Pap Smear Examination in Cervical Cancer Screening: A Review

Rahul Eshi1*, Jayesh Chaudhari1, Priyanka Ahire1, Kalpesh Mahale1

1Assistant Professor, P.G. College of Pharmaceutical Science and Research, Chaupale, Nandurbar (MS), India

Received: 15 Dec 2025 | Published: 01 Jan 2026
Manuscript No: HJBMR-06-25-007 | Download PDF

Abstract

Cervical cancer remains a major cause of morbidity and mortality among women worldwide, despite being largely preventable. Persistent infection with high-risk human papillomavirus (HPV) is the principal etiological factor. Early detection through cytological screening, particularly the Papanicolaou (Pap) smear, has significantly reduced cervical cancer incidence and mortality. This review highlights the pathophysiology, morphology, clinical features, diagnostic approaches, and laboratory role in cervical cancer screening, with emphasis on Pap smear examination and emerging diagnostic technologies.

Keywords

Cervical cancer, Pap smear, Human papillomavirus (HPV), Cytology, Liquid-based cytology, Screening, Laboratory diagnosis

Introduction

Cervical cancer is one of the most preventable malignancies, yet it remains a major public health concern in low- and middle-income countries. The disease develops slowly through well-defined precancerous stages, providing a crucial window for early detection using cytological screening methods such as the Pap smear.

Pathophysiology of Cervical Cancer

Persistent infection with high-risk HPV types, particularly HPV-16 and HPV-18, leads to malignant transformation of cervical epithelial cells. Viral oncoproteins E6 and E7 disrupt tumor suppressor pathways, resulting in genomic instability and progression from cervical intraepithelial neoplasia to invasive carcinoma.

Morphology of Cervical Cancer

Morphological changes range from mild dysplasia in early lesions to invasive carcinoma. Cytological features observed in Pap smears include koilocytosis, nuclear enlargement, hyperchromasia, and increased nuclear-to-cytoplasmic ratio, reflecting underlying histopathological alterations.

Symptoms, Complications, and Diagnosis

Early-stage cervical cancer is often asymptomatic, emphasizing the importance of routine screening. Advanced disease may present with abnormal vaginal bleeding, pelvic pain, and vaginal discharge. Diagnosis involves Pap smear screening, HPV DNA testing, colposcopy, and histopathological confirmation.

Treatment and Management

Management depends on disease stage and ranges from conservative treatment of precancerous lesions to surgery, radiotherapy, and chemotherapy for invasive disease. Laboratory investigations are essential for monitoring treatment response and detecting recurrence.

Laboratory Role in Diagnosis and Monitoring

The laboratory plays a central role in cervical cancer screening and diagnosis. Proper specimen collection, cytological evaluation, HPV testing, and quality control ensure diagnostic accuracy. Advances such as liquid-based cytology and molecular diagnostics have improved sensitivity and reliability.

Prevention Strategies

Prevention includes HPV vaccination, regular screening programs, and public awareness initiatives. Integration of laboratory services with clinical care is vital for reducing cervical cancer burden.

Conclusion

The Pap smear remains a cornerstone of cervical cancer screening. Combined with HPV testing and modern laboratory techniques, it enables early detection, effective management, and improved survival. Strengthening laboratory practices and expanding screening coverage are essential for protecting women’s health worldwide.

References

  1. Jain MA, Limaiem F. Cervical Squamous Cell Carcinoma. StatPearls; 2025.
  2. Nayak SS et al. Liquid-based cervical cytology. J Cytol. 2024.
  3. WHO. Cervical cancer elimination strategy.