. Pap Smears

In gynecology, the Papanikolaou test or Papanicolaou test (also called Pap smear, Pap test, cervical smear, or smear test) is a medical screening method, invented by Georgios Papanikolaou, primarily designed to detect premalignant and malignant processes in the ectocervix. It may also detect infections and abnormalities in the endocervix and endometrium.

The endocervix may be partially sampled with the device used to obtain the ectocervical sample, but due to the anatomy of this area, consistent and reliable sampling cannot be guaranteed. As abnormal endocervical cells may be sampled, those examining them are taught to recognize them.

The endometrium is not directly sampled with the device used to sample the ectocervix. Cells may exfoliate onto the cervix and be collected from there, so as with endocervical cells, abnormal cells can be recognised if present but the Pap Test should not be used as a screening tool for endometrial malignancy.

0306 - Womens Health - The Pap test, also called a Pap smear, checks for changes in the cells of your cervix. The cervix is the lower part of the uterus (womb) that opens into the vagina (birth canal). The Pap test can tell if you have an infection, abnormal (unhealthy) cervical cells, or cervical cancer.

Why do I need a Pap test?

A Pap test can save your life. It can find the earliest signs of cervical cancer - a common cancer in women. If caught early, the chance of curing cervical cancer is very high. Pap tests also can find infections and abnormal cervical cells that can turn into cancer cells. Treatment can prevent most cases of cervical cancer from developing.

Getting regular Pap tests is the best thing you can do to prevent cervical cancer. About 13,000 women in America will find out they have cervical cancer this year. And in 2004, 3,500 women died from cervical cancer in the United States.

Do all women need Pap tests?

It is important for all women to have pap tests, along with pelvic exams, as part of their routine health care. You need a Pap test if you are:

• 21 years or older

• under 21 years old and have been sexually active for three years or more

There is no age limit for the Pap test. Even women who have gone through menopause (when a woman's periods stop) need regular Pap tests.

How often do I need to get a Pap test?

It depends on your age and health history. Talk with your doctor about what is best for you. The American College of Obstetricians and Gynecologists recommends the following:

• If you are younger than 30 years old, you should get a Pap test every year.

• If you are age 30 or older and have had three normal Pap tests for three years in a row, talk to your doctor about spacing out Pap tests to every two or three years.

• If you are ages 65 to 70 and have had at least three normal Pap tests and no abnormal Pap tests in the last 10 years, ask your doctor if you can stop having Pap tests.

You should have a Pap test every year no matter how old you are if:

• You have a weakened immune system because of organ transplant, chemotherapy or steroid use

• Your mother was exposed to diethylstilbestrol (DES) while pregnant

• You are HIV-positive

Women who are living with HIV, the virus that causes AIDS, are at a higher risk of cervical cancer and other cervical diseases. The U.S. Centers for Disease Control and Prevention recommends that all HIV positive women get an initial Pap test, and get re-tested 6 months later. If both Pap tests are normal, then these women can get yearly Pap tests in the future.

Who does not need regular Pap tests?

The only women who do not need regular Pap tests are:

• Women over age 65 who have had a number of normal Pap tests and have been told by their doctors that they don't need to be tested anymore.

• Women who do not have a cervix and are at low risk for cervical cancer. These women should speak to their doctor before stopping regular Pap tests.

I had a hysterectomy. Do I still need Pap tests?

It depends on the type of hysterectomy (surgery to remove the uterus) you had and your health history. Women who have had a hysterectomy should talk with their doctor about whether they need routine Pap tests.

Usually during a hysterectomy, the cervix is removed with the uterus. This is called a total hysterectomy. Women who have had a total hysterectomy for reasons other than cancer may not need regular Pap tests. Women who have had a total hysterectomy because of abnormal cells or cancer should be tested yearly for vaginal cancer until they have three normal test results. Women who have had only their uterus removed but still have a cervix need regular Pap tests. Even women who have had hysterectomies should see their doctors yearly for pelvic exams.

A Pap test is a simple, relatively inexpensive procedure that can easily detect cancerous or precancerous conditions.

How can I reduce my chances of getting cervical cancer?

Aside from getting Pap tests, the best way to avoid cervical cancer is by steering clear of the human papilloma virus (HPV). HPV is a major cause of cervical cancer. HPV infection is also one of the most common sexually transmitted diseases (STD). So, a woman boosts her chances of getting cervical cancer if she:

• Starts having sex before age 18

• Has many sex partners

• Has sex partners who have other sex partners

• Has or has had a sexually transmitted disease (STD)

What should I know about human papilloma viruses (HPV)?

Human papilloma viruses are a group of more than 100 different viruses.

• About 40 types of HPV are spread during sex.

• Some types of HPVs can cause cervical cancer when not treated.

• HPV infection is one of the most common sexually transmitted diseases.

• About 75 percent of sexually active people will get HPV sometime in their life.

• Most women with untreated HPV do NOT get cervical cancer.

• Some HPVs cause genital warts but these HPVs do not cause cervical cancer.

• Since HPV rarely causes symptoms, most people don't know they have the infection.

How would I know if I had human papilloma virus (HPV)?

Most women never know they have HPV. It usually stays hidden and doesn't cause symptoms like warts. When HPV doesn't go away on its own, it can cause changes in the cells of the cervix. Pap tests usually find these changes.

How do I prepare for a Pap test?

Many things can cause wrong test results by washing away or hiding abnormal cells of the cervix. So, doctors suggest that for two days before the test you avoid:

• Douching

• Using tampons

• Using vaginal creams, suppositories, and medicines

• Using vaginal deodorant sprays or powders

• Having sex

Should I get a Pap test when I have my period?

No. Doctors suggest you schedule a Pap test when you do not have your period. The best time to be tested is 10 to 20 days after the first day of your last period.

How is a Pap test done?

Your doctor can do a Pap test during a pelvic exam. It is a simple and quick test. While you lie on an exam table, the doctor puts an instrument called a speculum into your vagina, opening it to see the cervix. She will then use a special stick or brush to take a few cells from inside and around the cervix. The cells are placed on a glass slide and sent to a lab for examination. While usually painless, a Pap test is uncomfortable for some women.

When will I get the results of my Pap test?

Usually it takes three weeks to get Pap test results. Most of the time, test results are normal. If the test shows that something might be wrong, your doctor will contact you to schedule more tests. There are many reasons for abnormal Pap test results. It usually does NOT mean you have cancer.

What do abnormal Pap test results mean?

It is scary to hear that your Pap test results are "abnormal." But abnormal Pap test results usually do NOT mean you have cancer. Most often there is a small problem with the cervix.

Some abnormal cells will turn into cancer. But most of the time, these unhealthy cells will go away on their own. By treating these unhealthy cells, almost all cases of cervical cancer can be prevented. If you have abnormal results, to talk with your doctor about what they mean.

My Pap test was "abnormal," what happens now?

There are many reasons for "abnormal" Pap test results. If results of the Pap test are unclear or show a small change in the cells of the cervix, your doctor will probably repeat the Pap test.

If the test finds more serious changes in the cells of the cervix, the doctor will suggest more powerful tests. Results of these tests will help your doctor decide on the best treatment. These include:

• Colposcopy: The doctor uses a tool called a colposcope to see the cells of the vagina and cervix in detail.

• Endocervical curettage: The doctor takes a sample of cells from the endocervical canal with a small spoon-shaped tool called a curette.

• Biopsy: The doctor removes a small sample of cervical tissue. The sample is sent to a lab to be studied under a microscope.

The FDA recently approved the LUMA Cervical Imaging System. The doctor uses this device right after a colposcopy. This system can help doctors see areas on the cervix that are likely to contain precancerous cells. The doctor uses this device right after a colposcopy. This system shines a light on the cervix and looks at how different areas of the cervix respond to this light. It gives a score to tiny areas of the cervix. It then makes a color map that helps the doctor decide where to further test the tissue with a biopsy. The colors and patterns on the map help the doctor tell between healthy tissue and tissue that might be diseased.

My Pap test result was a "false positive." What does this mean?

Pap tests are not always 100 percent correct. False positive and false negative results can happen. This can be upsetting and confusing. A false positive Pap test is when a woman is told she has abnormal cervical cells, but the cells are really normal. If your doctor says your Pap results were a false positive, there is no problem.

A false negative Pap test is when a woman is told her cells are normal, but in fact, there is a problem with the cervical cells that was missed. False negatives delay the discovery and treatment of unhealthy cells of the cervix. But, having regular Pap tests boosts your chances of finding any problems. If abnormal cells are missed at one time, they will probably be found on your next Pap test.

I don't have health insurance, how can I get a free or low-cost Pap test?

Programs funded by the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) offer free or low-cost Pap tests to women in need. These and other programs are available throughout the United States. To find contact information for a program near you, visit the NBCCEDP website at http://www.cdc.gov/cancer/nbccedp/ or call 1-888-842-6355 (select option 7). Also, your state or local health department can direct you to places that offer free or low-cost Pap tests.

Planned Parenthood offers low-cost Pap tests as well. To find the Planned Parenthood office in your area, call 1-800-230-7526 or visit their website at: http://www.ppfa.org

For more information . . .

You can find out more about Pap tests by contacting the National Women's Health Information Center (NWHIC) at 1-800-994-9662 or the following organizations:

Cancer Information Service, NCI, NIH, HHS
Phone Number: (800) 422-6237
Internet Address: http://cis.nci.nih.gov/

American College of Obstetricians and Gynecologists (ACOG) Resource Center
Phone Number: (800) 762-2264 x 192 (for publications requests only)
Internet Address: http://www.acog.org/

American Cancer Society
Phone Number: 1-800-227-2345
Internet Address: http://www.cancer.org

National Cervical Cancer Coalition (NCCC)
Phone Number: (800) 685-5531
Internet Address: http://www.nccc-online.org/

Planned Parenthood Federation of America
Phone Number: (800) 230-7526
Internet Address: http://www.ppfa.org

Centers for Disease Control
National Breast and Cervical Cancer Early Detection Program
Phone Number: (888) 842-6355
Internet Address: http://www.cdc.gov/cancer/nbccedp/

All material contained in the FAQs is free of copyright restrictions, and may be copied, reproduced, or duplicated without permission of the Office on Women's Health in the Department of Health and Human Services; citation of the sources is appreciated.

This FAQ was reviewed by Edward L. Trimble, MD, MPH
Head, Gynecologic Cancer Therapeutics & Quality of Cancer Care Therapeutics
Clinical Investigations Branch
Cancer Therapy Evaluation Program
Division of Cancer Treatment and Diagnosis
National Cancer Institute

Pap Smears: What They Are and What the Results Mean - Family Doctor

What is a Pap smear?

During a Pap smear, cells from the outside and the canal of the cervix are retrieved by gently scraping the outside of the cervix. The Pap smear is performed to detect cancerous or precancerous conditions of the cervix.

A Pap smear is a test your doctor does to check for signs of cancer of the cervix. The cervix is part of your uterus (womb). During a Pap smear, your doctor takes a sample of cells from your cervix to be tested.

To take the sample, your doctor will put a special instrument called a speculum into your vagina. This helps open your vagina so the sample can be taken. Your doctor will gently clean your cervix with a cotton swab and then collect a sample of cells with a small brush, a tiny spatula or a cotton swab. This sample is put on a glass slide and sent to a lab to be checked.

What is the sample checked for?

The cells on the slide are checked for signs that they're changing from normal. Cells go through a series of changes before they turn into cancer. A Pap smear can show if your cells are going through these changes long before you have cancer. Cervical cancer is not life-threatening if it's caught early. This is why getting regular Pap smears is so important.

What do the results mean?

A negative Pap smear means that your results are normal. A positive Pap smear means that your results aren't normal.

A positive Pap smear can be a sign of a number of changes in the cells on your cervix:

* Inflammation (irritation). This can be caused by an infection of the cervix, including a yeast infection, infection with the human papillomavirus (HPV) or herpes virus, or many other infections.
* Very early signs of cancer. These changes are called dysplasia.
* More serious signs of cancer. These changes affect the top layers of the cervix but don't go beyond the cervix. This is called "carcinoma in situ."
* More advanced cancer.

When should I have Pap smears?

You should have your first Pap smear when you start having sex or by age 18.

Continue having a Pap smear once a year until you've had at least 3 normal ones. After this, you should have a Pap smear at least every 3 years, unless your doctor thinks you need them more often. Keep having Pap smears throughout your life, even after you've gone through menopause.

Certain things put you at higher risk of cervical cancer. Your doctor will consider these when recommending how often you should have a Pap smear.

If you're older than 65, talk with your doctor about how often you need a Pap smear. If you've been having Pap smears regularly and they've been negative, you may not need to keep having them.

How reliable is the test?

No test is perfect, but the Pap smear is a reliable test. It has helped drastically lower the number of women who die of cervical cancer.

Sometimes the test may need to be redone because there were not enough cells on the slide. The lab will tell your doctor if this happens.

ThinPrep, PAPNET and FocalPoint are ways to make Pap smears more accurate. ThinPrep is a way of preparing the sample of cells that makes it easier to spot abnormalities. PAPNET and FocalPoint are computer systems that help lab technicians find abnormal cells. These options may not be available in all areas, and they may increase the cost of a Pap smear.

What should I do before the test?

Plan to have your test done at a time when you aren't having your menstrual period. Don't douche, use a feminine deodorant or have sex for 24 hours before the test.

What happens if I have a positive Pap smear?

If the results of your Pap smear are positive, your doctor may want to do another Pap smear or may want you to have a colposcopy.

A colposcopy gives your doctor a better look at your cervix and allows him or her to take a sample of tissue (called a biopsy). Your doctor will use an instrument called a colposcope to shine a light on your cervix and magnify it. Your doctor will explain the results and discuss treatment options with you.

What puts me at risk of cervical cancer?

The main risk factors for cervical cancer are related to sexual practices (see the box to the right). Sexually transmitted diseases (STDs) may make your cells more likely to undergo changes that can lead to cancer. STDs include HPV, herpes, gonorrhea and chlamydia. HPV is the virus that can cause genital warts. It seems to be very closely connected with these changes.

Is there anything I can do to avoid getting cervical cancer?

You may be able to reduce your risk of cervical cancer if you:

* Delay sexual intercourse until you're 20 years of age or older.
* Have only 1 sex partner who doesn't have an STD and is only having sex with you.
* Limit your number of sex partners.
* Always use latex condoms (rubbers) to protect against sexually transmitted diseases (STDs). (Remember condoms aren't 100% effective.)
* Avoid smoking.

Other Organizations

* Revolution Health Women's Health Community
http://www.revolutionhealth.com/forums/womens-health

Source

Written by familydoctor.org editorial staff.

American Academy of Family Physicians

Reviewed/Updated: 07/05