Pap Smear Test in Ankara (Cervical Cancer Screening)

The lower part of the uterus opening to the vagina is called the cervix (neck of the womb). The test performed to evaluate the cervix is called the Pap Smear, Cervicovaginal Smear, or Pap Test. It is named the “Pap Test” because it was first defined by George Papanicolaou in 1928.

Why is a Smear Test Necessary?

The Smear Test is a life-saving test because it allows us to diagnose Cervical Cancer and precursor cell changes called precancerous lesions early and treat them mostly before they progress to cancer. Additionally, the presence of infections such as Candida, Bacterial Vaginosis, or Trichomonas can be detected through this test.

How is a Pap Smear Performed?

As a result of tissue renewal everywhere in our body, cells on the surface are shed. In the smear test, after a vaginal examination speculum is inserted, cells shed from the cervix are collected with the help of a spatula or a soft brush and fixed (stabilized) with a special method. The prepared material is examined under a microscope by pathologists.

Who Should Have a Pap Smear?

The smear test should be performed as an annual screening for every woman over the age of 21, starting 1 year after the first sexual intercourse. If the patient has a special condition requiring closer monitoring, the gynecologist decides on this frequency.

• Under 21: Screening starts within 3 years following the first sexual intercourse in women under 21, and annual screening is recommended.

• Over 65: In elderly patients, if there are 2 consecutive negative smear results after the age of 65, the screening program can be discontinued.

• History of Cancer: In women with a history of gynecological cancer, the physician following the patient determines the frequency of screening after age 65.

• Immunosuppressed: Sexually active women whose immune system is suppressed for any reason or who carry the HIV virus must have a smear test every year, regardless of their age.

Is the Pap Smear a Painful Procedure?

The smear test is definitely not a painful procedure. During a routine examination, after the speculum is gently inserted, the patient does not feel any pain or discomfort while the smear sample is being taken.

Preparation: Things to Consider Before the Test

To ensure the most accurate results, please pay attention to the following before your appointment:

• Avoid sexual intercourse for 48 hours before the test.

• Do not perform vaginal douching for 24 hours before the test.

• Do not use vaginal suppositories, creams, or jellies for 48 hours before the test.

• There should be no menstrual bleeding (The test should be done when you are not on your period).

Types of Smear Test Methods

There are two distinct techniques used when taking a smear:

1. Conventional Smear: Cells are taken and spread on a glass slide and fixed.

2. Liquid-Based Cytology (LBC): Collected cells are placed into a special chemical liquid and fixed. Since this liquid is centrifuged and cells are examined, it is possible to obtain healthier information. Another advantage of this method is that the HPV DNA test can be studied from the same sample.

In our clinic in Ankara, we use the Liquid-Based Cytology technique for smear tests, and we can also take samples for the HPV Test at the same time for patients who require it (Co-Testing).

How are Smear Results Evaluated? (Bethesda System)

Today, the Bethesda System is used when evaluating smear tests. The evaluation result may come out as:

• Benign: Normal, healthy cells.

• ASCUS: Atypical Squamous Cells of Undetermined Significance.

• LGSIL (LSIL): Low-Grade Squamous Intraepithelial Lesion.

• HGSİL (HSIL): High-Grade Squamous Intraepithelial Lesion.

• AGUS: Atypical Glandular Cells of Undetermined Significance.

• Adenocarcinoma.

Important: The smear test never shows the final diagnosis; it is a screening tool. When an abnormality is detected in the smear result, a definitive diagnosis is reached by performing one or more of the following procedures: Repeat Smear, Colposcopy, Biopsy, ECC (Endocervical Curettage), or LEEP procedures.

Is Pap Smear Done During Pregnancy?

Ideally, a detailed preconception examination covering smear screening should be performed before getting pregnant. However, if a pregnant patient comes for follow-up and does not have a smear test performed within the last year, a smear test should be performed at her first control.

Taking a smear from a pregnant patient has no harm to the mother or the baby. On the contrary, the possibility of ensuring the detection of a possible cell abnormality or cancer that could change the course of pregnancy should be considered.