The Pap Test

What is a Pap test?

A Pap test (sometimes called a Pap smear) is a way to examine cells collected from the cervix, or the "mouth" of the womb (located at the top of the vagina), for the presence of:

• infection
• inflammation
• abnormal cells
• cancer

Why is a Pap test suggested to women?

A Pap test, along with a pelvic exam, is an important part of a woman's routine health care because it may detect abnormalities that can lead to invasive cancer. Most invasive cancers of the cervix can be detected early if women have Pap tests and pelvic exams regularly. As with many types of cancer, cancer of the cervix is more likely to be successfully treated if it is detected early.

But, the Pap test is not only useful in detecting cancerous cells, it can detect other changes in the cervix and vagina, including dysplasia, or pre-cancer cells. Inflammation in the cervical area may also be detected. Inflammation may be caused by:

• yeast infections
• trichomonas infections
• bacteria
• viruses
• medications or other chemicals
• hormones
• pregnancy
• miscarriage (or abortion)

Who should have Pap tests?

According to the National Cancer Institute:

• Cervical cancer screening should begin approximately three years after a woman begins having sexual intercourse, but no later than at 21 years old.
• Experts recommend waiting approximately three years following the initiation of sexual activity because transient HPV infections and cervical cell changes that are not significant are common and it takes years for a significant abnormality or cancer to develop. Cervical cancer is extremely rare in women under the age of 25.
• Women should have a Pap test at least once every three years.
• Women 65 to 70 years of age who have had at least three normal Pap tests and no abnormal Pap tests in the last 10 years may decide, upon consultation with their healthcare provider, to stop cervical cancer screening.
• Women who have had a total hysterectomy (removal of the uterus and cervix) do not need to undergo cervical cancer screening, unless the surgery was done as a treatment for cervical precancer or cancer.
• Women should seek expert medical advice about when they should begin screening, how often they should be screened, and when they can discontinue cervical screenings, especially if they are at higher than average risk of cervical cancer due to factors such as HIV infection.

If your Pap test shows abnormal results ...

According to the National Cancer Institute, when the Pap test shows an ambiguous or minor abnormality, the test is usually repeated to ensure accuracy.

If the test shows a significant abnormality, a colposcopy may be performed (using an instrument called a colposcope) to examine the vagina and the cervix.

A Schiller test may also be performed, in which the cervix is coated with an iodine solution.

A biopsy may be performed in which the physician removes a small amount of cervical tissue for examination by a pathologist. This is the only sure way to determine whether the abnormal cells indicate cancer.