Exploring Pap Smear Effectiveness
Nov. 19, 1999 (Minneapolis) -- Women probably don't give much thought to the
device that's used to perform their routine Pap smear. But a new study by
British researchers suggests that maybe they should.
Cervical screening is effective in decreasing incidence and death from
invasive disease of the cervix. When a woman has a Pap, or cervical smear,
test, clinicians obtain cells from the cervix using a collection device that
helps the laboratory technician detect disease, such as cancer. The device may
be a spatula, a cotton-tipped stick, a brush, or a combination of tools. The
more cells collected, the easier it is for the Pap smear to be analyzed
effectively in the lab. Although one collection device, known as the Ayre's
spatula, is commonly used in the U.S., scientists in the U.K. now are
questioning whether that method is best.
P. Martin-Hirsch, MD, of the department of obstetrics and gynecology at St.
Mary's Hospital in the U.K., and his colleagues gathered data from 34 earlier
studies comparing various devices and their ability to detect abnormalities
within the cervix. Their findings suggest that design of the Ayre's tool is the
"least effective device for cervical sampling." Instead, they suggest
extended-tip spatulas. These have a longer tip than the Ayre's spatula that can
reach into the cervix further and obtain more cells for evaluation.
But despite the magnitude of the British report, some U.S. experts aren't so
sure of the significance of the report. Ephraim Resnik, MD, an
obstetrician-gynecologist at Columbia-Presbyterian Medical Center of New York
Presbyterian Hospital, tells WebMD that current U.S. methods of collecting
cervical samples are "certainly yielding the results we're looking
for." In addition, he says that most clinicians use a combination of tools
rather than just one -- a point that these researchers did not emphasize.
Peter Schwartz, MD, agrees. "Using an endocervical device in association
with a spatula gives much more accurate information about abnormalities within
the cervix [than one tool alone]. Many elements make a Pap smear adequate and
help provide a proper result," he tells WebMD. "In this day and age, a
woman wants to be sure that her Pap smear is performed in an appropriate manner
with a sample device that can adequately see the cervical canal. She can ask
her doctor whether such a device is being used. Also, it's important that a
woman is confident that the lab analyzing the smear has trained personnel."
Schwartz is professor of obstetrics and gynecology and chief of gynecological
oncology at Yale University School of Medicine and Yale-New Haven Hospital in
Schwartz says that all new screening in the U.S. focuses on the women
receiving the Pap smear in the first place. He says it's important for women to
remember that "the single largest group of women who get invasive cancer
are women who don't have Pap smear screening, and this is true in every
So the next time a woman schedules her annual Pap smear, it may be a good
idea to not only get to know the doctor who is performing the test, but also
the device being used and the quality of the lab as well.