CERVICAL SMEAR (1): WHAT IS IT? WHY AND WHEN SHOULD IT BE DONE?

Dr. Claude Allouche, Obstetrician-Gynecologist
Ahuza Clinic, Raanana, Israel
058 726 02 64

WHAT IS A CERVICAL SMEAR? Frottis ivrit

A cervical smear, or cervical screening, is a gynecological examination used for early detection of potential abnormalities in the cervix. It involves taking a sample from the cervix, the part of the uterus that opens into the vagina. This simple test assesses the health of the cervical lining, as small lesions can sometimes develop into cervical cancer.

WHAT IS THE PURPOSE OF A CERVICAL SMEAR?

The main purpose of a cervical smear is to detect cervical cancer by identifying any pre-cancerous lesions. Cervical cancer often presents no symptoms, making regular screening crucial for early detection.

During a cervical smear, cells are collected from the cervix and analyzed under a microscope in a laboratory. These cells may be normal or display abnormalities ranging from minor to more serious issues.

  • In 95% of cases, the results are normal.
  • A small number of cases may show abnormalities, which are generally benign or easy to treat.
    The smear can also detect infections, such as human papillomavirus (HPV), a virus known to cause cervical cancer.

Note: A cervical smear should not be confused with other tests such as a blood smear (used to diagnose malaria) or a vaginal swab (used to detect vaginal infections).

WHEN AND HOW OFTEN SHOULD YOU HAVE A CERVICAL SMEAR?

In both France and Israel, it is recommended that women begin cervical screening by smear at the age of 25. After two normal smears taken one year apart, it is advised to repeat the test every three years until the age of 65. This screening schedule applies in both countries.

In some cases, the smear may be performed alongside testing for high-risk HPV. If both tests are negative, the next smear can be postponed for five years instead of three.

This examination is designed to detect the effects of a sexually transmitted virus, the human papillomavirus (HPV). Therefore, it is only necessary for women who have been sexually active. If a woman has not had sexual contact and remains a virgin, this test is unnecessary.

Sources:

  • Ministry of Solidarity and Health. Screening for cervical cancer. Ministry of Solidarity and Health website. Paris; 2018 [accessed May 21, 2019].
  • National College of French Gynecologists and Obstetricians (CNGOF). Patient Information Sheet – Cervical Screening Smear. CNGOF website. Paris; 2017 [accessed May 21, 2019].
  • National Cancer Institute (INCA). Answers to your questions about cervical cancer screening. INCA website. Boulogne-Billacourt (France); 2018 [accessed May 21, 2019].
  • National Health Service (NHS). Cervical screening. NHS website. London; 2019 [accessed May 21, 2019].

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HOW IS A CERVICAL SMEAR PERFORMED?

A cervical smear (“pap smear” in English and “pap” פאפ in Hebrew) is a sample taken from the cervix to screen for cancer or a pre-cancerous lesion of the cervix.
. Painless, it lasts less than five minutes

HOW IS A CERVICAL SMEAR TAKEN?
The examination consists of several stages:
1. The doctor asks you to take off the bottom of your outfit and lie down on the examination table, placing your feet in the stirrups (supports provided for this purpose).

2. He opens the labia majora and gently introduces an instrument made up of two walls, the speculum, into the vagina. To keep the vagina open and the cervix clearly visible, the walls are slowly pulled apart.

3. The doctor introduces a small spatula, or a small brush, inside the speculum which is used to lightly scrape the surface of the cervix. This makes it possible to collect cells from the junction between the exocervix (the outermost part of the cervix) and the endocervix (the innermost part). This removal is not painful.

4. The doctor then collects other cells from the endocervix, using a swab (a kind of large cotton swab), or even a small brush.

5. The various samples are spread on glass slides and a fixing product is sprayed on them. This gesture is used to "freeze" the cells, so that they do not deteriorate before being analyzed.

6. The most modern methods use a small brush to collect cells from the exocervix and those from the endocervix in one go. The brush is then immersed in a liquid. This method makes it possible to carry out, if necessary, the search for the papillomavirus by the HPV test without having to take the patient again).

7. The doctor closes the speculum and removes it.
Finally, the doctor sends the necessary information to the pathology laboratory, which will analyze the sample:
* age ;
* current pregnancy;
* recent childbirth;
* date of last menstrual period;
* use of oral contraception or presence or absence of an intrauterine device;
* menopause with or without hormone replacement therapy;

The sample is then sent to the laboratory, which will send the results to the doctor taking the sample a few weeks later.
The latter will contact you by telephone if the result of this examination is abnormal or inconclusive.

 

RECOMMENDATIONS BEFORE MAKING AN APPOINTMENT FOR A CERVICAL SMEAR
Cervical smear ia recommendations

The cervical smear is a sample taken from the cervix to detect cancer or a pre-cancerous lesion of the cervix.

Here are some tips for scheduling your cervical smear at the right time:

* It should be performed every 3 years, if it is normal each time and in the absence of risk factors. Nevertheless, an annual gynecological examination is recommended in order to visualize the cervix with a speculum even if the smear is not carried out each time.

* In some cases it can be performed before the age of 3, for example after conization, laser treatment, previous abnormal smear or papillomavirus infection

* Sometimes, when the sample has not returned enough material for the laboratory to interpret the smear correctly and give a satisfactory answer, it may be necessary to recheck the smear a second time; in this case your Gynecologist will reconvene you.

* It is recommended even if the patient has previously been vaccinated against the papillomavirus (HPV) because the vaccine only protects against 70% of oncogenic virus types.

* Before an IVF (IVF) program, it is systematically carried out if it is more than a year old.

* plan your appointment so that the sample can be taken away from the menstrual period (ideally, in the middle of the cycle);

* do not schedule an appointment or postpone it if you suffer from an infection of the vagina (vaginitis) and if you are taking local (vaginal) treatment.

* A patient who has had a total hysterectomy no longer needs Pap smears.

Moreover :
* avoid having sex 24 to 48 hours before the appointment;

* the day of the exam,
       * bring the results of the smear from the previous cervix if necessary, and any other useful document (eg: operative report, abdominopelvic ultrasound).
       * Remember to wear protection because in some cases very little bleeding may occur following the sample.
According to most ravs, this bleeding, when it occurs, does not make you "nidah" ​​because it comes from the cervix and not from the endometrium.

* In general, the cost of the smear is borne by your koupat holim if the recommendations are respected, even if in certain cases and according to the koupot a financial contribution may be requested (between 28 and 104 shekels).
If the smear is taken in private consultation, you will have to pay the cost of the smear directly to the laboratory (about 250s), which could be covered if you have private insurance.