Diagnostics & Testing

Pap Test

What is a Pap test?

A Pap test or smear is a screening test during which a sample of cells is taken from a woman's cervix and vagina. The test detects changes in the cells of the cervix prior to the development of clinical problems.

The Pap test is your best protection against cervical cancer and other disorders of the cervix. A Pap test might help your health care provider detect a problem before you are aware that something is wrong. Early detection is critical to a successful outcome.

How is a Pap test performed?

A Pap test can be done in your doctor's office during a regular pelvic exam. For the test, a speculum (a device used to widen the vagina) is placed into the vagina, and a sample of cells is taken from the cervix. The cells are placed on a glass slide or in a liquid fixative and sent to a laboratory for analysis.

When should a Pap test be performed?

The American College of Obstetricians and Gynecologists recommends:

Low risk patients:
  • Cervical cancer screening should begin at age 21 years regardless of sexual history.
  • For women aged 21 to 29 years, cervical cytology screening is recommended every 2 years.
  • For women 30 years and older, who have had 3 consecutive negative PAP tests, are HPV (human papillomavirus) negative and have no history of CIN 2 or CIN 3, HIV, immunocompromised state or DES exposure in utero, the recommended screening interval may be extended to every 3 years.
  • Routine cytology testing should be discontinued in women who have had a total hysterectomy for benign conditions and who have no history of high-grade CIN.
  • Cervical cancer screening can be discontinued between the ages of 65 and 70 years in women who have 3 or more consecutive negative cytology test results and no abnormal test results in the past 10 years.
Increased-risk patients:
  • Annual Pap smear
  • Annual pelvic exam
Increased risk is defined by the presence of any one of the following:
  • Infection with certain high-risk strains of HPV
  • HIV-positive
  • Cigarette smoking
  • Multiple sexual partners
  • Prior abnormal Pap smear or cervical dysplasia

What happens if the Pap test results are abnormal?

An abnormal Pap test may not mean that cancer cells were found during the examination. There are many causes for abnormal Pap test results.

Your health care provider will evaluate the results to determine if you should have:

  • A repeat Pap test
  • A colposcopy
  • A laboratory test
  • A combination of the above

Based on the results of these procedures and tests, you might need additional treatment.

Why might a repeat Pap test be necessary?

A repeat Pap test might be necessary if you had an infection at the time of the Pap test or if there were not enough cells collected during the Pap test. Since decreased levels of estrogen can lead to vaginal atrophy and also influence Pap test results, menopausal women might need to take estrogen before the repeat Pap test.

If the results of the repeat Pap test are still abnormal, your health care provider might recommend that you have a colposcopy to further evaluate the problem.

What is colposcopy?

Colposcopy is a closer examination of the cervix and the walls of the vagina. During the examination, a speculum is inserted into the vagina (as done in a Pap test). A doctor looks through a magnifying instrument called a colposcope to detect cervical problems that cannot be seen by the eye alone. Acetic acid (vinegar) is often used on the cervix to help visualize abnormal cells. During the colposcopy, the colposcope remains outside the vagina. Biopsies (tissue samples) of the abnormal cervical area might be taken.

Colposcopy is not always necessary immediately after an abnormal Pap test. Be sure to ask your health care provider about other options.

What type of follow-up is recommended for an abnormal Pap test?

Based on new follow-up guidelines for minimally abnormal Pap tests (ASCUS-atypical cells of undetermined significance), colposcopy is recommended as a follow-up option only when the results of a test called the hybrid capture HPV DNA are positive. Colposcopy is not recommended as the first option for evaluation unless the Pap test results indicate a definite and more severe abnormality.

What is the hybrid capture test?

The hybrid capture test detects 14 human papillomavirus (HPV) types by determining the presence of viral deoxyribonucleic acid (DNA) in the samples taken following an abnormal Pap test. HPV infection has been shown to be the primary cause of most cancerous and precancerous conditions of the cervix. A sample for HPV testing is collected with the Pap smear sample in women over the age of 30. In women aged 21 to 29, HPV testing can be performed on the Pap smear specimen after an abnormality has been detected without requiring a second visit.

What do the results of the hybrid capture test indicate?

The hybrid capture test results can accurately distinguish women who are at higher risk to have cervical abnormalities from those who do not. When compared to a Pap follow-up only, this test reduces the risk of delayed detection of high-grade disease or cervical cancer. In addition, the hybrid capture test is a less expensive alternative to colposcopy. Colposcopy is often unnecessary when performed as the first follow-up option for minimal abnormalities indicated by a Pap test if they are negative for HPV.

What follow-up is needed based on the results of the hybrid capture test?

If the hybrid capture test results are negative, and a patient has ASCUS, a follow-up Pap test is usually recommended in one year. If the hybrid capture test results are positive, with ASCUS, a colposcopy is recommended. Recommendations for repeat Pap tests will be made by your health care provider.


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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 5/20/2011...#4267