Cervical swab

The statutory health insurance companies offer women various preventive examinations as part of their annual gynecological cancer screening program. One of these investigations is the Cervical swab.

What is the cervical swab?

A cervix smear is a cell swab from the area of ​​the cervix. For the smear, the gynecologist inserts a speculum into the vagina to stretch it a little so that the gynecologist has a better view of the cervix.

With the help of a cotton swab or spatula, cells are then removed from the cervix. The gynecologist can usually detect noticeable tissue changes or possible pathogens under the microscope. The cell smear is then sent to a special laboratory, where a so-called Pap test is carried out in order to detect changed cells, precursors of cancer or cervical cancer at an early stage and treat them if necessary.

Function, effect & goals

A cervical swab is one of the gynecological preventive examinations that are designed to reduce the risk of developing cervical cancer in women. Cervical cancer is one of the most common types of cancer in women.

The smear is carried out in order to be able to diagnose and treat cervical cancer as early as possible and to prevent the onset of the disease through early detection. Through the Pap test cell changes and abnormalities can already be recognized. This test has been carried out in Germany since around 1970 as part of preventive gynecological examinations. These improvements in diagnostics, along with improvements in living and hygienic conditions, have led to a decrease in the rate of cervical cancer.

The cervical swab is also called the Pap test after its discoverer, Papanicolaou, a Greek doctor. Not infrequently noticeable changes are observed in this examination, but these do not necessarily mean cancer. It can also be a matter of inflammation or slight cell changes that can regress again. If the Pap test detects a precancerous stage, in most cases the abnormal tissue can be removed, thus preventing the disease from breaking out. It usually takes years before cervical cancer develops, and repeated annual smears can be used to observe the formation of new cells, so regular yearly cervical swabs is the safest prevention.

The evaluation of the cervical swab is usually based on the Munich nomenclature, which divides the findings into five groups. If abnormalities or tumor cells are found, further diagnostic measures such as a tissue sample or scraping are carried out. It is not uncommon for smears to show abnormal cell findings, which are, however, in most cases harmless and continue to be observed. If a tumor is suspected based on the cervical swab, a biopsy is usually performed, in which a tissue sample is taken and sent to a laboratory.

Even if cervical cancer can occur despite regular preventive care, it is still considered the safest preventive measure because abnormalities in cellular findings appear before the symptoms of the disease develop. Regular annual cancer screening is therefore recommended to all women and most of them also take advantage of it. And if a cervical cancer is found by the cervical swab, the chances of a cure are usually better because the cancer is usually diagnosed at an early stage through the preventive care. If the findings are conspicuous but not dramatic, the cervical swab is repeated after 3 months in order to be able to assess any changes.

Risks, side effects & dangers

Even if cervical cancer can usually be detected at an early stage through the cervical swab or if the disease does not even break out through early intervention, the test does not offer absolute certainty.

There remains a residual risk that abnormal cells could be overlooked and that cancer could develop despite regular preventive measures. But since the disease develops over a long period of time and the smear is taken annually, abnormal findings are recognized in about 90% of the women examined. Another risk is that abnormal findings and associated fears may arise, even if everything is medically in order. There are also findings that go back on their own.

In the case of slight or moderate changes, gynecologists tend to observe and wait and repeat the test several times at intervals of a few weeks so as not to worry the women. If the cell abnormalities persist even after several smears, further diagnostic measures must be taken.

Another disadvantage is that the cervical swab allows early detection of cervical cancer, but not cancer of the uterus or ovaries. That is why the cervical swab is combined with a gynecological examination of the ovaries and usually an ultrasound examination of the uterus and ovaries during preventive examinations. The tricky thing about these types of cancer is that they usually only cause symptoms when the cancer has progressed. If a woman has already been diagnosed with cervical cancer and successfully treated, she still has to take regular preventive care.

To compensate for the disadvantages of the Pap test, an HPV test was developed. The main cause of cervical cancer is suspected to be human papilloma viruses, which can be detected in cervical cells using this new test. However, this test is not yet part of the statutory preventive benefits and therefore cannot yet replace a cervical swab.