Pap Smear

Pap smears at a glance

• The Pap test allows early detection of cervical cancer or of cells that lead to cervical cancer, and saves thousands of lives each year.
• Along with pelvic exams, Pap smears should be a part of routine health exams for the vast majority of women from ages 21 to 65 and sometimes older.
• Women in their 20s should have Pap tests every three years starting at age 21. Women over the age of 30 should have a Pap test every three years, and a high risk HPV (hrHPV) test every five years or have a Pap test with hrHPV co-testing every five years until age 65. Women with compromised immune systems should consult their doctors about having them more often.
• An abnormal Pap smear result does not necessarily mean there is a problem; often more testing is the next step.

What is a Pap smear?

A Pap smear or Pap test checks for cell changes in the cervix, the lower part of the uterus (or womb) that opens into the vagina. The test can detect some of the earliest signs of cervical cancer as well as infections and abnormal cells that can turn into cancer.

Doctors often perform Pap smears in conjunction with pelvic exams, where a doctor or nurse practitioner looks for redness, swelling, discharge or sores inside and outside the vagina.

During a Pap smear, the doctor inserts an instrument called a speculum into the vagina, opening it to see the cervix. The doctor then uses a special stick or brush to sample cells in and around the cervix.

The cell samples are placed onto a glass slide and delivered to the laboratory for evaluation, which typically takes about three weeks. Most test results are normal, and even abnormal results don't always indicate the development of cancer.

In the event of an abnormal test, the doctor will generally call for additional tests to determine if the cause is cancer or other, lesser problems with the cervix.

When to have a Pap test

Routine Pap tests have led to a decline in the number of cervical cancer cases and deaths. For this reason, women should generally schedule regular Pap smears based on their age:

• Starting at age 21, women should have a Pap smear every three years.
• Between the ages of 30 and 65, women should have a Pap smear every three years and an hrHPV test every five years. Women may also co-test, or receive a Pap-smear and HPV test, every five years. 
• After age 65-plus, women who have had three consecutive normal Pap tests and no abnormal tests for at least 10 years can talk to their doctor about whether to continue the test.

When to consider more frequent testing

• If you are HIV-positive
• If your mother was exposed to diethylstilbestrol (DES), a drug given to pregnant women from about 1940 to 1970 in the mistaken belief that it would reduce complications and losses
• Your immune system is weak due to an organ transplant, chemotherapy or steroid use

The human immunodeficiency virus (HIV), which causes AIDS, increases the odds of cervical cancer and other cervical diseases in HIV-positive women. The U.S. Centers for Disease Control and Prevention recommends that women in this group be tested soon after diagnosis and again in six months. If both tests are normal, these women can safely resume annual testing.

Who does not need a Pap smear

• Women older than 65 with three normal tests consecutively and no abnormal tests for 10 years, pending their doctors’ recommendations
• Women without a cervix who are at low risk for cervical cancer. However, these women should consult their doctors first.

What happens after an abnormal Pap smear?

Sometimes a test is unclear or shows small changes in the cells of the cervix, in which case a doctor usually repeats the test.

Pap smears can also result in a false positive, meaning the test shows abnormalities that do not exist, which is revealed by further testing.

If an abnormal test suggests there may be more serious changes in the cervix, doctors typically recommend additional procedures, including:

• A colposcopy, where a doctor uses a tool called a colposcope to inspect the vagina and cervix in more detail
• A biopsy, in which the doctor takes a small sample of cervical tissue for evaluation under a laboratory microscope
• An endocervical curettage, which involves sampling cells from the lower part of the cervix, using a spoon-shaped tool called a curette

False negatives are another possibility, meaning test results indicate everything is normal when there may be a problem.

A false negative result can delay the discovery and treatment of a cervical problem, making routine Pap smears a valuable procedure to pursue. If a problem is missed on one test, it can be caught during the next, often in time to successfully treat the problem.

Preparing for a Pap test

Doctors usually suggest scheduling a Pap test 10 to 20 days after the first day of your last period. In order to avoid false results, it’s recommended to avoid douching, using tampons, vaginal deodorants, and vaginal creams, suppositories and similar medications, as well as sexual intercourse for two days before the Pap smear.