No other cancer screening test has seen the success of the pap smear.
Sir John Williams, in the late 1800s first described what would eventually be known as carcinoma in situ (CIS) of the cervix, or abnormal cervical cells that remain in the place where they first formed. Some refer to CIS as precancer. Identifying cancer early when treatment options can prolong the length and quality of a person’s life is the cornerstone of preventive medicine.
In the early 1900s, several scientists discovered that changes inside cervical cells could be seen before cervical cancer was recognized. Pathologists in this early part of the century relied on microscopic examination of tissue biopsies, which meant there was a visible abnormality on the cervix which could be seen by the naked eye. This unfortunately translated to being “too late” for many women, because cancer had taken hold already.
In the 1940s, as the cervical smear was being developed, scientists learned that changes inside cervical cells could be seen several years before cancerous growths, visible by the naked eye, had developed. This process of viewing cervical cells under a microscope is termed cytology. The discovery that individual cells from the cervix have features which may be used to diagnose carcinoma (cancer) is attributed to the “father of cytology,” Dr. George N. Papanicolaou. His landmark publication in 1941 marked the beginning of cervical cancer screening with cytology and the test that bears his name, “the pap smear.”
The finding of abnormal cervical cells on a pap smear, which have the potential to grow into cervical cancer, was a breakthrough in preventative care for women. As a result, the pap smear over the last 40 to 50 years has decreased the incidence of cervical cancer by 75%.
Overtime, cervical cytology (the pap smear) as a means of screening for pre cervical cancer has changed. Most notably and recently, with the addition of testing for human papillomavirus (HPV). It is recognized that an infection with HPV is required for the development of most cervical cancers. It is also established that most women with HPV will NOT go on to develop cervical cancer. A woman’s healthy immune system and other personal risk factors, contribute to her ability to “clear” this virus, thus decreasing her risk for the development of cervical cancer.
Through extensive research and collaboration, two prominent societies, the American Society for Colposcopy and Cervical Pathology (ASCCP) and the American College of Obstetricians and Gynecologist (ACOG), have made recommendations for cervical cancer screening with the pap smear.
The most recent guidelines were published by the ASCCP in 2012 which changed the frequency of screening for women and placed a larger emphasis of combined screening with HPV testing. These changes were made to balance the benefit of screening with the risk of over (and sometimes unnecessarily) treating women for abnormal pap smears.
The nuances of the screening recommendations are many, but there are several steps you as a patient can take to maximize your health:
- Annual Well Woman Exams with your gynecologist
- Get pap smears per your gynecologist’s recommendations
- Do NOT smoke or use other tobacco products – tobacco promotes the abnormal cells which can develop into cancer
- Get yourself vaccinated or your children (girls and boys) vaccinated for HPV per the CDC recommendations
Last minute facts:
- About 60% of women diagnosed with cervical cancer have NOT been screened in the past 5 years or longer
- The lifetime risk of acquiring a genital HPV infection is about 80%
- HPV-16 and HPV-18 (both covered by all of the HPV vaccines on the market) are present in upwards of 70-80% of cervical cancers
There is a myriad of information available about cervical cancer, screening, and HPV. If you would like more information please reach out to us on the portal.
Dr. Kaleb Jacobs