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