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Pap Test - PAP Smear
Overview & Description
A Pap smear is a sampling of cells from a woman's cervix. The cervix is the opening between the vagina and the uterus. The cells are scraped from the cervix during a pelvic exam.
Cervical dysplasia is a condition in which a woman has abnormal changes in the top layer of cells of her cervix. These changes are an early sign that cervical cancer may develop.
A cervical cell goes through precancerous stages for months to years before becoming an invasive, malignant, carcinoma. Catching the disease at the precancerous stage can prevent the development of cervical cancer. Since the Pap smear was introduced 60 years ago, deaths from cancer of the cervix have decreased by 70%.
Who is a candidate for the test?
The American Cancer Society recommends that women have yearly Pap smears beginning at age 18 or when they become sexually active. If a woman has had three negative annual Pap tests in a row, the doctor may recommend less frequent testing. Some women may need more frequent screenings if they are at high risk for cancer of the cervix. Risk factors include the following:
How is the test performed?
The first step is for the healthcare provider to perform a pelvic exam. A speculum is a metal or plastic instrument that is placed in the vagina. This instrument allows the provider to see the interior of the vagina and the cervix. A small, sterile brush is used to take a sample of cells from the internal opening of the cervix. A small wooden spatula is used to scrape the outside of the cervix. These two scrapings are placed on a glass slide or in a small bottle filled with a special liquid. The cells are analyzed later under a microscope in a laboratory.
Preparation & Expectations
What is involved in preparation for the test?
A Pap smear should be performed during the weeks before the start of menstruation. Women should not douche or have sexual intercourse for 24 hours before the test. No vaginal creams, diaphragms, or tampons should be used for 24 hours before the test. To minimize discomfort, a woman should empty her bladder just before the exam.
Results and Values
What do the test results mean?
A healthy Pap smear shows no abnormal cells or evidence of inflammation. The presence of abnormally growing cells on the surface of the cervix may be reported as an abnormal PAP smear. Categories of cell changes include:
All of these categories describe different degrees of abnormal cells. Not all mean that a woman has or will develop cervical cancer. However, a woman should follow up with her doctor if her Pap smear results are abnormal. All these changes are within the top layer of the cervix. The cancer has not spread more deeply into the cervix or to other organs.
A woman who has had two or more abnormal Pap smears (ASCUS, CIN I, or HPV changes) should undergo colposcopy. This is a test in which the cervix is viewed with a special lighted microscope. A cervical biopsy may also be needed. This involves taking a small tissue sample from the cervix. The sample is examined further to find the cause of the abnormal cells.
Attribution
Author:David T. Moran, MD
Date Written:
Editor:Crist, Gayle P., MS, BA
Edit Date:08/30/02
Reviewer:Melinda Murray Ratini, DO
Date Reviewed:08/15/02