Pap Smear
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
- What is a Pap smear?
- Who should have a Pap smear?
- Which women are at increased risk for having an abnormal Pap smear?
- How is a Pap smear done?
- What are the risks of having a Pap smear?
- How is a Pap smear read (analyzed)?
- What information is included on a Pap smear report?
- Why is a woman's menstrual status important for the Pap smear?
- Why is a woman's past Pap smear history pertinent?
- When might a Pap smear not be adequate for interpretation?
- How is the final Pap smear diagnosis made?
- What are the possible recommendations for follow-up after a Pap smear?
- What treatments are available if a Pap smear is abnormal?
- What is the follow-up after treatment for an abnormal Pap smear?
- What is the current status of human papilloma virus (HPV) testing?
- When should women start and stop having Pap smears, and how often should Pap smears be performed?
- What is the current status of the newer Pap smear technologies?
- With Pap smears so available, why are women still dying of cervical cancer?
- Historical note: Dr. Pap
- Pap Smear At A Glance
- Patient Comments: Pap Smear - Results
- Patient Comments: Pap Smear - Testing
- Find a local Obstetrician-Gynecologist in your town
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 (a "false positive" result) - while very good, is not perfect. The sensitivity of a Pap smear - which means its ability to detect every single abnormality -- while good, is also not perfect, and some "false negative" results (in which abnormalities are present but not detected by the test) will occur. 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 had a 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:
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| 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) |
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| American College of Obstetrics and Gynecology | 3 years after first sexual intercourse or age 21, whichever comes first. | Yearly until age 30 years. Beginning at age 30, if three 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. |
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