Fortunately, the number of women in the United States who die annually from cervical cancer has decreased steadily over the past 40 years. The development of the Pap test, the screening test for cervical cancer and pre-cancer, is the primary reason for this increased survival.
This guide is intended to provide you with the information you need to know about the Pap test and screening for cervical cancer.
What Is Cervical Cancer?
The cervix is the opening to the uterus, or womb. Most, if not all, cases of cervical cancer are caused by the human papillomavirus (HPV). The human papillomavirus, spread by sexual contact, can infect cervical cells. Most experts now consider cervical cancer a sexually transmitted disease.
The virus changes normal cervical cells into precancerous cells, which, if left untreated, can ultimately develop into cervical cancer. The Pap test detects the abnormal cells early, before they change to cancerous cells, and allows for early treatment.
Recommendations for Screening
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A Pap test is not a pelvic exam, you do not need a Pap test until you have been sexually active for at least three years or have reached the age of 21. A pelvic exam should be performed at or around the onset of sexual activity.
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Pap tests are not necessary in women who have had a hysterectomy for treatment of a benign condition and who previously had consistently normal Pap tests. Women who have had a hysterectomy for a gynecologic malignancy or for a history of abnormal Pap tests may continue to need Pap tests more frequently.
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Women who have had a hysterectomy for treatment of cervical, ovarian or uterine cancer; women who have had a hysterectomy but still have a cervix; and women who have had a hysterectomy for a benign condition but who previously had abnormal Paps, should all still have Pap tests regularly.
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Screening may be discontinued in women over age 70 if they have had regular previous screenings and the screenings have been consistenly normal. However, since many women are uncertain of the past results of their Pap tests or the details of their surgery if they have had a hysterectomy, many doctors continue to do Pap tests regularly - even over age 70.
Frequency of Testing
The frequency of testing is based on your level of risk for cervical cancer. If you are not at high risk for cervical cancer, you should have a Pap test every year until you have normal Pap tests for three years in a row. At that point, if you are over age 30, based on your doctor's recommendation you could have a Pap test only once every two to three years if you are not at increased risk for developing cervical cancer.
Women who fall into a high risk category for cervical cancer should have a Pap test every year.
You are at high risk for cervical cancer if you:
- had exposure to DES (diethylstilbestrol, a synthetic hormone) that was given to your mother while she was pregnant with you
- have had a history of genital warts (condyloma)
- have had a prior abnormal Pap test
- are being treated with immunosuppressive medications
- have a history of high-risk HPV strain
- are a current smoker
It is important, no matter your degree of risk, that you have your regularly scheduled Pap tests. The Pap test, though very effective, is not perfect. About 20 percent of the time, when there are abnormal cells present in the cervix, they will not show up on a Pap test. Luckily, the abnormal cells grow very slowly. The chance of missing the cells on two separate Pap tests is very low. This is why it is important not to miss your routine screening appointments.
How Is a Pap Test Performed?
It is best to perform the Pap test on women who are not actively menstruating and have restrained from sexual activity and using vaginal medications or spermicides for 48 hours prior to the test. If you are scheduled for a Pap test and are menstruating, it is best to call your doctor's office to reschedule the test.
On the day of your appointment, a device called a speculum is inserted into the vagina to expose the cervix. Cells are collected from the cervix using a plastic spatula and a small brush. The sample cells are then either spread onto a slide (conventional Pap) or placed into a liquid (ThinPrep®, Sure Path®) and sent off to a laboratory for evaluation. The results should be available within a few weeks.
Pap Test Results and Recommendations
There are two parts to a Pap test report: the adequacy of the specimen and a descriptive diagnosis (which tells whether the cells are normal or abnormal.)
Adequacy of the specimen:
If it is determined that the specimen for the Pap test was inadequate (not enough cells or too much inflammation or blood to accurately read the slide), a diagnosis will not be given and the test should be repeated. If the specimen was adequate, you will receive one of the following diagnoses.
Descriptive Diagnosis:
- If there are no abnormal cells, your doctor will recommend that you repeat the Pap test in one to three years - based on your risk status for cervical cancer.
- If you have evidence of an infection (trichomonas, yeast, bacteria, fungus or herpes), your doctor will advise treatment if you are symptomatic and show characteristics of the disease.
- Epithelial cell abnormalities (squamous): The most common abnormal Pap diagnosis is "atypical squamous cells - undetermined significance" (ASC-US). A number of factors can lead to this result, including inflammation and air-drying of the specimen, but some patients with a Pap diagnosis of ASC-US do have a serious abnormality. If you have this result, your doctor may either check the liquid in your Pap test for HPV; he or she may recommend a repeat test in 4-6 months; or he or she may recommend a colposcopy (described below).
If the repeat test is also abnormal, your doctor will refer you to a gynecologist for a colposcopy. This is an office procedure that uses a magnifying instrument to directly examine the skin of the vagina and cervix. During this procedure, the doctor may take a scraping of tissue from the cervical canal and a biopsy from the surface skin of the cervix.
If your Pap result is a low-grade squamous intraepithelial lesion (LSIL) or a high-grade squamous intraepithelial lesion (HSIL), your doctor will also refer you to a gynecologist for a colposcopy. These abnormalities are caused by the human papillomavirus and are considered precancerous abnormalities.
- Epithelial cell abnormalities (glandular): These are abnormal cells from either the endocervix (the neck of the womb) or the endometrium (the lining of the womb itself). Some treatment may be necessary, depending on the degree of abnormality.
- Adenocarcinoma/Squamous Cancer: This is an extremely rare finding and suggests that cancer of the cervix is present. If your test reveals this result, you will be referred to a gynecologist who specializes in treating cervical cancer.
With the increased use of the Pap test, cervical cancer is being detected more often during an early, curable stage. Having your scheduled Pap test is an easy and effective way of keeping yourself healthy.
Dana-Farber/Brigham and Women's Cancer Center
The Dana-Farber/Brigham and Women's Cancer Center is the integration in adult oncology of one of the world's leading cancer institutes with one of the world's leading teaching hospitals. Together, we have comprehensive treatment programs for all types of cancer - including breast, gynecologic, colon and pancreatic cancers. Together, we have a team of world-renowned experts in each of our 12 specialized treatment centers, dedicated to bringing the most advanced care and support to every patient, including the latest clinical trials.
If you need a gynecologist, primary care physician, specialist, or more information on services at Brigham and Women's Hospital, call our Physician Referral Service at 1-800-BWH-9999, Monday - Friday, 8:00 a.m. to 5:00 p.m. or visit our web site at www.brighamandwomens.org.
