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The purpose of a Pap smear is to sample the squamous cells of the cervix, looking for any changes away from normal. A Pap smear is the most reliable test to date for cervical cancer. It is also important to know that a Pap smear is not a test for ovarian or endometrial cancers (cancer of the uterus).
A Pap smear (also called a Pap test) is usually given as part of a pelvic exam. It is a screening test in which cells collected from the cervix are examined for abnormal cell changes that may indicate the presence of cervical cancer or a precancerous condition. If abnormalities are found, your doctor may order diagnostic exams to identify the cause.
The importance of having Pap tests on a routine basis cannot be overstated. Most invasive cervical cancers can be prevented if you have Pap tests regularly. That is because they can detect squamous cell abnormalities that may lead to cervical cancer at their earliest stages. Early detection enables doctors to start you on a treatment before cancer develops, which increases the likelihood that your treatment will be successful.
Like all screening tests, the Pap test is not 100% accurate. Many factors can interfere with accuracy and can lead to false positive and false negative results. Newer testing methods, including liquid-based Pap tests, may improve sensitivity. However, until a foolproof test is developed, having Pap tests on a regular basis increases the likelihood that any problems will be detected over time, from one exam to the next.
How often should you have a Pap test? That depends on what your doctor recommends, your age, and other factors. But conventional practice has changed in the past couple of years, and some women may not need a Pap test every year. For more information, see the revised cervical cancer screening guidelines issued by the American College of Obstetricians and Gynecologists.
Preparing for a Pap test.
You should have this test when you are not menstruating; the best time is between 10 and 20 days after the first day of your menstrual period. For about two days prior to the test, do not douche or use vaginal creams, spermicidal foams, or jellies. Do not have intercourse within 24 hours before the Pap smear because it can cause inaccurate test results.
How the test is done.
The Pap test is a quick and painless procedure which involves taking a small sample of cells from the cervix, usually during a routine pelvic exam. The cells are sent to a laboratory where they are prepared and evaluated under a microscope by a cytotechnologist, who is looking for any abnormal features associated with cancerous or precancerous cervical cells.
What the results mean.
In reporting Pap results to your physician, the laboratory uses a set of standard terms called the Bethesda System . These terms are described in the chart below along with additional tests and treatments your doctor may order to gather more information about a particular result.
If your doctor tells you that your Pap test results are "abnormal," it is not necessarily cause for alarm. Cells on the surface of the cervix sometimes appear abnormal but are very rarely cancerous. Also keep in mind that abnormal cells do not always become cancerous. If you get an abnormal result, ask your doctor for specific information about what the result means.
Be aware that false positive and false negative results can happen. If one of these results comes back from your Pap test, you will save yourself a lot of worry and confusion if you know what these terms mean:
- False positive: You are told that you have abnormal cells when, in fact, the cells are normal. A false positive means that there is no problem.
- False negative: You are informed that your cells are normal when an abnormal change has actually taken place. This means you could have a problem and there may be a need for more tests.
Pap test result: What the test result means
WNL Within normal limits - the cells are of healthy size and shape. A negative result.
Follow-up tests/treatments may include:
- No special procedures needed
- Continue routine Pap tests
ASC-US Atypical squamous cells of undetermined significance (ASCUS). The squamous cells do not appear completely normal, but doctors are uncertain about what the cell changes mean. Sometimes the changes are related to HPV infection. Considered mild cell abnormalities.
Follow-up tests/treatments may include:
- HPV testing
- Repeat Pap test
- Colposcopy and biopsy
- Estrogen cream
ASC-H Atypical squamous cells cannot exclude a high-grade squamous intraepithelial link to glossary) lesion. The cells do not appear normal, but doctors are uncertain about what the cell changes mean. ASC-H may be at higher risk of being precancerous.
Follow-up tests/treatments may include:
AGC Atypical glandular cells. Glandular cells are mucus-producing cells found in the endocervical canal (opening in the center of the cervix) or in the lining of the uterus. The cells do not appear normal, but doctors are uncertain about what the cell changes mean.
Follow-up tests/treatments may include:
- Colposcopy and biopsy and/or endocervical curettage
AIS Endocervical adenocarcinoma in situ . Precancerous cells are found in the glandular tissue.
Follow-up tests/treatments may include:
- Colposcopy and biopsy and/or endocervical curettage
LSIL Low-grade squamous intraepithelial lesion. Low-grade means there are early changes in the size and shape of cells. "Lesion" refers to an area of abnormal tissue. Intraepithelial is the layer of cells that forms the surface of the cervix. LSILs are considered mild abnormalities caused by HPV infection.
Follow-up tests/treatments may include:
HSIL High-grade squamous intraepithelial lesion. High-grade means that there are more marked changes in the size and shape of the abnormal (precancerous) cells. This means the cells look very different from normal cells. HSILs are more severe abnormalities and have a higher likelihood of progressing to invasive cancer.
Follow-up tests/treatments may include:
- Colposcopy and biopsy and/or endocervical curettage
- Further treatment with LEEP, cryotherapy, laser therapy, conization, or hysterectomy
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