Papanicolaou test; Pap smear; Cervical cancer screening - Pap test; Cervical intraepithelial neoplasia - Pap; CIN - Pap; Precancerous changes of the cervix - Pap; Cervical cancer - Pap; Squamous intraepithelial lesion - Pap; LSIL - Pap; HSIL - Pap; Low-grade Pap; High-grade Pap; Carcinoma in situ - Pap; CIS - Pap; ASCUS - Pap; Atypical glandular cells - Pap; AGUS - Pap; Atypical squamous cells - Pap; HPV - Pap; Human papilloma virus - Pap cervix - Pap; Colposcopy - Pap
The Pap test checks for cervical cancer. Cells scraped from the opening of the cervix are examined under a microscope. The cervix is the lower part of the uterus (womb) that opens at the top of the vagina.
This test is sometimes called a Pap smear.
How the Test is Performed
You lie on a table and place your feet in stirrups. The health care provider gently places an instrument called a speculum into the
Cells are gently scraped from the cervix area. The sample of cells is sent to a lab for examination.
If you're a woman 21 or over, it's important to begin getting regular pelvic examinations to take charge of your health. An important part of this pelvic exam may include a test, called a Pap smear, to detect the often life threatening disease, cervical cancer even before it starts. And here's the key, cervical cells become abnormal years before they turn to cancer. That gives an excellent window of opportunity. So, what is a Pap smear? A Pap smear is a microscopic examination of cells scraped from the opening of the cervix. The cervix is the lower part of the uterus, or womb, that opens at the top of the vagina. The test looks for cervical cancer or abnormal cells. Most cervical cancers can be found, and treated early, or even before they start, if women have routine Pap smears and pelvic examinations. So, I repeat, starting at age 21, most woman should have a Pap smear every two years. If you are over age 30 or your Pap smears have been negative 3 times in a row, your doctor may say you need a Pap smear every three years. And after age 65 to 70, most women can stop having Pap smears. For this test, you will lie on a table and place your feet in stirrups. The doctor will insert an instrument called a speculum into the vagina and open it slightly to see inside the vaginal canal. Cells are gently scraped from the cervix area, and sent to a lab for examination. When a Pap smear shows abnormal changes, you will need further testing. The next step depends on the results of the Pap smear, and on your previous history of Pap smears, and risk factors you may have for cervical cancer. You may need a biopsy using a light and a low-powered microscope, called colposcopy. You may also need a test to check for infection with human papilloma virus, or HPV, which can cause cervical cancer. If you are diagnosed with cervical cancer, the doctor will order more tests to determine how you should be treated, and how far the cancer has spread. This is called staging. Treatment will depend on the stage of the cancer, the size and shape of the tumor, your age and general health, and your desire to have children in the future. Early cervical cancer can be treated with surgery to remove the abnormal tissue, or freeze abnormal cells, or burn abnormal tissue. Treatment for more advanced cervical cancer may include radical hysterectomy, removal of the uterus and much of the surrounding tissue, including lymph nodes and the upper part of the vagina. Radiation may be used to treat cancer that has spread beyond the pelvis, or if cancer returns. The woman may also have chemotherapy to kill the cancer if the cervical cancer's advanced. The Pap smear test is not 100% accurate and cervical cancer may be missed in a small number of cases. Fortunately, cervical cancer develops very slowly in most women and follow-up Pap smears should identify worrisome changes in plenty of time for treatment. Make sure your doctor knows about all the medicines you are taking. Some, including estrogen and progestins, may affect the result of your Pap smear. Pap smears can be a wonderful, life saving tool.
How to Prepare for the Test
Tell your provider about all the medicines you are taking. Some birth control pills that contain estrogen or progestin may affect test results.
Also tell your provider if you:
- Have had an abnormal Pap test
- Might be pregnant
DO NOT do the following for 24 hours before the test:
- Douche (douching should never be done)
- Have intercourse
- Use tampons
Avoid scheduling your Pap test while you have your period (are menstruating). Blood may make the Pap test results less accurate. If you are having unexpected bleeding, do not cancel your exam. Your provider will determine if the Pap test can still be done.
Empty your bladder just before the test.
How the Test will Feel
A Pap test causes little to no discomfort for most women. It can cause some discomfort, similar to menstrual cramps. You may also feel some pressure during the exam.
You may bleed a little bit after the test.
Why the Test is Performed
The Pap test is a screening test for cervical cancer. Most cervical cancers can be detected early if a woman has routine Pap tests.
Screening should start at age 21.
After the first test:
- You should have a Pap test every 3 years to check for cervical cancer.
- If you are over age 30 and you also have HPV testing done, and both the Pap test and HPV test are normal, you can be tested every 5 years (HPV is the human papillomavirus, the virus that causes genital warts and cervical cancer).
- Most women can stop having Pap tests after age 65 to 70 as long as they have had 3 negative tests within the past 10 years.
You may not need to have a Pap test if you have had a total hysterectomy (uterus and cervix removed) and have not had an abnormal Pap test, cervical cancer, or other pelvic cancer. Discuss this with your provider.
A normal result means there are no abnormal cells present. The Pap test is not 100% accurate. Cervical cancer may be missed in a small number of cases. Most of the time, cervical cancer develops very slowly, and follow-up Pap tests should find any changes in time for treatment.
What Abnormal Results Mean
Abnormal results are grouped as follows:
ASCUS or AGUS:
- This result means there are atypical cells, but it is uncertain or unclear what these changes mean.
- The changes may be due to HPV.
- They may also mean there are changes that may lead to cancer.
- These cells could be precancerous and they could be coming from the outside of the cervix or inside the uterus.
LOW-GRADE DYSPLASIA (LSIL) OR HIGH-GRADE DYSPLASIA (HSIL):
- This means changes that may lead to cancer are present.
- The risk of progression to cervical cancer is greater with HSIL.
CARCINOMA IN SITU (CIS):
- This result most often means the abnormal changes are likely to lead to cervical cancer if not treated
ATYPICAL SQUAMOUS CELLS (ASC):
- Abnormal changes have been found and may be HSIL
ATYPICAL GLANDULAR CELLS (AGC):
- Cell changes that may lead to cancer are seen in the upper part of the cervical canal or inside the uterus.
When a Pap test shows abnormal changes, further testing or follow-up is needed. The next step depends on the results of the Pap test, your previous history of Pap tests, and risk factors you may have for cervical cancer.
For minor cell changes, providers will recommend another Pap test or repeat HPV testing in 6 to 12 months.
Follow-up testing or treatment may include:
- Colposcopy-directed biopsy -- Colposcopy is a procedure in which the cervix is magnified with a binocular like tool called a colposcope. Small biopsies are often obtained during this procedure to determine the extent of the problem.
- An HPV test to check for the presence of the HPV virus types most likely to cause cancer.
- Cervix cryosurgery.
- Cone biopsy.
American College of Obstetricians and Gynecologists. Practice bulletin no. 140: management of abnormal cervical cancer screening test results and cervical cancer precursors. Obstet Gynecol. 2013;122(6):1338-1367. PMID: 24264713
American College of Obstetricians and Gynecologists. Practice bulletin no. 157: cervical cancer screening and prevention. Obstet Gynecol. 2016;127(1):e1-e20. PMID: 26695583
Salcedo MP, Baker ES, Schmeler KM. Intraepithelial neoplasia of the lower genital tract (cervix, vulva): etiology, screening, diagnostic techniques, management. In: Lobo RA, Gershenson DM, Lentz GM, Valea FA, eds. Comprehensive Gynecology. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 28.
Saslow D, Solomon D, Lawson HW, et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. CA Cancer J Clin. 2012;62(3):147-172. PMID: 22422631
Spriggs D. Gynecological cancers. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 199.
US Preventive Services Task Force website. Final recommendation statement. Cervical cancer: screening.
Last reviewed on: 7/17/2017
Reviewed by: Cynthia D. White, MD, Fellow American College of Obstetricians and Gynecologists, Group Health Cooperative, Bellevue, WA. Internal review and update 11/06/2018 by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.