If you are between thirty and sixty years old, you will receive a call every five years to have a smear made. Fortunately the result is usually good. But what if it's wrong?
Around 75 percent of women experience an abnormal result at some point in live and that is quite a lot. If you get such a result that raises questions. Moreover, it probably scares you a lot. For instance because you are referred to a gynaecologist for further examination, while you usually have no complaints at all.
Often women are afraid that they may have cervical cancer if their smear is not good. In the Netherlands about 3 women die per 100,000 women from cervical cancer: with about 0.003 percent that is not a lot. Cervical cancer is a very nasty disease where there is a good chance that you will lose your uterus and ovaries, with all the associated consequences. It is a good thing that women are called in every 5 years to have a smear made. Cervical cancer is most common in women who do not participate in the population screening and therefore do not have themselves regularly checked. It is therefore advisable to have that smear made every 5 years.
A deviating result can be a false alarm. The result of a smear is expressed in figures. Pap 1 is a normal result. With Pap 2 up to Pap 5 there may be something wrong: from an innocent irritation or infection to troubled cells: a pre-stage of cervical cancer or cervical cancer. If you get an abnormal result, a gynaecologist first examines what the tissue in your cervix looks like. The gynaecologist does this by carefully examining the cervix and sometimes by taking a biopsy. He or she then takes a small piece of tissue away, the cells of which are examined under a microscope. You feel little to nothing from such a biopsy.
At 50% of the women with a Pap result up to and including 3a, no precursor of cervical cancer is found in the tissue. Sometimes it appears to be a cervix irritation, caused by a fungal infection or - if you also suffer from blood loss after having sex - chlamydia. Both can be controlled with a vaginal tablet or antibiotics. Usually you have to come back for a new smear after 6 months, to check whether your body has cleaned up the abnormal cells itself. If that is the case, you can safely wait 5 years until you get the next call for a smear. If not then the viewing investigation is repeated.
Not really. The only thing you can do is ensure good resistance. Eat healthy, do not smoke, drink alcohol moderately and exercise sufficiently.
With a result from Pap 3b there is a greater chance that the gynaecologist will find a preliminary stage of cervical cancer during examination. But the chance of cancer is still small. It just means that you are on time. A preliminary stage is good and easy to treat. It takes 10 to 15 years before there is a 50 percent chance that the troubled cells will develop into cervical cancer. To treat an early stage of cervical cancer, the tissue with the troubled cells is "peeled away" from the cervix under local anaesthesia. This procedure lasts 10 minutes and is called a lisexcision. The tissue is then examined microscopically to rule out that there are more troubled cells in the deeper layers. A cervix is approximately 4 centimetres long. The gynaecologist takes away about 2 to 3 millimetres of tissue. After a lisexcision you can still get pregnant. Moreover, there is a good chance that after the procedure you will only get smears with a normal Pap 1 result.
Cervical cancer is caused by infection with the HPV virus that you are contracted by sexual contact. So you could say that sex causes cervical cancer. Condoms help prevent infection by 70 percent. About 80 to 90 percent of all people carry the HPV virus in one or more variants. Not all variants of the HPV virus are dangerous, only a small number of them increase the risk of cervical cancer. At most cases, the virus is cleared away by the body, but some continue to carry it. It can then lead to a cancer precursor. Because the virus is transmitted through sex, women sometimes think that the HPV virus is an STD and wonder if their partner has cheated. Understandable, but not necessary. The virus is not an STD. And because HPV infections occur so often, some doctors doubt whether the virus is only transmitted by sex. Moreover, not all women with abnormal smears have the HPV virus in their blood.
There are more than 100 variants of the HPV virus, 12 of which can cause cancer. The HPV vaccination protects against 2 variants that together cause 70 percent of cervical cancer cases. Who is vaccinated has a much lower risk of cervical cancer at a later age. Since 2009 the Dutch government has been offering girls of 13 the opportunity to get vaccinated against these 2 types of the HPV virus. Because the vaccination program started so recently the precise figures on the decrease in cases of cervical cancer are not yet known.
80 to 90% of all people carry the HPV virus: the cause of cervical cancer.
At 3% the HPV virus can lead to a pre-cancer stage.
PAP1: The smear is normal. After 5 years you will have a new Pap smear.
PAP2: A number of cells look slightly different than normal. The smear is done again after six months. The second result is often normal.
PAP3A: Slightly abnormal cells were found. You will usually be referred to the gynaecologist for further examination.
PAP3B: The cells are slightly more abnormal than with Pap 3a. Even now you are usually referred to the gynaecologist and sometimes a small treatment is needed.
PAP4: The cells are more abnormal than in Pap 3. The chance of treatment is high, around 90 percent.
PAP5: The cells are highly abnormal, the result may indicate cervical cancer but that is not always the case. If so, surgery and further treatment are necessary.
Pap is an abbreviation for the name Papanicolaou, a Greek doctor who made the classification of the results of smears. Some doctors work with a different, more precise classification: the Kopac result. If you get a Pap or Kopac result, always ask your doctor what that result means in your case and what will happen next.
"I was at work when I called the doctor for the result of my smear. Without any fear, because I had always had a good result before that and I had no complaints. But this time it was different: I had Pap 3a. They had found abnormal cells in my cervix. I remember thinking that I could be dying. Even though the doctor had just tried to reassure me by saying that I had no cancer. I think I was worried anyway was because he used that word. What also didn't help is that I was sent to the gynaecologist. Because I had all kinds of questions, I took a friend with me so that she could listen in and we could discuss it together afterwards. "Like the doctor said, there was no cause for concern. And if there was something wrong. At least I was on time and I could be helped quickly. He wanted to remove a piece of tissue from my cervix." For further investigation therefore immediately investigated whether the HPV virus was in my blood: the cause of cervical cancer. Fortunately I did not have that in my blood. There were some troubled cells in my cervix. But there was no cause for concern and I didn't need surgery. I only had to come back after half a year for a new smear. I have already had that. This time it was Pap 2: slightly better. To keep an eye on it, I will be checked again in six months. That reassures me. I am quite shocked by the negative result and hope that I am so healthy that my body can clean up those strange cells. And I hope that next time my result will be completely correct. "