Cervical cancer is a global challenge particularly in low and middle level countries. The region like Sub-Saharan Africa, Central America and Southeast Asia, with the highest incidence of cervical cancer and mortality rate. In India cervical cancer bring the second most common cancer among the women. The review highlights effectiveness of the PAP smear test as primary screening tool and for identification of the pre-cancerous lesion. It has proven its efficiency, cost effectiveness and reduce the several barriers such as lack of awareness and cultural stigma. The review highlights the importance of PAP smear test for early detection of cervical cancer and pre-cancerous lesion. The PAP smear test being the effective, simple and affordable, also helps in reducing mortality rate and support early diagnosis and provide treatment plan.

Cervical cancer is the most common cancer worldwide. According to the World Health Organization (WHO) 2022 census data, about 94% of the 350,000 deaths are caused by cervical cancer. The highest rate of cervical cancer incidence and mortality are in sub-Saharan Africa, Central America and South-East Asia [1]. In India cervical cancer is the second most common cancer among women; moreover 22.86% of women affected with the cervical cancer. Additionally, it has been also found that in every 8 minutes 1 women dead due to cervical cancer [2]. The women who lie in between age group of 21-60 are mostly affected by cervical cancer [2]. In Sikkim, women aged 30-49 has undergone screening for cervical cancer which include 0.7% from urban, 0.5% from rural and 0.6% in total [3]. The state Sikkim was the first state to introduce the Human Papillomavirus (HPV) vaccine all over the state in 2018-2019, focus on girls who are aged from 9-13 years. This vaccination campaign was primary initiative and the vaccination campaign was done through schools all over the state [4].

Cervical cancer usually progresses at a very slow rate. It initially starts as a pre-cancerous condition such as dysplasia which is also known as intraepithelial neoplasia. Initially this pre-cancerous cell begins to develop in the basal layer of the squamous epithelium of cervix and uteri. These pre-cancerous cells develop gradually and become invasive carcinoma and the pre-cancerous lesion remain stagnant to the epithelium with or without any morphological changes and with a minor diagnostic procedure we can detect and cure it at initial phase [5]. The cervical cancer is increasing in the developing countries because of multiple reasons, like having many sexual partners, early sexual activities, not using condoms regularly and the main cause of cervical cancer is infection with the Human Papillomavirus (HPV). Majorly there are two types of diagnostic test for cervical cancer screening: Papanikolaou test and HPV test. The PAP test detects early pre-cancerous and cancerous cell lesions and HPV test detect the presence of high-risk type of Human Papillomavirus in the cell collected from a women cervix [6]. In comparison with other screening test the PAP smear test is globally accepted for its effective results and also for the early detection of the cancerous cells. The PAP smear test was developed by Dr. George Papanicolaou with its introduction in the year 1941, the PAP smear test became the most effective and the standard screening method for detecting the cervical cancer or any other pre-malignant lesions. The effectiveness of this test not only plays a role in detection of the cancerous cells but also help in the diagnosis of the bacterial infection or any inflammatory condition where it detect the underlying cause [7]. The abnormality found in the cervical epithelium are basically categorised based on the cell severity and the grading system that is Bethesda system: Cervical Intraepithelial Neoplasia (CIN) 1 indicates mild changes in the cell morphology whereas CIN 2 it indicates moderate changes in the morphology of the cells and CIN 3 it indicates severe dysplasia and this grading system is very much useful and plays a vital role in guiding treatment plans. There are some social barriers for screening despite having effectiveness, barriers such as lack of awareness, cultural stigma and also inadequate access to healthcare services which limit the use of PAP smear screening, in low or middle-income countries and state all over the world. In this backdrop the present study has been undertaken to identify or access the role of PAP smear for the easy detection of cervical cancer. In this backdrop, the present study has been undertaken to identify or access the role of PAP smear for early detection of cervical cancer.

Electronic search has been carried out using the databases viz. Google, Google Scholar, Pub Med for the study. The search was restricted for a period of 17 years ranging from 2008 to 2025. The search terms included PAP, cervical cancer and HPV, Neoplasia, CIN, abnormality in cervix, screening techniques and Bethesda system. Duplication was avoided by excluding review of multiple copies of the same article in several databases.

The PAP smear test has been regularly showing its good and effective results in the early detection of the cervical cancer and also its pre-cancerous stages. Multiple studies have shown a major reduction in the cervical cancer cases and also the mortality because of the regular screening [7]. The following table representing few studies conducted among the female individuals and total no of individuals affected with cervical cancer. 

Table 1:Characteristics of the studies included in the analysis [6]

The outcome of this review clearly shown an effectiveness of PAP smear in the detection or reduction of the cervical cancer. Regular screening helps in the early detection of abnormal changes in the cervical cells, which can be diagnosed and treated before turning into an invasive cancer. The result from various studies includes in this review confirm that women who undergo regular screening for PAP smear had majorly low risk of developing the cervical cancer compared to those who did not do screening. The PAP smear test is cost-effective screening methods, its implementation is limited in many low and middle level people, due to many factors: such as lack of awareness, social stigma, limited access to healthcare and also insufficient infrastructure. This all factors are mostly relevant in the rural and underdeveloped areas where women are not much aware about all these procedures.

In region like Sikkim, the introduction of the HPV vaccination and also promoting the screening awareness are very much needed steps. However, there are still a need for better public health education about Gynecological care and community-based screening initiative [4]. The PAP smear screening should be integrated with primary healthcare services for further improvement and reduction of the risk of cervical cancer to women. 

This review highlights the significant impact of the PAP smear test for the screening of the cervical cancer and it may reduce the mortality rate. The PAP smear test being a simple, affordable and effective tool, it plays a very much important role in the diagnosing and additionally making a treatment plan.