Abnormal Pap Smears

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Abnormal Pap Smears

The Pap test is a procedure performed to detect cervical cancer in women.

The Pap test involves collecting cells from the cervix, the lower, narrow end of the uterus above the vagina.

Early detection of cervical cancer through a Pap test gives you a better chance of a cure. A Pap test also detects changes in the cells of the cervix that indicate cancer may form in the future. Early detection of these abnormal cells through a Pap test is the first step in stopping the possible formation of cervical cancer.

Why it is done
A Pap test is used to detect cancer of the cervix.

A Pap test is usually done along with a pelvic exam. For women over age 30, the Pap test can be combined with a test to detect human papillomavirus (HPV), a common sexually transmitted infection that can cause cervical cancer. In some cases, HPV testing may be done instead of a Pap test.

Who should have a Pap test?
You and your doctor can decide when it’s time for you to start getting a Pap test and how often you should get it.

Doctors generally recommend starting Pap tests at age 21.

How often should I have a repeat Pap test?
Doctors generally recommend that women between the ages of 21 and 65 repeat the Pap test every three years.

Women 30 years of age or older may consider having a Pap test every five years if the procedure is done in conjunction with a human papillomavirus (HPV) test. Others may consider HPV testing instead of Pap smears.

If you have certain risk factors, your doctor may recommend more frequent Pap tests, regardless of your age. These risk factors include the following:

  • Diagnosis of cervical cancer or a Pap test that showed precancerous cells
  • Exposure to diethylstilbestrol before birth
  • An HIV infection
  • Weakening of the immune system due to organ transplantation, chemotherapy, or chronic corticosteroid use.
  • History of smoking

You and your doctor can talk about the benefits and risks of a Pap test and decide what’s best for you based on risk factors.

Who Can Stop Performing Routine Pap Smears?

In some situations, a woman and her doctor may decide to stop doing routine pap smears, for example:

  • After a total hysterectomy. After a total hysterectomy, surgical removal of the uterus and cervix, see your doctor if you need to continue Pap tests.
  • If the hysterectomy was performed for a noncancerous condition, such as uterine fibroids, you can stop performing routine pap smears.
  • But if the hysterectomy was done because of a cancerous or precancerous disorder of the cervix, your doctor will recommend that you continue to perform routine pap smears.
  • Older age. Doctors usually suggest that women can stop doing routine pap smears at age 65 if their previous cervical cancer screening tests were negative.

Talk to your doctor about possible options to decide together what is best for you based on your risk factors. If you have sex with different people, your doctor will recommend that you continue to do routine pap smears.

A Pap test is a safe way to detect cervical cancer. However, the Pap test is not foolproof. You may get false-negative results, meaning that the test indicates that there are no abnormalities, even if you have abnormal cells.

A false negative does not mean a mistake was made. Some of the factors that can cause a false-negative result include the following:

  • Inadequate collection of cells
  • A small number of abnormal cells
  • Blood or inflammatory cells that block abnormal cells

While abnormal cells may not be detected, time is on your side. Cervical cancer has taken several years to form. And if abnormal cells are not detected in one test, they are very likely to be detected in the next.

How to Prepare
To make sure your Pap test is as effective as possible, follow these tips before the test:

  • Avoid sexual intercourse, douching, or using vaginal medications or spermicidal foams, creams, or gels for two days before your Pap test.
  • These substances can kill or hide abnormal cells.
  • Try not to schedule a Pap test to match your period. If possible, it is best to avoid this time of the cycle.

What to Expect

During the Pap test

The Pap test is done in the doctor’s office and takes only a few minutes. You may be asked to undress completely or just from the waist down.

You will need to lie on your back on an examination table with your knees bent. You will support your heels in supports called stirrups.

The doctor will carefully insert an instrument called a speculum into your vagina. The speculum keeps the walls of the vagina apart so the doctor can easily see the cervix. The insertion of the speculum may cause a feeling of pressure in the pelvic area.

The doctor will then take samples of the cervical cells with a soft brush and a flat scraping device called a spatula. This is usually painless.

After the Pap Test

After the Pap test, you can do your daily activities without restrictions.

Depending on the type of Pap test you have, the doctor transfers the sample of cells obtained from your cervix to a container that contains a special liquid to preserve the sample (liquid-based Pap test) or to a glass slide (conventional Pap test).

The samples are sent to a laboratory where they are examined under a microscope to look at the characteristics of the cells that indicate cancer or a precancerous disorder.

Ask your doctor when you will be able to get your test results.


A Pap test can alert the doctor to the presence of suspicious cells that require further testing.

Normal Results
If only healthy cervical cells are found during a Pap test, the result is considered negative. You will not need any further treatment or testing until it is time for your next pelvic exam Pap test.

Abnormal Results
If abnormal or rare cells are found on your Pap test, you are said to have a positive result. A positive result does not mean you have cervical cancer. What a positive result means depends on the type of cells found in the test.

Here are some terms your doctor might use and what you could do from that:

  • Atypical squamous cells of undetermined significance (ASC-US). Squamous cells are thin and flat and grow on the surface of a healthy cervix. In the case of ASC-US, the Pap test reveals slightly abnormal squamous cells, but the changes do not necessarily involve the presence of precancerous cells.
  • With liquid-based testing, the physician can reanalyze the sample to verify the presence of viruses known to promote the development of cancer, such as some types of human papillomavirus (HPV).
  • If no high-risk virus is found, the abnormal cells found in the test are not of major importance. If alarming viruses are found, you should have more tests.
  • Squamous intraepithelial lesion. This term is used to indicate that cells collected from the Pap test may be precancerous.
  • If the changes are low-grade, this means that the size, shape, and other characteristics of the cells suggest that if a precancerous lesion is present, it is likely to be years away from becoming cancer.
  • If the changes are high-grade, there is a greater chance that the lesion will turn into cancer much sooner. Additional diagnostic tests are needed.
  • Atypical glandular cells produce mucus at the opening of the cervix and inside the uterus. Atypical glandular cells may appear slightly abnormal, but it is not clear whether they are cancerous or not.

Additional tests are needed to determine the origin of the abnormal cells and their importance.

Squamous cell carcinoma or adenocarcinoma cells This result means that the cells collected in the Pap test appear so abnormal that the pathologist is virtually certain of the presence of cancer.

If the Pap test is abnormal, your doctor may perform a procedure called a colposcopy, in which he or she uses a special magnifying instrument (colposcope) to examine the tissues of the cervix, vagina, and vulva.

Your doctor may also remove a tissue sample (biopsy) from any area that seems abnormal. The tissue sample is then sent to a laboratory for analysis and definitive diagnosis.


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