Smear: conduct of the examination, results, and interpretations
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The smear is a gynecological examination that allows superficial cells to be taken for analysis under a microscope. It is a screening test for cervical cancer.

But, then, how does the examination of the smear take place? Here are the answers to your questions about the reasons for this collection, how often to carry it out, and the results.

What is a smear?

The smear is a medical procedure to remove superficial cells by light friction. This sampling is done using a small brush, a spatula, or a special cotton swab. Once placed on a glass slide, the cells are examined under a microscope to observe any abnormalities.

The most common Pap smear is the cervicovaginal smear. This is a gynecological exam that involves taking cells from the cervix and looking at them under a microscope to analyze their appearance (to detect cancer or precancerous lesions).

There are other types of smears that can be performed.

Blood smear

The blood smear involves smearing a little blood on a glass slide and observing it under a microscope. This type of smear is used in particular to check whether or not the different blood cells have morphological abnormalities.

Anal smear

The anal smear is a sample of cells from the lining of the anus. These cells are then examined under a microscope to see if they have had abnormal changes that could lead to cancer.

Microbiological smear

The microbiological smear can, for example, be carried out in the throat. This is a sample collection for bacteriological or mycological examinations.

Who can perform a smear?

Several health professionals can perform a Pap smear:

  • Your doctor or gynecologist;
  • a general practitioner;
  • a midwife;
  • a medical biologist from a medical analysis laboratory.

Why do a cervicovaginal smear?

The cervix is located between the vagina and the uterus. It can thus be the site of papillomavirus (or human papillomavirus, HPV) infections.

These viruses are sexually transmitted and can develop affected cells into cancer cells. Thus, 70% of cervical cancers are due to prior infection with the papillomavirus.

Cervical cancer

Cervical cancer is a silent disease whose symptoms are long and imperceptible. It is the second leading cause of cancer in women in the world and its screening is therefore very important.

How much should a smear be done?

According to the National Cancer Institute, in France, it is recommended to have a smear every three years, between 25 and 65 years.

In Quebec, this test is also called a “Pap test” or Pap smear (named after the doctor who created it).

How is the smear exam done?

During a smear, the patient is placed in the gynecological position while the doctor inserts a speculum to spread the walls of the vagina. He then removes the cells from the surface of the cervix using a special cotton swab or a small brush. The review is very quick.

The cells are laid out on a glass slide, fixed and a dye is added. They are then sent to a laboratory for microscopic analysis. Cancer cells that do not look the same as normal cells can be detected.

The practitioner who performs the smear then asks the patient for some information:

  • His age;
  • if she is pregnant;
  • the date of the last menstrual period or menopause;
  • whether or not to take treatment;
  • history of illness;
  • the date and results of the last smear.

This information will be sent to the laboratory with the samples.

The results of a smear

Depending on how the cells look, the doctor will be able to determine if they are normal or if the cervix has an infection or precancerous or cancerous lesions.

This test also monitors the evolution of precancerous cells and ensures that cancer does not recur after treatment.

It is important to have regular screening. This is because the smear is not a 100% reliable test and cells can change over time.

If there is no abnormality on two consecutive smears, it is recommended to repeat the examination every 2 or 3 years. If the examination reveals an abnormality, the doctor may perform other tests:

  • a viral test: to confirm the presence of a papillomavirus infection or mycosis;
  • a biopsy.

There is a vaccine for cervical cancer that protects against the main types of HPV. However, this vaccine does not replace smear screening, which remains essential.

Image Credit: Image by stefamerpik on Freepik

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