it first came into use 50 years ago, the Pap test has
lowered the number of deaths from cancer of the cervix
by 70 percent in the U.S. The Pap test detects changes
in the cells of the cervix (the opening of a woman's
uterus). These changes could lead to cancer. The Pap
test helps find these changes early so they can be treated
before they become serious. By having a Pap test, a
woman can help prevent cancer of the cervix.
page tells you:
Who should have a Pap test
How often the test should be done
What the results mean
Pap test is the best way to find changes that may lead
to cervical cancer.
cervix is the lower, narrow end of the uterus. It opens
into the vagina. The cervix is covered by a thin layer
of tissue (like the skin inside your mouth). As with
all cells, the cells that make up this tissue grow all
the time. During this growth, the cells at the bottom
layer slowly move to the surface of the cervix. When
these cells reach the surface, they are shed. During
this process, some cells can become abnormal.
the Pap test, a sample of cells is taken from the surface
of the cervix. The test can find abnormal cells that
could lead to cancer of the cervix and the vagina. It
is not used to detect cancer in other parts of the body.
Regular Part of Your Health Care
a regular Pap test is an important part of your overall
health care. When you start having the test and how
often you have it depends on your history. You should
have your first Pap test by age 18 or when you start
having sex with men - whichever comes first.
Pap tests should continue past menopause. If your tests
show abnormal results or if you have had cancer, your
doctor may advise you to have a Pap test more often.
If you have had a hysterectomy for benign (not cancer)
disease, you should still have the Pap test if you have
any of the risk factors listed.
women have a higher risk of developing cervical changes.
Your risk may be higher if you:
had more than one sexual partner or a male sexual
partner who has had more than one partner;
intercourse for the first time at an early age;
Have had certain sexually transmitted diseases (STDs),
such as genital warts (human papillomavirus) or herpes;
Are infected with human immunodeficiency virus (HIV)
or have a weakened immune system (such as a transplant
you have any of these risk factors, it is important
for you to have a Pap test each year. If you have no
risk factors and have had three normal tests in a row,
your doctor may suggest you have the test done less
often. You should still see your doctor each year for
a pelvic exam. Abnormal cells may go through several
stages of change before cervical cancer appears. This
usually happens over a number of years. If cancer does
occur, symptoms may include bleeding, pelvic pain or
discharge. In most cases there are no symptoms, though.
the Pap test, a speculum is inserted into the vagina.
A small sample of cells is collected with a small brush
or swab and scraper. The
brush or swab is inserted into the cervical canal to
reach the higher cells. The Pap test can be done during
a pelvic exam. Do not douche or use vaginal medication,
spermicides or lubrication for 2 to 3 days before the
test. These products may wash away or hide any changed
cells. It is best to schedule the Pap test for a time
when you're not having your menstrual period.
speculum will be inserted into your vagina. This device
gently opens the vagina so the cervix can be seen. A
small brush and scraper are used to remove cells from
the inside and outside of the cervix. You will not feel
cell sample is then placed on a glass slide to be sent
to the lab for testing. A technician or doctor uses
a microscope to look for cells that do not appear normal.
The results are classified based on how the cells look.
Your health insurance often will pay for this Pap test.
are several new methods designed to improve the accuracy
of test results. Your doctor may suggest you use one
of them. One method sends the cells to the lab in a
bottle of liquid. The cells then are transferred to
a slide and read in the standard way. Other methods
use the help of a computer to find abnormal cells. It
is not clear that these methods detect cervical cancer
better than the standard Pap test. Your insurance company
may not pay for these newer types of tests.
false-positive result shows a problem when there isn't
one. A false-negative result shows there isn't a problem
when there really is one.
results of your Pap test are most often classified by
a system developed by the National Cancer Institute.
The classification of the cells helps doctors plan treatment:
Normal: Only normal cells were seen on your Pap test.
ASCUS (Atypical squamous cells of undetermined significance):
Changes were seen in cells lining the outer cervix.
AGUS (Atypical glandular cells of undetermined significance):
Changes were seen in the cells lining the inner cervix.
Squamous intraepithelial lesion (SIL): The cells that
were tested show certain levels and changes. SIL can
be low grade or high grade.
Low-grade SIL includes mild changes and changes
linked to human papillomavirus. Some types of
these viruses have been linked to cancer of the
High-grade SIL includes moderate and severe changes
and very early "precancer".
Cancer: The cells have spread into other tissues.
enlarged view of cervical cells shows abnormal cells
(middle) growing toward the surface of the cervix.
the Pap Test Always Accurate?
any test, the Pap test is not always accurate. It may
report abnormal cells are present when they aren't.
This is known as a false-positive result. A Pap test
may also miss abnormal cells - known as a false-negative.
False-negative results can occur for a number of reasons:
The sample contains too few or too many cells
An infection or blood covered up abnormal cells
Douching or vaginal medicines have washed away abnormal
Pap test results are based on how cells on a slide look,
even experts may not agree. Sometimes the reason for
false-negative results is not known. Your doctor may
suggest a test be repeated.
the lab reports any abnormal finding, the doctor may
arrange for further tests. This may be as simple as
a repeat Pap test in a few weeks or a few months. In
the lab, a technician or doctor uses a microscope to
study the cell sample. Sometimes your doctor will do
an exam called a colposcopy to decide if you need treatment.
A magnifying device called a colposcope is used to look
at the cervix. With this device, your doctor may be
able to see changes that suggest abnormal cells.
may help the doctor decide whether a cervical biopsy
needs to be done. For a biopsy, the doctor removes some
of the cells to be studied under a microscope. You may
feel a little pain during the biopsy. Treatment depends
on the findings. In many cases, all that is required
is to remove a thin layer of cells from the surface
of the cervix. New cells often are normal and no further
treatment is needed.
Pap test is the best way to find changes that may lead
to cervical cancer. Finding abnormal cells can help
prevent cancer of the cervix. Only a very small number
of women with abnormal Pap test results have cancer.
By understanding the Pap test and how results are reported,
you can take an active part in your health care.
A minor surgical procedure to remove a small piece of
tissue that is then examined under a microscope.
Viewing of the cervix, vulva, or vagina using magnification
with a special instrument.
Immunodeficiency Virus (HIV): A virus that attacks certain
cells of the body's immune system and causes acquired
immunodeficiency syndrome (AIDS).
Papillomavirus (HPV): The common name for a group of
related viruses. Some of these viruses cause genital
warts and are linked to cervical changes and cancer.
Intraepithelial Lesion (SIL): A condition that occurs
when normal cells on the surface of the cervix are replaced
by a layer of abnormal cells. SIL is classified as high
grade or low grade. It is not cancer.
excerpt from ACOG's Patient Education Pamphlet is provided
for your information. It is not medical advice and should
not be relied upon as a substitute for visiting your
doctor. If you need medical care, or have any questions,
please contact your obstetrician-gynecologist. Copyright
(c) 2000 The American College of Obstetricians and Gynecologists.
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