Cervical screening in the context of "Pap test"

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⭐ Core Definition: Cervical screening

Cervical cancer screening is a medical screening test designed to identify risk of cervical cancer. Cervical screening may involve looking for viral DNA, and/or identifying abnormal, potentially precancerous cells within the cervix as well as cells that have progressed to early stages of cervical cancer. One goal of cervical screening is to allow for intervention and treatment so abnormal lesions can be removed before progression to cancer. An additional goal is to decrease mortality from cervical cancer by identifying cancerous lesions in their early stages and providing treatment before progression to more invasive disease.

Currently available screening tests fall into three categories: molecular, cytologic, and visual inspection. Molecular screening tests include nucleic acid amplification tests (NAAT), which identify high-risk human papillomavirus (HPV) strains. Cytologic tests include conventional Pap smear and liquid-based cytology. Visual Inspection tests involve application of a solution to enhance identification of abnormal areas and can utilize the naked eye or a colposcope/magnifying camera.

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👉 Cervical screening in the context of Pap test

The Papanicolaou test (abbreviated as Pap test, also known as Pap smear (AE), cervical smear (BE), cervical screening (BE), or smear test (BE)) is a method of cervical screening used to detect potentially precancerous and cancerous processes in the cervix (opening of the uterus or womb) or, more rarely, anus (in both men and women). Abnormal findings are often followed up by more sensitive diagnostic procedures and, if warranted, interventions that aim to prevent progression to cervical cancer. The test was independently invented in the 1920s by the Greek physician Georgios Papanikolaou and named after him. A simplified version of the test was introduced by the Canadian obstetrician Anna Marion Hilliard in 1957.

A Pap smear is performed by opening the vagina with a speculum and collecting cells at the outer opening of the cervix at the transformation zone (where the outer squamous cervical cells meet the inner glandular endocervical cells), using an Ayre spatula or a cytobrush. The collected cells are examined under a microscope to look for abnormalities. The test aims to detect potentially precancerous changes (called cervical intraepithelial neoplasia (CIN) or cervical dysplasia; the squamous intraepithelial lesion system (SIL) is also used to describe abnormalities) caused by human papillomavirus, a sexually transmitted DNA virus. The test remains an effective, widely used method for early detection of precancer and cervical cancer. While the test may also detect infections and abnormalities in the endocervix and endometrium, it is not designed to do so.

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Cervical screening in the context of Cervical cancer

Cervical cancer is a type of cancer that develops in the cervix or in any layer of the wall of the cervix. It is due to the abnormal growth of cells that can invade or spread to other parts of the body. Early on, typically no symptoms are seen. Later symptoms may include abnormal vaginal bleeding, pelvic pain or pain during sexual intercourse. While bleeding after sex may not be serious, it may also indicate the presence of cervical cancer.

Virtually all cervical cancer cases (99%) are linked to genital human papillomavirus infection (HPV); most who have had HPV infections, however, do not develop cervical cancer. HPV 16 and 18 strains are responsible for approximately 70% of cervical cancer cases globally and nearly 50% of high-grade cervical pre-cancers. Minor risk factors include smoking, a weak immune system, birth control pills, starting sex at a young age, and having many sexual partners. Genetic factors also contribute to cervical cancer risk. Cervical cancer typically develops from precancerous changes called cervical intraepithelial neoplasia over 10 to 20 years. About 75% of cervical cancers are squamous cell carcinomas, 20-25% are adenocarcinoma, 3% are adenosquamous carcinomas, and less than 1% are small cell neuroendocrine tumors of the cervix. Diagnosis is typically by cervical screening followed by a biopsy. Medical imaging is then done to determine whether or not the cancer has spread beyond the cervix.

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