Pap Tips

How can you encourage your patients to have regular Pap tests?

Identify women who are due for a Pap test
A reminder system or tagging patient files may be useful for keeping track of women who are due for a Pap test. Call the NSW Cervical Screening Program on 131 556 to order some file tags.
Take the initiative and raise the issue of Pap tests
The easiest way to introduce the subject is simply to ask: "While you're here, can we check when you last had a Pap test?"
Ensure women are physically & psychologically comfortable
Some women may appreciate a cover sheet to maintain privacy, while others will be interested to observe the procedure. Address the concerns and questions each woman may have about a Pap test.

Why is a Pap test recommended every two years?
Cervical cancer usually takes more than a decade to develop, so two-yearly Pap tests can help with the early detection of pre-cancerous changes.

Should any woman have a Pap test more often than every two years?

There are at least two situations when a woman should have a Pap test outside the recommended protocol:

a)	Women with an abnormal Pap test result should have subsequent Pap tests according to the guidelines developed by the National Health and Medical Research Council (NHMRC).
b)	Screening guidelines do not apply to women with symptoms of unusual vaginal bleeding such as persistent intermenstrual, postcoital or post-menopausal bleeding. These women should have a Pap test taken and be referred for investigation even if the test is reported as normal. Women with an unusual or suspicious appearance of their cervix should also be referred for investigation by colposcopy.

Did you know...

• Cancer of the cervix is the eighth most common cancer in Australian women, yet is also one of the most preventable and curable of all cancers.
• The Pap test can detect early changes in the cells of the cervix before they have a chance to develop into cancer. These cellular changes may not be permanent.
• Up to 90 per cent of the most common form of cervical cancer could be prevented if all women had regular two-yearly Pap tests.

What's the advice for women over 70?

If women are screened regularly up to the age of 70 years they will have a low risk of developing cervical cancer since the disease usually takes more than a decade to develop. It is recommended that screening may stop at 70 years, provided the woman has had two normal Pap tests within the previous five years and is asymptomatic.

Cervical cancer does occur in women over 70, particularly those who have not been well screened throughout life. A Pap test may still be carried out on women over 70 years who have been screened inadequately in the previous five years, who request a Pap test or if there are abnormal symptoms.

Patient barriers to cervical screening and how to overcome them.

"I'm afraid of finding something (wrong)..."
Try to find out whether there is any specific reason for this anxiety (eg. family history of cancer). Explain that the lifetime risk of developing cervical cancer is about 1 in 100. Reinforce that the majority of Pap tests are normal and that abnormalities, when they occur, are usually pre-cancerous changes that can be easily treated. Check that arrangements about giving results are clear and acceptable.
"It hurts..."
Enquire about earlier examinations and check whether the technique requires further explanation. Warm the speculum, and encourage relaxation techniques and tilting of pelvis.

"But it's a test for cancer"

Some women incorrectly think a Pap test is a means for detecting cancer. If they also view cancer as incurable and have a fatalistic outlook, then the Pap test is seen as irrelevant. For these patients, the concept that screening is to detect pre-cancerous lesions in women who are well and asymptomatic may require repeated explanation. Sometimes younger members of the family (eg daughter) can be co-opted to provide support.

If you go to the histopathology request instead of the cytology request form in Medical Director you do not get to provide:

1. An appropriate clinical history
2. A record of the woman's choice to be included on the Pap Test Register (PTR).

These Pap Tips are available to download for use in Divisional newsletters (see below).