Also called Papanicolaou test.
A Pap test is a procedure that removes a small sample of cells from the cervix so that they can be examined under the microscope. The test is named after Dr George Papanicolaou, who developed the test.
Why a Pap test is done
A Pap test is mainly used to:
Pap tests are also done to follow-up previous abnormal Pap tests, to monitor precancerous conditions or to check for cancer recurrence after treatment.
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Who should have a Pap test
- Women who are sexually active should have regular Pap tests by the time they are 21 years of age.
- Women who are 69 or older should talk to their doctor about whether they can stop having Pap tests. The decision to stop is often based on a woman having 2 or 3 previous normal (negative) Pap results.
- Women who have never been sexually active should talk to their doctor about whether a Pap test is necessary. Some women may have been exposed to substances that put them at higher than average risk of developing cervical cancer.
- A Pap test is done every 1–3 years, depending on the screening guidelines in their province or territory.
- Women who stop having sex should continue to have regular Pap tests.
- Women who have had a total hysterectomy may still need a Pap test. They should talk to their doctor about whether this is necessary.
- Pap tests are usually continued if the hysterectomy was done to treat a precancerous or cancerous condition. Samples of tissues from the vagina can be taken during a Pap test and checked for changes.
- Pap tests are not necessary if the hysterectomy was done for a non-cancerous (benign) condition and the woman does not have a history of a precancerous cervical condition or HPV.
- Women who have had a partial hysterectomy should continue to have regular Pap tests based on their provincial or territorial screening guidelines.
- When a woman has a Pap test, a pelvic examination may also be done to make sure the pelvic organs are normal and to check for infections.
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How to prepare for a Pap test
- Avoid having the test during menstruation.
- For best results, the test should be done in the middle of a woman’s cycle, 10–20 days after the first day of the menstrual period.
- Avoid having sexual intercourse for 24 hours before the test.
- Do not use a vaginal douche, vaginal medications or contraceptive (spermicidal) creams, foams or gels (except as directed by the doctor) for 48 hours before the test. These products can wash away or hide abnormal cells.
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How a Pap test is done
A Pap test is usually done as part of an annual checkup or during a pelvic examination (gynecologic examination) in a doctor’s office or clinic. The test only takes a few minutes. There may be some discomfort, pressure or cramping during the procedure, but it is not usually painful.
- An instrument called a speculum (a clear plastic or metal device) is gently put into the vagina to widen it so that the upper part of the vagina and cervix can be seen.
- A small wooden stick or spatula is used to gently scrape the surface of the lower part of the cervix to pick up cells.
- A special brush, called a cytobrush (or cytobroom), is used to obtain cells from the inner part of the cervix (which leads into the uterus).
- The sample is sent to the laboratory to be examined under a microscope.
There may be some slight vaginal bleeding for 1–2 days after a Pap test.
It may take anywhere from 2–8 weeks for a Pap test result to come back from the laboratory.
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What the results mean
Different laboratories may use different systems for reporting Pap test results. A Pap test result may be described as normal (or negative) or abnormal.
Normal (negative)
A normal result means that no abnormal or cancerous cells were found.
Abnormal
Abnormal results do not necessarily mean that a woman has cancer. Abnormal results may be caused by:
- infection, such as yeast or human papillomavirus (HPV) infection
- inflammation
- an intrauterine device (IUD)
- precancerous cell changes
Abnormal cells in the cervix or vagina may be classified according to the degree of abnormality (from mild to severe). Abnormal cells in the cervix are also described using the Bethesda reporting system, which provides information about the type of cell change found.
Some abnormal cells return to normal on their own. Other abnormal cells or precancerous changes in the cervix or vagina may turn into cancer over time if left untreated. If the results show cancer, it may be reported as:
- squamous cell carcinoma
- adenocarcinoma
- other types of cancer
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What happens if a change or abnormality is detected
The doctor will decide if further tests, treatment or follow-up is needed. Follow-up options may vary. Some changes or abnormalities may or may not require treatment, depending on how severe they are.
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What the risks of a Pap test are
Screening tests such as the Pap test carry a risk of misleading test results.
- false-negative result – Cancer or abnormal cells are not detected by the test even though they are present. This may occur when there is not enough tissue sampled during the test or when abnormal cells are missed.
- false-positive result – Cancer or abnormal cells are detected even though they are not present. This may lead to unnecessary follow-up tests, procedures and anxiety.
False-negative Pap test results are more common than false-positive Pap test results. Regular Pap tests are important because the next test will likely detect any abnormal changes or cancer following a false-negative result.
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Newer Pap test techniques
In recent years, 2 newer Pap test techniques have been introduced.
Computerized Pap test
A computerized Pap test uses a computer to examine a cell sample and mark areas of abnormal cells. The technologist or pathologist then takes a closer look at the areas identified by the computer. This system seems to be as accurate as the usual laboratory practice.
AutoPap and PapNet are 2 types of computerized Pap tests.
Liquid-based Pap test
For a liquid-based Pap test, the sample of cells collected from the cervix with a cytobrush (cytobroom) is put in a special solution instead of being smeared onto a glass slide. The solution containing the sample is then sent to the laboratory. A special machine prepares the sample, and the pathologist examines the slide in the usual way. The solution containing the sample may also be used for HPV testing, if necessary.
ThinPrep and SurePath are 2 types of liquid-based Pap tests.
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