As of 1 December 2017, the pap smear changed from checking the cells of the cervix for abnormalities to checking for the presence of Human papilloma virus (HPV). It has been discovered that the presence of HPV in the cervix accounts for pretty much all cervical cancers, and thus checking for the presence of this virus is a far more accurate test than the older fashioned pap smear.
If the HPV test for a woman is negative, then a check is performed every 5 years.
If the HPV test for a woman is positive, it will depend on the type of HPV detected as to what happens next.
HPV types 16 and 18
These are high risk types of HPV that account for about 70% of all cancers. If this HPV type is detected, a pap smear to check the cells of the cervix is also automatically performed by pathology. The woman will then need to have a colposcopy (see later) performed with the gynaecologist to look more closely at the cervix.
Other HPV types, not type 16 or 18
There are many other HPV types which the woman can carry, but these are far lesser risk for development of cervical cancer than types 16 and 18.
If another low risk type of HPV is detected, a pap smear to check the cells of the cervix is automatically performed by pathology. The result of the pap smear will then determine further management. A colposcopy may need to be performed, or a simple repeat HPV test may need to be performed in 12 months and just watched from there.
Colposcopy and biopsy of the cervix
As seen above, a colposcopy is performed if HPV types 16 or 18 are detected, or if a low risk HPV is detected and the pap smear shows a high-grade change, or shows a persistently low-grade change over a couple of years.
Colposcopy is performed in Dr Friebe’s rooms and takes about 10 minutes. A speculum is gently placed in the vagina to visualise the cervix, and a watery vinegar solution is applied to the cervix with cotton wool. The cervix is then examined under a magnifier, and any abnormal tissue lights up a bright white colour.
Any abnormal tissue is biopsied. A local anaesthetic spray is applied to the cervix, and a small match head amount of cervix tissue is nipped off the surface. This is a very quick procedure with minimal pain. The biopsy is sent to pathology, and further management will depend on the result. Results are always conveyed by Dr Friebe by phone, in person or by a letter depending on the situation.