Pap Smear

Medical Revising Author: Carolyn Crandall, MD, FACP
Medical Revising Editor: William C. Shiel Jr., MD, FACP, FACR

• What is a Pap smear?
• Who should have a Pap smear?
• Which women are at increased risk for having an abnormal Pap smear?
• How is a Pap smear done?
• What are the risks of having a Pap smear?
• How is a Pap smear read (analyzed)?
• What information is included on a Pap smear report?
• Why is a woman's menstrual status important for the Pap smear?
• Why is a woman's past Pap smear history pertinent?
• When might a Pap smear not be adequate for interpretation?
• How is the final Pap smear diagnosis made?
• What are the possible recommendations for follow-up after a Pap smear?
• What treatments are available if a Pap smear is abnormal?
• What is the follow-up after treatment for an abnormal Pap smear?
• What is the current status of human papilloma virus (HPV) testing?
• When should women start and stop having Pap smears, and how often should Pap smears be performed?
• What is the current status of the newer Pap smear technologies?
• With Pap smears so available, why are women still dying of cervical cancer?
• Historical note: Dr. Pap
• Pap Smear At A Glance
• Related cervical cancer articles:
  Cervical cancer - on WebMD

What is a Pap smear?

A Pap smear (also known as the Pap test) is a medical procedure in which a sample of cells from a woman's cervix (the end of the uterus that extends into the vagina) is collected and spread (smeared) on a microscope slide. The cells are examined under a microscope in order to look for pre-malignant (before-cancer) or malignant (cancer) changes.

A Pap smear is a simple, quick, and relatively painless screening test. Its specificity - which means its ability to avoid classifying a normal smear as abnormal -- while very good, is not perfect. The sensitivity of a Pap smear - which means its ability to detect every single abnormality -- while extremely good, is also not perfect. Thus, a few women develop cervical cancer despite having regular Pap screening.

In the vast majority of cases, a Pap test does identify minor cellular abnormalities before they have had a chance to become malignant and at a point when the condition is most easily treatable. The Pap smear is not intended to detect other forms of cancer such as those of the ovary, vagina, or uterus. Cancer of these organs may be discovered during the course of the gynecologic (pelvic) exam, which usually is done at the same time as the Pap smear.

Who should have a Pap smear?

Pregnancy does not prevent a woman from having a Pap smear. Pap smears can be safely done during pregnancy.

Pap smear testing is not indicated for women who have hysterectomy (with removal of the cervix) for benign conditions. Women who have had a hysterectomy in which the cervix is not removed, called subtotal hysterectomy, should continue screening following the same guidelines as women who have not had a hysterectomy.

The screening guidelines of several key medical organizations are summarized in the table below.

Organization	When to start Pap smear testing	Frequency of Pap smear testing	At what age to stop having Pap smears
American Cancer Society 2004	3 years after vaginal intercourse, no later than age 21	Yearly with exceptions: every 2 years if liquid-based kit every 2-3 years if 3 normal tests in a row in women >30 years old	Total hysterectomy for benign disease > 70 years old with at least 3 normal Pap smear results and no abnormal Pap results in the last 10 years
United States Preventative Services Task Force 2003	Within 3 years of onset of sexual activity or age 21, whichever comes first	At least every 3 years (no evidence that every year is better than every 3 years)	Recommend against doing Pap smears in women older than 65 years of age, if adequate screening with normal results and otherwise not at risk for cervical cancer. Recommend against doing Pap smears in women who have had a total hysterectomy for benign disease.
American College of Obstetrics and Gynecology	3 years after 1st sexual intercourse or age 21, whichever comes first.	Yearly until age 30 years. Beginning at age 30, if 3 normal annual Pap results, can do a Pap alone every 2-3 years	Difficult to set an upper age limit-postmenopausal women screened within the prior 2-3 years have a very low risk of developing abnormal Pap smears.

Next: Which women are at increased risk for having an abnormal Pap smear? »

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From the Doctors at MedicineNet.com

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Last Editorial Review: 3/23/2005