Goals

The speculum exam and Papanicolaou (PAP) smear is the process of examining and obtaining cells from the ectocervix and endocervix 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 different ways to screen for cervical cancer, with the most commonly used method being the Liquid-Based Cytology (LBC) PAP test.

1. Liquid-Based Cytology (LBC) PAP test

This method requires the use of a vial containing a cell-preserving fluid. A plastic spatula and a cytobrush are used to sweep the cervix and sample the transformation zone. After the cell sample is collected, the spatula and brush are rinsed 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 now the method used in Saskatchewan.

2. HPV DNA Testing

In this test, a cell sample is collected from the cervix and the sample 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). In Saskatchewan, HPV reflex testing is done for people in specific age groups with certain abnormal PAP results. At this time, there is no approved test for HPV in males.

Contraindications

• Pelvic inflammatory disease
• Active vaginitis
• Active cervicitis