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Tests and Procedures - Pap Test

What is a Pap test?

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

  • Infection
  • Inflammation
  • Abnormal cells
  • Cancer

Why is a Pap test recommended?

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  cancers of the cervix can be detected early if women have Pap tests and pelvic examinations regularly. As with many types of cancer, cancer of the cervix is more likely to be successfully treated if it is detected early.

The Pap test is useful for detecting not only cancerous cells, but also other cervical and vaginal abnormalities including dysplasia (precancerous cells) and inflammation. Inflammation may be caused by:

  • Yeast infections
  • Trichomoniasis infections
  • Bacteria
  • Viruses
  • Medications or other chemicals
  • Hormones
  • Pregnancy
  • Miscarriage (or abortion)

Who should have Pap tests?

Abnormal pap 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. The iodine stains healthy cells brown while abnormal cells maintain their typical white or yellow color.

A biopsy may be performed in which the doctor 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.

A woman should always consult with her doctor about when and how often a Pap test and pelvic examination should be performed.

According to the National Cancer Institute, the American Cancer Society (ACS), and the American College of Obstetricians and Gynecologists (ACOG), general guidelines include:

  • Cervical cancer screening should begin approximately three years after a woman begins having sexual intercourse, but no later than at 21 years old.
  • ACOG recommends cervical cytology screening with regular Pap tests every two years until age 30. ACS recommends Pap tests be done every three years for this age group. Women under age 30 have a higher likelihood than older women of acquiring high-risk types of human papillomavirus (HPV) that can cause precancerous cervical disease, which should be ruled out before extending the testing intervals.
  • ACOG recommends that at or after age 30, women who have had three normal test results in a row may get screened every three years the ACS recommends testing every five years and adding the HPV test to the Pap test (which is preferred), or doing the Pap test alone every three years until the age of 65. However, women with certain risk factors such as human immunodeficiency virus (HIV) infection, a weak immune system, in utero DES exposure, or a previous diagnosis of cervical cancer may need more frequent screening and should discuss this with their doctors.
  • Women 65 to 70 years of age who have had at least three normal Pap tests in a row, are sexually inactive, and have had no abnormal Pap tests in the last 10 years may decide, upon consultation with their health care provider, to stop cervical cancer screening, according to ACOG. Women over age 65 who have had regular screening with normal results for the past 10 years and no history of cervical cancer or serious precancer should not be screened for cervical cancer, acording to the ACS.
  • 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 who have had a hysterectomy without the removal of the cervix should continue to have screening according to these general guidelines.
  • Women who have been vaccinated against HPV should follow the guidelines for their age group.
  • 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 or infection with the HPV virus.

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