The smear too many women forget it!

50% of women have little or no evidence of smear cervical cancer. It is not enough. This is why a smear screening program is being set up. This sample taken during a gynecological examination is a quick and painless examination.

By detecting pre-cancerous cells of the cervix, Papanicolaou's Pap smear, named after its inventor, can save your life.

Pap smears for cancer of the cervix

The cervix is the preferred site of infection with certain papillomavirus (HPV for Human papilloma virus), which is implicated in nine out of ten cervical cancers. These sexually transmitted infections remain mostly benign and regress in the year that follows.

But in some cases, they develop into precancerous lesions (dysplasias) that can turn into cancer of the cervix if they are not detected and treated. Approximately 65% of invasive cervical cancers occurred in women who had not smeared in the last three years. And it is young women, 41 years on average, who pay the highest price.

Dr. Bernadette Carcoppino, a gynecologist, and Dr. Yéhouda Benchimol, obstetrician gynecologist, answer the questions that arise.

The smear, what is it?

It is a collection of cells of the cervix, made during a gynecological examination, which can detect the presence of abnormalities. It's a simple act, quick and painless. You are in a gynecological position. The doctor sets up a speculum to spread the walls of the vagina and expose the cervix. He then uses a small wooden spatula to scrape the bottom of the vagina and the surface of the cervix, and a stick to take more delicately the cells located inside the cervix.

Ideally, "the exam should be done outside the period of menstruation or bleeding, at a distance from sexual intercourse (48 hours), not after vaginal cleansing or placement of eggs or cream," says Dr. Yehuda Benchimol.

There are two smear techniques and it is the doctor who chooses the one he prefers: conventional smear on blade, the oldest and most used, or smear in thin layer in liquid medium, which allows, in case of discovery of cell abnormalities, to perform a search for papillomavirus DNA on the same sample. Another advantage is that it reduces the number of uninterpretable smears.

At what age should you make a smear?

From 25 years old up to 65 years old according to the High Health Authority, beyond if the doctor recommends it. And even if you have stopped having sexual activity, because the HPV can remain silent for a long time.

It is not useful to start before age 20, because it takes a latency (about ten years) before seeing the first anomalies appear. This examination, which has long been the initiative of women and their doctors, has been the subject of organized cervical cancer screening since May 2018.

What is the rhythm of the samples?

The first two smears are one year apart. If they are normal, the rhythm then changes to one every three years.

"This frequency is based on the history of each woman (change of partner, anomaly ...), or at the discretion of his visits during which we verify that everything is up to date," said Dr. Bernadette Carcoppino.

Can we smear when we are pregnant?

"Yes, the only risk is sometimes minor bleeding, because of the greater fragility of the cervix," says Dr. Benchimol.

Is the result of a smear 100% reliable?

No, this test is not foolproof. "His sensitivity is around 70%," says Dr. Benchimol. On 100 lesions, it detects only 70. "Thus, if the smear occurs at a time in the cycle when there is not enough cervical mucus or the action was not performed correctly, the results can be distorted. False positive, the result indicates the presence of precancerous or cancerous cells when there are none. A second smear and / or biopsy can uncover and correct the error.

False negative, the smear indicates a normal result while there are lesions of the cervix. This is often the result of imperfect sampling (either the abnormal cells were not picked up by the brush, or they were not transferred to the slide to be examined under a microscope) or, more rarely, a misinterpretation

Generally, the doctor realizes it at the next smear, hence the importance of regularity to "catch up" with errors. Rest assured, the improvement of the techniques and gestures of the doctor significantly reduces the number of false negatives.

My daughter is vaccinated, will she need to smear?

Yes, because this vaccination essentially protects against two types of virus, HPV 16 and HPV 18, found in 70% of cervical cancers.

Since there are at least 120 different papillomaviruses, protection remains partial and smear screening every three years is essential.

And if the smear reveals an anomaly?

If your smear has minor cell changes, your doctor will suggest that you repeat the smear six months later to re-check the condition of your cervix, perform an HPV test that detects the virus's DNA, and has a sensitivity greater than 95%, or to perform a cervical examination with a magnifying loupe (colposcopy).He will then take a sample of the abnormal area of ​​your cervix (biopsy). If your smear has more important abnormalities, a colposcopy will be proposed and your doctor will evaluate with you the most suitable treatment: laser, cryotherapy or conisation. The latter, a little heavier than the first two, is a surgical procedure that involves removing a portion of the cervix-like cone, hence its name. The specialist will determine, using a colored reagent, the extent of the lesions and remove the affected part. A removed tissue analysis will confirm that all malignant cells have been removed. Know that a cancer taken in its infancy has more than 99% chance of cure.

Who to turn to for a smear?

To his GP, his gynecologist or a midwife. You can also smear at the health insurance centers of Medicare, the mutual centers.

How much does it cost ?

The smear is fully covered by Medicare as part of the national organized cervical cancer screening program.