Goals

The speculum exam and Papanicolaou (PAP) smear is the process of examining and obtaining cells from the cervix for microscopic analysis. The PAP smear is the recommended diagnostic test to screen for cervical cancer.

Background

Worldwide, cervical cancer is one of the most deadly cancers for women, especially those living in low-income countries (World Health Organization, 2011), who don’t have access to PAP testing. Stage one cervical cancer (limited to the cervix) has cure rates of 80-99% (Cervical Cancer UK, 2012) and the average time that it takes for abnormal cells to progress to invasive cancer is as long as 10 to 20 years, although this is variable (Alberta Health Services, 2012).

There are two types of cervical cancer, squamous cell and adenocarcinoma. Squamous cell carcinoma, which accounts for about 70% of cervical cancers, is cancer that affects the squamous cells that make up the outer layer of the cervix. Adenocarcinoma is cancer that has affected the columnar, or glandular, cells that line the endocervical canal (De Los Santos & Straughn, 2011).

There are three different ways to screen for cervical cancer:

1. Conventional Cytology (CC) PAP test

This involves obtaining a cell sample from the cervix using a spatula and cytobrush, and placing it on a glass slide. The goal is to sample cells from the squamo-columnar junction, as this is the area of metaplasia that is most vulnerable to cellular mutation related to Human Papillomavirus (HPV) infection. Once the cells have been obtained, it is important to sufficiently transfix them with the proper spray and allow the slide to completely dry prior to closing it and sending to lab. It is the most common screening test for cervical cancer in Canada.

2. Liquid-Based Cytology (LBC) PAP test

This is a variation of conventional cytology and requires the use of a vial containing a cell-preserving fluid. A broom brush is used to sweep the cervix and sample the transformation zone. After the cell sample is collected, the swab is placed in the fluid-containing vial. This allows all cell materials to be available to the lab. After the sample has been treated to remove debris (e.g., red blood cells, and inflammatory cells that can interfere with conventional cytology results), a layer of cells is placed on a slide and reviewed. LBC enhances the detection of precancerous lesions by improving sample preparation. Liquid-based cytology is currently not commonly used in Saskatchewan.

3. HPV DNA Testing

In this test, a cell sample is collected with a broom brush and the entire head of the brush is placed in the HPV medium, then tested for HPV DNA. This type of screening has not been included in routine screening programs offered in Canada and is used for the management of women over the age of 30 who have had abnormal results from cytology testing (Murphy & Howlett, 2007).

Contraindications

• Pelvic inflammatory disease
• Active vaginitis
• Active cervicitis