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Pap Test

  • Chris Woolston, M.S.
  • Posted March 11, 2013

What's a Pap test?

A Pap test -- named for its inventor, George Papanicolaou -- is a medical test that can detect a potential case of cervical cancer before it even starts. The test is undoubtedly a life saver. By some estimates, widespread use of the Pap test has cut cervical cancer deaths by 70 percent.

What happens during a Pap test?

The test is very simple. You will lie back on a table with your feet in stirrups while a doctor or nurse collects a few cells from your cervix with a tiny brush or swab. The cells are then put on a glass slide that will be sent to a laboratory. The lab will check for abnormal cells that have at least some potential to turn cancerous. The results should come back within about three weeks. If you don't hear back from your doctor by then, call to double-check on the results.

How often should I have one?

Most women should start having Pap tests (also called Pap smears) around age 21 and then every two years after that. If you're 30 or over and youve had three normal tests in a row, your doctor might recommend spreading out the tests to one every three years. If you're over 65 and your doctor says you're at low risk for cervical cancer -- perhaps because you've had a long history of normal results -- you may be able to stop getting the test entirely.

Women at high risk for cervical cancer should get the test every year. Youre considered high risk if any of the following applies to you:

  • You're HIV-positive.
  • Your immune system is unusually weak (perhaps as a side effect of medications for an autoimmune disorder)
  • You have had abnormal Pap tests that showed precancerous cells
  • You've had cervical, uterine, vaginal, or vulvar cancer.

Insurance companies often pay for Pap smears as part of an annual pelvic exam. However, some only pay for one test every three years. If you need help paying for the test, call your local women's clinic or a city health clinic. You might even get the test for free.

What does my Pap test result mean?

If you have an abnormal result, your doctor will want to run more tests. Keep in mind that "abnormal" usually doesnt mean "cancerous." Most abnormal cells die on their own without ever turning into cancer. Further testing will help your doctor decide on the best course of action.

Doctors have a system for classifying results. Most tests come back completely normal. But here are some of the other possibilities:

  • ASC (Atypical squamous cell). This means that some of the cells on the surface of the cervix (squamous cells) aren't entirely normal, but they aren't obviously precancerous, either.
  • AGC (Atypical glandular cell)). AGC means that there were some cells from the lining of the cervix (glandular cells) that aren't entirely normal. As with ASC, though, they aren't necessarily precancerous.
  • LSIL (Low-grade squamous intraepithelial lesion). This is a mild abnormality that's caused by an infection of the human papilloma virus (HPV). It's usually harmless.
  • Precancerous: This means that you have cells that likely would have turned into cancer if left on their own. You'll need further tests and treatments to protect you from real trouble down the road.
  • HSIL (High-grade squamous intraepithelial lesion). These are precancerous cells that have the potential to turn into particularly aggressive cancer. Obviously, it's extremely important to get the right follow-up treatment to prevent this cancer before it starts.
  • AIS (Adenocarcinoma in situ). These are precancerous cells that came from glandular tissue.
  • Cancerous: In some cases, the Pap smear finds cells that have already turned to cancer. If this happens, your doctor will likely refer you to a cancer specialist (oncologist).

How accurate is the Pap smear?

No screening test is perfect, the Pap smear included. In rare cases, a test may come back as abnormal even though the cells are perfectly healthy. This is known as a false positive. Or a test may come back as normal even though there were some cells that should have raised a red flag. This is called a false negative.

In each case, the mistake is usually fixed. If your test was mistakenly labeled "abnormal," follow-up tests will show that youre perfectly fine. If a test missed some abnormal cells, they should show up on your next pap smear before they have a chance to turn to cancer.

References

US Department of Health and Human Services. Pap test. 2010. http://www.womenshealth.gov/faq/pap-test.cfm

National Cancer Institute. Pap Test. 2009. http://www.cancer.gov/cancertopics/factsheet/Detection/Pap-test

Centers for Disease Control and Prevention. Cervical Cancer Screening. 2010 http://www.cdc.gov/cancer/cervical/basic_info/screening.htm

Mayo Clinic. Pap smear: Screening Test for Cervical Cancer. April 17, 2008. http://mayoclinic.com/health/pap-smear/HQ01177

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