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These questions focus on common questions from health practitioners who collect Pap smears. Who should have Pap smears? The national policy in Australia is that asymptomatic women should be screened every two years. Screening should commence at 18-20 years of age, or one to two years after first sexual intercourse, whichever is later. Screening can stop at 70 years of age, provided the woman has had two normal Pap smears in the preceding five years. Women over 70 years who have never had a Pap smear, or who request a Pap smear, should be screened. This policy applies to both heterosexual and homosexual women. Virgins
do not need to be screened. Most cancers of the cervix take many years to develop, frequently more than 10 years. If a woman has been regularly screened prior to the age of 70, it is most unlikely that she will develop cervical cancer during the rest of her life. If however an asymptomatic woman over 70 years requests screening, this should be done. Is it safe to take a smear from a pregnant woman? It is safe to take a Pap smear from a pregnant woman provided a cytobrush is not used. What if the woman has symptoms? Women who have symptoms or signs consistent with cervical cancer should be managed on the basis of their symptoms. In these circumstances, a Pap smear report may be unreliable. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists has issued guidelines for the investigation of intermenstrual and postcoital bleeding. http:/www.ranzcog.edu.au/Open/statements/pdfs/C-gyn6.pdf What is the national policy about the need for smears after a hysterectomy? Most women who have had a hysterectomy (with removal of the cervix) do not need to continue having Pap smears. If the woman does not know her Pap smear history and/or the histology from the hysterectomy, then one vaginal vault smear is recommended. If this is normal, then no further smears are required. Women who have had a sub-total hysterectomy (ie the cervix has not been removed) should continue to be screened at the recommended two-yearly interval. Continued screening is advised post-hysterectomy for: Full details of the policy for these women can be viewed at
http:/www.ranzcog.edu.au/Open/statements/pdfs/C-gyn8.pdf There is no official policy on this in Australia. 'Standards in
Colposcopy and Treatment' issued by an RANZCOG and ASCCP Working Party
states that two or three attempts would appear to be reasonable current
practice. It is prudent to keep a written record of the attempts made. This should happen infrequently, but when it does, you can ask the
Victorian Cervical Cytology Registry (phone 03 9250 0399) to request an
updated address for the woman from the Health Insurance Commission. If you write 'urgent' on the Cytology Request Form, we will give this
smear preference over others. In general, urgent reports are available on the
day the smear is received at VCS or on the next working day. We will
either send the results to you electronically or we will fax the results
to you. Overall, VCS reports about 1.5% of Pap smears as being unsatisfactory. The common reasons for this include obscuring of the cervical cells by blood or inflammation, and insufficient numbers of squamous cells on the slide. Sometimes inadequate fixation of the cells occurs. Many of these underpinning causes are beyond the control of the
practitioner collecting the smear or the laboratory. Some unsatisfactory
reports could be avoided by collecting smears in a different manner.
Please refer to our instructions for taking
a Pap smear Most precancerous abnormalities of the cervix commence in the
transformation zone where the columnar epithelium of the endocervical
canal meets the squamous epithelium of the vagina. If a Pap smear contains
cells from the endocervix, this increases the probability of any abnormal cells
being included in the sample. Overall, around 80% of Pap smears reported by VCS include an endocervical component. Endocervical sampling is less likely in pregnant women and in post-menopausal women. Use of an endocervical brush as well as a spatula increases the chances that an endocervical component will be sampled. Endocervical brushes should not be used in pregnant women. If a ThinPrep test is needed, then a wooden spatula should not be used. Rather, the sample should be collected using the Cervex Sampler or a plastic spatula, as well as a cytobrush. Make a conventional smear first, and then agitate the sampling instruments in the ThinPrep fluid. Label the container and send it to VCS along with the conventional smear. Supplies of ThinPrep fluid are available from VCS.
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