Welcome to the latest installment of “Over 90 Percent of What Planned Parenthood Does,” a series on Planned Parenthood Advocates of Arizona’s blog that highlights Planned Parenthood’s diverse array of services — the ones Jon Kyl doesn’t know about.
Pap tests are not beloved — there, I said it. Many people who receive them hope for the day that medical science devises an equally effective but noninvasive test, whatever that might entail, as they may find them to be anything from slightly awkward to incredibly traumatizing. However, the evidence overwhelmingly shows that access to Pap testing (also called Pap smears) has transformed cervical cancer from a top killer into something that can be caught early and treated before it can do much damage. As a tool to reduce cancer deaths, Pap tests have been a resounding success.
In countries with widespread access to Pap tests, cervical cancer rates have plummeted.
A Pap test involves an instrument called a speculum being placed into the vagina to hold it open while a health care provider uses a small spatula or a tiny brush to collect cells from the cervix, which is at the opening of the uterus. These cells are analyzed in a laboratory, where a technician can determine if they are precancerous. (Cervical cancer is caused by a sexually transmitted virus called human papillomavirus, or HPV.) When caught in its precancerous stages, cervical cancer can be treated with procedures such as colposcopy and cryotherapy.
- people with cervixes start getting routine Pap tests at age 21
- Pap tests should be done every three years or every five years if a Pap test and an HPV test are performed at the same time
- Pap tests should continue until about age 65 — or later, if there is a recent history of abnormal Pap tests
The Pap test is named for its inventor, George Papanicolaou, who immigrated to New York in 1913. Trained as a physician in Europe but without a penny to his name when he stepped off the boat, he spent the first few months of his new life in the New World as a carpet salesman before landing a job at Cornell University. His task: to study the menstrual cycle of the guinea pig, which neither bleeds nor sheds tissue during menses. He developed a technique to collect cervical cells from the rodents using a nasal speculum and a Q-tip, after which he spread the cells onto a slide in a preparation called a “smear.” He could then examine the guinea pigs’ cervical cells under a microscope, and soon determined that the cells cycled through different shapes and sizes in lockstep with the menstrual cycle itself — allowing him to track the rodents’ menstrual cycles despite the lack of telltale bleeding.
He found that human cervical cells went through such cycling as well — apparently he subjected his wife, Maria, to daily cervical-cell collections so that he could better understand the relationship of cervical-cell morphology to the stages of the human menstrual cycle. After spending many years staring at normal cervical cells, Papanicolaou realized that his seemingly useless procedure might be used to identify cervical cells that were not normal — cells that had developed abnormalities indicative of disease. So he started collecting cervical cells from people with all sorts of pathological conditions, looking for patterns amid the endless sea of cells.
Eventually he found a correlation nestled within the chaos: Under the microscope, cancerous cervical cells had huge nuclei while the rest of the cells’ innards wasted away, contained within uneven membranes. He revealed his diagnostic technique in 1928, but it was brushed aside as a primitive procedure that paled in comparison to biopsy, the preferred method of cancer diagnosis. The world of medicine heaved a bored sigh, and nothing came of Dr. Papanicolaou’s test.
During the next couple of decades, he refined his technique. At the time, other researchers were noting that cancer entailed a progressive series of steps as cells slowly transitioned from normal to cancerous. As oncologist and writer Siddhartha Mukherjee explains in The Emperor of All Maladies:
Cervical cancer typically arises in an outer layer of the cervix, then grows in a flaky, superficial whirl before burrowing inward into the surrounding tissues.
Instead of focusing on full-fledged cancer cells, Dr. Papanicolaou wondered if he could identify the stages in the slow progression of cells from normal to malignant. This way, his test could be used to detect precancerous cellular abnormalities — when the condition could be treated — rather than as a shoddy diagnostic technique for cancer that had already developed — when the condition might be incurable.
In 1952, the Pap test got a new lease on life when the National Cancer Institute ran an enormous clinical trial to determine its efficacy in cancer prevention. In total, 150,000 cervix-wielding Tennesseans were regularly tested and tracked over time. More than 500 of them were found to be asymptomatic owners of precancerous cervical cells — and were treated surgically before the cells could continue their slow journey toward malignancy.
As they say, the rest is history. In countries with widespread access to health care, cervical cancer rates have nosedived thanks to Pap testing. In the United States, half of cervical-cancer deaths occur among people who have never had a Pap test; in some undeveloped countries, cervical cancer remains a major cause of death.
Planned Parenthood health centers offer Pap tests as part of our commitment to preventive health care. Other ways to reduce risk for cervical cancer include vaccination with Gardasil, which protects against the two strains of HPV responsible for 70 percent of cervical cancers. Planned Parenthood clinicians can also talk to you about safer-sex techniques that can further protect you from the virus that causes cervical cancer.