PAP Test

The Pap test, or Pap smear, is a screening test for cervical cancer. The test can detect changes in the cells on the cervix (the opening to the uterus, or womb, at the top of the vagina). These changes may be cancerous, pre-cancerous, or caused by inflammation. Why do we need a Pap smear every year? Even though cervical cancer is almost 100% curable when diagnosed and treated in the early stages, nearly 5,000 women die of it each year. Deaths from cervical cancer have declined more than 70% since the Pap test was invented 50 years ago.

Who Should Get a Pap Test?
Every woman should have regular pelvic exams and Pap tests beginning at age 18, or younger if they have had sexual intercourse.

Preparations for a Pap Test
You should not douche 24 to 48 hours before a Pap test. The solution may wash away cells shed from the cervix. You should not use any vaginal creams or gels (including medicinal creams) or have vaginal intercourse 24 to 48 hours before a Pap test. The creams, gels, or seminal fluids may hide cervical cells. You should schedule your exam for after your period, as blood can also obscure cells.

How is a Pap Test Done?
The Pap test is a very simple and quick test. During the pelvic exam, the doctor or midwife will insert a speculum (it looks like a duck's bill) into your vagina, then gently open it so the cervix can be seen. A thin brush and a wooden or plastic spatula (similar to a tongue depressor) are used to collect a sample of cells from the cervix. These cells are sent to the lab to be viewed (or "read") by a cytotechnologist.

Will it Hurt?
Usually the test does not hurt. You may feel the scraper or brush being wiped across your cervix, which sometimes causes a slight twinge. Many women report the most uncomfortable part of the exam is the pressure caused by the opening of the speculum. You can help make the exam more comfortable by breathing deeply and trying to relax the muscles at the opening of your vagina.

How are the Results Reported?
The laboratory will contact our office with the results of your Pap smear. Most results come back "negative", which means the cells sampled were normal. Abnormal results are reported following a system that describes the level of change in the cells. These changes range from very minor to severe.

Infection
The Pap test may report the presence of Candida (yeast), Trichomonas, Garnerella (the most commonly found bacteria in the vagina), or other bacteria. You can have these infections without symptoms. Your doctor or midwife may offer treatment or further testing. Rarely, the Pap test will show cells invaded by the Herpes virus. A Pap test is not a reliable test for Herpes. If this happens, your physician or midwife will take a culture specifically for Herpes.

Reactive or Repair-related Changes
These changes are benign and are most commonly seen in women who are menopausal (lack of estrogen can cause the cervical and vaginal linings to thin and become inflammed), who have had a recent vaginal infection or biopsy, and women who use an IUD or diaphragm for birth control. Women who have had radiation to the pelvis may also show reactive changes on their Pap test.

Squamous Cell Abnormalities

• Atypical Cells of Undetermined Significance - This means the cytologist has seen cells that are abnormal, but the cause of the abnormality is not clear. Your doctor or midwife will recommend a repeat Pap test after a short period of time.
• Low-grade Squamous Intraepithelial Lesion (LGSIL) - These cells are undergoing a transformation with distinct characteristics. These changes may also be called dysplasia. If the cells are low-grade, the changes are mild. These changes have been linked to the Human Papilloma Virus (HPV). HPV causes genital warts and some types have been linked to cervical cancer. In about half of the cases of LGSIL, the cells will spontaneously return to normal. Further evaluation of a LGSIL is recommended though, because 25% of the lesions will progress to a high-grade lesion, and 25% will persist as LGSIL.
• High-grade Squamous Intraepithelial Lesion (HGSIL) - These cervical changes are moderate to severe. If left untreated, 50 to 75% will progress to cervical cancer. If your report shows HGSIL, your doctor or midwife will recommend a biopsy.
• Cancer - If the cells appear to be cancer, your doctor or midwife will want to do a biopsy to confirm the diagnosis.

What's Next?

• Repeat Pap Smear - A repeat Pap smear may be recommended within a certain time frame, depending on your medical history. (Generally 3 months to 6 months).
• Colposcopy - During this procedure, the doctor inserts a speculum into the vagina so the cervix can be seen. A colposcope is used to view the cervix under magnification. The colposcope looks like binoculars on wheels and acts as a microscope. A vinegar-like solution called acetic acid is applied to the cervix with a cotton swab. They may feel a little cold. This solution turns abnormal cells whihte. A small pinch of tissue may be taken from this area and sent to a pathologist for definitive diagnosis. This pinch may feel like a menstrual cramp. An ECC may be taken to sample the cells in the endocervical canal. This is an area of the cervix which cannot be viewed through a colposcope. Adenocarcinoma is a type of cancer that grows quickly in the upper portion of the cervix. It is common in young women.

Who is at Increased Risk for Cervical Cancer?

• You have had more than one sexual partner, or are with a person who has had more than one sexual partner.
• You have a history of genital warts (condyloma) or Human Papilloma Virus (HPV)
• You smoke
• You begin having sexual intercourse at an early age (before age 18)

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