website.