For a long time, the Pap smear has been a lifesaving screening tool for cervical cancer.
But it's recently become the subject of debate on social media, with many users asking if the test is worth the discomfort. Indeed, the percentage of women who have never had a cervical cancer screening has been rising for years; a recent study found that nearly one in three women between 21 and 29 in the U.S. - about 6.2. million women - has never been screened.
During a Pap smear, an instrument called a speculum is inserted into the vagina. Then, the health care provider takes samples of the cervical cells using a small stick called a spatula and a soft brush. Those cells are then examined for signs of cancer. Some people may experience discomfort, sometimes pain, during their Pap smear.
But Blair McNamara, an assistant professor of obstetrics and gynecology in the Division of Gynecologic Oncology at Yale School of Medicine, says it's essential for women to get a Pap smear.
"The whole goal of Pap smears is to prevent cervical cancer, which women used to die from in large numbers in the U.S., and unfortunately still do globally, especially in countries where Pap smear programs are less prevalent," McNamara said.
In an interview, McNamara explains the stigma surrounding Pap smears, their role in detecting cervical cancer, and ways to make the test more comfortable.
Why are people so afraid of Pap smears?
Blair McNamara: For your provider to collect a Pap smear test, they have to perform a pelvic exam with a speculum, which inherently is not a comfortable exam and can feel very vulnerable. Pap smears sometimes beget other testing and procedures, which can also cause anxiety for patients, especially if they've had an abnormal Pap smear in the past. The technology of Pap smears and detecting precancers really early has significantly reduced the rate of cervical cancer among young women, which is amazing. But the process to do that can be uncomfortable and scary.
What is the role of Pap smears in detecting cervical cancer?
McNamara: A Pap smear collects cells from the cervix, which are then evaluated under a microscope and tested for HPV [human papillomavirus] by a pathologist. HPV contributes to more than 90% of cervical cancers in the U.S.; Pap smears allow us to detect those infections as well as abnormalities of cervical cells really early.
It's important to recognize that Pap smears are screening tests. Screening tests inherently have high false positive rates, which means that many patients with abnormal Pap smears ultimately do not end up having an issue that needs treatment. Pap smears allow physicians and advanced practice providers [APPs] to find patients at high risk of having a cervical pre-cancer and evaluate those patients with biopsies. If a cervical pre-cancer is found, it is treatable with an excision to remove any of the precancerous tissue, with lasers to evaporate the cells, or by freezing the tissue.
What are the risks associated with cervical cancer, especially if it's not detected early?
McNamara: If it is not detected early, cervical cancer often causes patients a lot of pain, can metastasize to other parts of the body, and damage other organs. Once cervical cancer has metastasized patients often die from it. However, if cervical cancer is detected early, it can be cured with surgery or radiation.
Are there ways to make the cancer screening more comfortable?
McNamara: Having a doctor or APP you feel comfortable, and who makes you feel like you can speak up and ask questions, is really important.
