The PAP Test
The PAP Test is an important part of your overall health care. This simple test analyzes cells taken from your cervix and tells the doctor if there are any abnormal cells that may lead to cancer. A PAP test is simple, fast, and painless and is generally performed as part of your annual gynecological exam. The doctor uses a brush to scrape a small number of cells from the cervix and sends the sample to a lab for testing. At the lab, the sample is carefully examined using a microscope to see if abnormal cells are present in your cervix.
How Often Should You Have a PAP Test?
All women should have a routine pelvic exam every year. If you are under 30, it is recommended you have a PAP test every year. You can choose to continue to have annual PAP tests every two to three years if you are over 30 and have had three normal tests in a row.
Certain risk factors might mean that you should have a PAP test every year:
If you have previously been treated for cancer
If you have the HIV infection
If you have a weakened immune system
If you were exposed to the drug diethylstilbestrol (DES) before birth
To make an educated decision, talk with your doctor about whether or not you still need a PAP test. It is important to remember that you can have cervical cancer even if you are not sexually active or are not having menstrual periods.
The Test Results
Most labs in the United States use the "Bethesda System" to describe PAP results. This standard system helps doctors plan any treatment that may be needed and will place you in one of the following groups:
Normal (negative): Only normal cells are detected. There are no signs of cancer or precancer.
Atypical Squamous Cells (ASC): Some cells were seen that cannot be called normal, but do not meet the requirements to be called precancer. The abnormal cells may be caused by an infection, irritation, recent intercourse, or may be precancerous.
Squamous Intraepithelail Lesion (SIL) Cells: Changes were seen in the cells that may show signs of precancer.
Atypical Glandular Cells: Cell changes were seen that represent an abnormality that needs to be evaluated more closely.
Cancer: Abnormal cells were seen that have spread deeper into the cervix or to other tissues. These cells have become cancer.
It is best to speak with your doctor about what the results of your PAP test mean and any follow-up testing or treatment that may be needed.
Follow Up Testing
If your PAP test shows the appearance of abnormal cells, your doctor will most likely recommend additional testing. Follow up testing may be as simple as a repeat PAP test. Sometimes an exam called a colposcopy is recommended. This exam uses a device like a microscope to look at your cervix and is done in the doctor's office.
Your doctor may also want to test for the human papillomavirus (HPV), a group of related viruses, a few of which are linked to changes in the cells of your cervix. Recent studies have shown that some types of HPV cause cancer of the cervix. For this reason, your doctor may recommend that you have a genetic test that looks for certain high-risk types of the HPV known to cause cancer. This recommendation is most often made for women over 30. Women under 30 are not good candidates for this HPV DNA test because they often test positive for HPV that will clear up on its own. Speak with your doctor about the vaccine [link to Gynecology > The HPV Vaccine] that is available that protects against the two types of HPV that most often lead to precancer of the cervix.