Mary's legacy

Spare a thought for Mary Papanicolaou. Her husband was George Papanicolaou. That's George looking down the microscope and Mary watching on. It was George Papanicolaou who invented the PAP smear and his first and very long term patient was Mary. George first started looking at PAP smears in the 1920's but it wasn't until the mid-1940's that it became more widely accepted as a useful investigation - that's a lot of PAP smears before anyone else started paying attention! George and Mary's pioneering work paved the way for future generations of women to have their risk of dying from cervical cancer massively reduced.

The above photo shows what a PAP smear looks like under the microscope.

Having an abnormal PAP smear result that necessitates a visit to the gynaecologist does NOT mean that you have cervical cancer. In fact, in probably 99.9% of the time it means that you don’t have cancer. PAP smears are deigned to pick up abnormalities in the cells of the cervix BEFORE they become cancerous. The PAP smear result ranges from NORMAL all the way through to cancer and in between there are two stages of abnormality. The progression is from NORMAL to LOW GRADE ABNORMALITY to HIGH GRADE ABNORMALITY to CANCER. Even the cancerous stage usually has a microinvasive stage early on before it becomes deeply invasive. Generally it takes about 10 years for a PAP smear to go from normal all the way through to cancerous. This is why if you get a PAP smear done every 2 years the chances of picking up an abnormality BEFORE it becomes cancer is extremely good. Most women who are diagnosed with cervical cancer have either NEVER had a PAP smear or who have had a LONG time between PAP smears.

LOW GRADE abnormalities are generally monitored and the majority of them return to normal in time. This can take years.

HIGH GRADE abnormalities are almost always treated, usually by a relatively minor procedure which removes part of the cervix. This can be done under either a local anaesthetic (you’re awake) or a general anaesthetic (you’re asleep).

If in the unlikely event that a cancer is detected then treatment is tailored for the individual patient by a subspecialist, a gynaecological oncologist.

The finding of HPV (human papilloma virus aka “the wart virus”) causes a lot of concern in women when it is detected in a PAP smear. A significant percentage of abnormalities of the cervical cells are caused by HPV. This does NOT mean that you have genital warts. There are over 120 different types of HPV. Some give you warts on your skin. Some give you plantar warts. Some give you genital warts. Some just give you abnormalities in the cells of your cervix. If you have been sexually active once you’ve a good chance of having acquired the virus. It’s pretty much ubiquitous. After that it’s a matter of your immune system detecting the virus and getting rid of it. The virus is sneaky – it hides inside the cells of the cervix, away from the immune system. However, eventually the immune system will detect it and get rid of it – almost always. You might recall (probably more easily than me) that when you were in primary school at one point there was lots of kids who had warts on their hands etc. They were the kids that no one wanted to hold hands with – especially during square dancing (well we had to do square dancing anyways). Then, one day you realised that they didn’t have warts any more. That’s because their immune systems detected the virus, attacked it and got rid of it. Voila, warts gone. This is why there was so much effort to develop a vaccine for cervical cancer – like Gardasil. It stimulates the immune system to attack the wart viruses most likely to cause the abnormal cells in the cervix.

If you do need to see a gynaecologist about an abnormal PAP smear, they will repeat the smear and then look at your cervix under magnification after special stains (fluids) have been put on the cervix to show up abnormal areas. This procedure is called a colposcopy and more information about it can be found HERE. A biopsy may need to be taken but this generally gives only mild cramping. Once the biopsy and PAP smear results are obtained then treatment (if necessary) can be organised.

One final word about abnormality of the cells of the cervix – one of the biggest risk factors for these abnormalities is SMOKING. Yet another reason to give up those smokes!