Pap Smear (cont.)
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.
In this Article
- Pap smear facts
- 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
- Find a local Obstetrician-Gynecologist in your town
What is the current status of the newer Pap smear technologies?
New technologies have been developed to try to circumvent the problem of false-negative Pap smears. False-negative results occur when a disease or condition is present but the test does not detect it. False-negative Pap smears (slides with abnormal cells judged to be "normal") are estimated to be between 5% and 30%.
The new techniques consist of alternative ways to prepare and read Pap smears. In one new preparation method known as liquid-based cytology, cervical cells are obtained as usual but a new technique is used to prepare the slides for analysis. The physician puts the cell sample into a vial of liquid preservative. The cells are then sent to the laboratory where they are filtered and spread on glass slides. This method removes any contamination from blood or mucous.
Prepared slides are usually read by cytotechnologists who examine thousands of slides under a microscope every day. This exhausting process may be subject to human error. Computer systems are now being developed to assist by providing an automated analysis of slides. Slides containing abnormally appearing cervical cells can first be automatically identified and then subjected to a second, manual re-screening.
Recent guidelines are conflicting as to whether to recommend the new technologies because sound scientific research is not available on which to base a thoughtful recommendation. Besides being more expensive, the underlying problem is that the new technologies (such as liquid-based cytology) have never been proven to decrease mortality from cervical cancer as compared to conventional Pap testing. In addition, even if future research shows that more cases of cervical cancer are detected with the new technologies versus the conventional Pap testing, there may be too many "false positive" cases in which women are labeled to have abnormal Pap smears when they are perfectly normal. This last point is critical. The information must be gathered before rational recommendations can be widely instituted.
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