What is a Pap smear?
The Pap smear test can detect pre-cancerous cells. That means the cells can be removed before they have a chance to develop into cervical cancer, which makes this test a potential lifesaver.
These days, you’re more likely to hear it called a Pap test rather than a Pap smear.
What to expect during your Pap test
While no real preparation is necessary, there are a few things that can affect Pap results. For more accurate results, avoid these things for two days before your scheduled test:
- vaginal suppositories, creams, medicines, or douches
- powders, sprays, or other feminine hygiene products
A Pap test can be performed during your period, but it’s better if you schedule it between periods.
If you’ve ever had a pelvic exam, the Pap test isn’t much different. You’ll lie on the table with your feet in the stirrups. A speculum will be used to open your vagina and allow your doctor to see your cervix.
Your doctor will use a swab to remove a few cells from your cervix. They will place these cells on a glass slide that will be sent to a laboratory for testing.
A Pap test may be a bit uncomfortable, but it’s generally painless. The whole procedure shouldn’t take more than a few minutes.
Understanding your results
You should receive your results within a week or two.
In most cases, you’ll get a normal result. That means there’s no evidence that you have abnormal cervical cells. And you won’t need to think about it again until your next scheduled test.
If you don’t receive a normal result, it doesn’t mean that you have cancer. It doesn’t even necessarily mean there’s anything wrong.
Test results can also be inconclusive. This result is sometimes called ASC-US, which means atypical squamous cells of undetermined significance. The cells didn’t look quite like normal cells, but they couldn’t really be classified as abnormal.
Normal cervical cells are present in about 75 percent of women with inconclusive results. In some cases, a poor sample can lead to inconclusive results. That might happen if you recently had intercourse or used feminine hygiene products.
An abnormal result means some cervical cells have changed. But it doesn’t mean you have cancer. In fact, most women who have an abnormal result do not have cervical cancer. Some other reasons for an abnormal result are:
Abnormal cells are either low-grade or high-grade. Low-grade cells are only slightly abnormal. High-grade cells look less like normal cells and may develop into cancer. The existence of abnormal cells is known as cervical dysplasia. The abnormal cells are sometimes called carcinoma in situ or pre-cancer.
Your doctor will be able to explain the specifics of your Pap result, the likelihood of a false-positive or false-negative, and what steps should be taken next.
When Pap results are unclear or inconclusive, your doctor may want to schedule a repeat test in the near future.
If you didn’t have Pap and HPV co-testing, an HPV test might be ordered. It’s performed similarly to the Pap test. There’s no specific treatment for asymptomatic HPV.
Cervical cancer also can’t be diagnosed via a Pap test. It takes additional testing to confirm cancer.
If your Pap results are unclear or inconclusive, the next step will likely be a colposcopy. A colposcopy is a procedure in which your doctor uses a microscope to inspect your cervix. Your doctor will use a special solution during the colposcopy to help differentiate normal areas from abnormal ones.
During a colposcopy, a small piece of abnormal tissue can be removed for analysis. This is called a cone biopsy.
Abnormal cells can be destroyed by freezing, known as cryosurgery, or removed using loop electrosurgical excision procedure (LEEP). Removing abnormal cells can prevent cervical cancer from ever developing.
If the biopsy confirms cancer, treatment will depend on other factors, such as stage and tumor grade.
Who should get a Pap test?
Most women between the ages of 21 and 65 should get a Pap test every three years.
You might need more frequent testing if:
- you’re at high risk of cervical cancer
- you’ve had abnormal Pap test results in the past
- you have a weakened immune system or you’re HIV-positive
- your mother was exposed to diethylstilbestrol while pregnant
Also, women between the ages of 30 and 64 are advised to get a Pap test and a human papillomavirus (HPV) test together every five years, or a Pap test alone every three years.
The reason for this is that co-testing is more likely to catch an abnormality than Pap testing alone. Co-testing also helps detect more cell abnormalities.
Another reason for co-testing is that cervical cancer is almost always caused by HPV. But most women with HPV never develop cervical cancer.
Some women might not need to have Pap tests anymore. This includes women over age 65 who have had three normal Pap tests in a row and haven’t had abnormal test results in the past 10 years.
Also, women who have had their uterus and cervix removed, known as a hysterectomy, and have no history of abnormal Pap tests or cervical cancer may not need them, either.
Talk to your doctor about when and how often you should have a Pap test.
Can I have a Pap test while pregnant?
You can have a Pap test while you’re pregnant. You can even have a colposcopy. Having an abnormal Pap or a colposcopy while pregnant shouldn’t affect your baby.
If you need additional treatment, your doctor will advise if it should wait until your baby is born.
After an abnormal Pap test you may need more frequent testing for a few years. It depends on the reason for the abnormal result and your overall risk for cervical cancer.
Tips for prevention
The main reason for a Pap test is to find abnormal cells before they become cancerous. To lower your chances of getting HPV and cervical cancer, follow these prevention tips:
- Get vaccinated. Since cervical cancer is almost always caused by HPV, most women younger than 26 years of age should get vaccinated for HPV.
- Practice safe sex. Use condoms to prevent HPV and other sexually transmitted diseases (STDs).
- Schedule an annual checkup. Tell your doctor if you develop gynecological symptoms between visits. Follow up as advised.
- Get tested. Schedule Pap tests as recommended by your doctor. Consider Pap-HPV co-testing. Tell your doctor if your family has a history of cancer, especially cervical cancer.