Pap Test
Pap Smear Tests Explained

screening for cervical cancer


Pap Test


What Is A Pap Test?
Who Needs One & How Often?
What If I've Had A Hysterectomy?
How Do I Prepare For a Test?
When Should I Have a Test?
How Is A Pap Test Done?
What Do The Results Mean?
How Much Does It Cost?

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Cervical Cancer

What Is A Pap Test?

A Pap test, also known as Pap smear test, checks for cell changes and abnormalities in the cervix. It is an integral part of a cervical cancer diagnosis and is particularly important as a way of screening for signs or symptoms of cervical cancer. This is because very often the disease presents with few (if any) early signs. The Pap test was named in 1943 after its originator Dr Papanicolaou. As it usually takes years for pre-cancerous cells to develop into cervical cancer, regular Pap tests can reveal cancer in its early and most curable stage. It can also detect about 50 percent of endometrial cancers and a smaller number of other female gynecological tumors. Occasionally a Pap test will show signs of other conditions such as trichomoniasis, a type of vaginitis which is usually transmitted sexually.

Who Needs One & How Often?

1. According to new guidelines by the American College of Obstetricians and Gynecologists (ACOG) Pap tests are recommended for all women at the onset of sexual activity, or from the age of 21 onwards - whichever comes first - every 2 years.
2. Women over the age of 30, after 3 or more consecutive negative tests can usually space Pap tests out to every 3 years. This includes women going through menopause.
3. Women over the age of 65 can talk to their doctor about stopping tests if they have had at least 3 normal Pap test results in the previous 10 years.

More frequent testing, as a form of cervical cancer prevention, may be recommended to women if:
4. They had first sexual intercourse before the age of 17.
5. They have a history of the human papillomavirus infection (HPV) - one of the main causes of cervical cancer. Or they presented with abnormal results in previous tests.
6. Their mother was exposed to the drug DES while pregnant (DES was prescribed to some women before 1970 to prevent miscarriage).
7. They have a weakened immune system because of organ transplant, steroid use or chemotherapy.
8. They are HIV positive. The US Centers for Disease Control and Prevention recommend all HIV-positive women to have an initial Pap test and then re-test 6 months later. If both Pap tests are normal then they can test annually thereafter.

What If I Have Had a Hysterectomy?

Women who have had a hysterectomy should talk to their doctor about whether or not they need a routine Pap test. A total hysterectomy involves removal of the uterus and cervix, and for this reason regular Pap tests may not be necessary. Women who have had a total hysterectomy because of cancer or abnormal cell growth should continue to have a Pap test every year to monitor for cancer of the vagina. Once they have had 3 normal test results they may be monitored less closely, although an annual pelvic examination is still recommended. Women who have had their uterus removed but not the cervix will still need regular Pap tests as normal.

How Do I Prepare For a Test?

The main thing you need to do is avoid washing away or hiding abnormal cells of the cervix. For 2 days before a Pap test avoid:

1. Using tampons
2. Douching
3. Vaginal creams, medicines or suppositories
4. Using vaginal hygiene produces such as deodorant sprays and powders
5. Sexual intercourse

When Should I Have a Pap Test?

Avoid scheduling a test when you have a period. The best time to be tested is 10 to 20 days after the first day of your last period. This is around the midpoint of a woman's menstrual cycle, when the cervical canal is most open and better samples can be taken.

How Is A Pap Test Done?

Most Pap tests are carried out during a routine pelvic examination. While the woman lies on the exam table the doctor inserts an instrument called a speculum into the vagina, opening it to view into the cervix. He then uses a small plastic brush (cytobrush) and a flat wooden spatula to obtain a sample of cells scraping inside and around the cervix. Does the test hurt? Although the Pap test is not painful, like any internal examination it can cause an uncomfortable feeling. In a conventional Pap test the sample of cells are then fixed with a chemical onto a glass slide and sent to a lab for examination. This technique has largely been replaced in the United States by the liquid-based cytology Pap test. With the newer method cells are placed in a vial of preservative liquid. The vial is then sent to the lab where an automated device prepares the sample for testing. One of the main advantages of of liquid-based cytology is that doctors can also check for the HPV virus. It also seems to preserve the specimen better, although both methods appear just as good at detecting abnormalities.

What Do The Results Mean?

Results from a Pap test normally take about 3 weeks. They are sent to a cytotechnologist (a trained technologist) for analysis who will look at the Pap smear and report on whether it is normal or not. If there is any question about its normality it is sent to a pathologist who is an expert on cells and tissue disease for further analysis. Pap smear results classify cells into several categories of cervical dysplasia ranging from the obviously normal to the extreme of carcinoma in situ or invasive cancer. The problem is usually how to classify cells which fall in the middle categories which show abnormalities but not that much abnormality. For this reason one common system is to classify 'somewhat abnormal' cells into 3 further categories: cervical intraepitheilial neoplasia (CIN): 1, 2 and 3. Category 1 being mild and category 3 showing severe dysplasia. CIN is a pre-cancer state, but in most cases it does not develop into cancer. Depending on which category of CIN is present doctors may recommend either the wait and see approach (as sometimes cells spontaneously revert to normal) or else recommend treatment.

What If My Pap Test Shows 'Abnormal?

If you receive an 'abnormal' result from a Pap test, or the result is not clear, your doctor will probably want to repeat the test. Do remember that most cases of abnormal Pap tests are not cancer. Atypical cells are usually the result of an infection of the cervix (cervicitis) or vagina (vaginitis). Other times it can be pre-cancerous cell changes (CIN/dysplasia). If the second test finds any serious changes in the cells of the cervix, more powerful tests will be ordered. These could include:

Colposcopy: A colposcopy is where a technician examines the cervix and vaginal area with a lighted tube called a colposcope.

LUMA Cervical Imaging System: This can be used immediately after a colposcopy. This system shines a light on the cervix to see how different areas respond to the light. It maps the cervix and helps doctor determine which area of tissue should be used for a biopsy.

Endocervical Curettage (ECC): A sample of cells is taken from the endocervical canal with a small spoon-shaped instrument called a curette.

Biopsy: A sample of cervical tissue is removed and sent to a lab for analysis. Examples include Punch Biopsy, Cone Biopsy and Loop Electrosurgical Excision Procedure (LEEP). These procedures may also be cervical cancer treatments.

What is a ‘False Positive’ Test Result?

A Pap test is very specific. If a smear shows invasive cervical cancer, that information is nearly always correct. However it is not as sensitive as it could be which means a false negative or a false positive can occur. Manual reading of slides will lead to a certain amount of human error; no matter how well trained those involved. A false positive is where a woman is told that she has abnormal cervical cells, whereas in fact they are really normal. This can be upsetting but it medically causes no problems. A false negative on the other hand is when a woman is told her cells are normal where in fact they are not. This can delay diagnosis and treatment. For this reason regular Pap tests are recommended so that if a problem is missed first time around, it is less likely to be next time. Newer automated screening processes associated with the liquid-based cytology method are also reducing errors related to Pap smears. Using high-speed microscopes and image interpretation software new machines can analyze results faster and more thoroughly. These machines can still only however identify 'normal' slides. A pathologist must still manually diagnose cell abnormalities.

See also: Cervical cancer survival rates.

How Much Does It Cost?

The cost can range from $50 to $200, depending on the doctor. Most health insurance companies cover the cost of Pap tests. Also, the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) offers free or low cost tests throughout the US to low income women. Call: call 1-800-232-4636 for more details. Alternatively Planned Parenthood offers low cost Pap tests to women whose level of income exceeds the amount allowable at their county health department. For more details see their website:

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For more gynecological cancers, see the following:

Cervical Cancer Stages
Cervical Cancer in Pregnancy
Cervical Cancer Recurrence

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