Pap Smear Guidelines: What You Need to Know About Cervical Cancer Screenings
What is a Pap Smear?
A Pap smear is a procedure used to test for cervical cancer in women; it is also sometimes known as a Pap test, or cytology. A Pap smear is designed to detect cancerous or precancerous cells in order to guide treatment, if necessary.
Why is it done?
A Pap smear is a screening test for cancer of the cervix. This screening can be combined with an HPV test, which is done to check for the specific sexually transmitted virus that is responsible for most cases of cervical cancer.
Who should have one?
It is important to consult your doctor regarding the need for a Pap smear, as guidelines can change. Currently, the American College of Obstetricians and Gynecologists (ACOG) recommends a Pap smear once every 3 years for all women aged 21-29, and every 5 years for women older than 30. Females who have undergone a total hysterectomy (which includes the cervix) typically no longer need Pap smears unless cervical cancer or precancerous cells were already present.
Furthermore, women who have received HPV vaccines still require routine Pap smears.
What to expect?
The Pap usually takes only a few minutes, and causes minimal discomfort. However, it is good to be aware of exactly what goes on before, during, and after. This will help lessen pre-procedure anxiety!
You will be asked to undress, either fully, or from the waist down. You will also need to lie on your back with your feet on the examination table.
The doctor inserts a speculum, which is a tool used to keep the vaginal walls open during the test. It is normal to feel some pressure or discomfort during this part of the procedure. Your doctor will usually use lubricant during this process.
Then, using a small brush or swab, your doctor will collect a sample of cells from the cervix.
After the Pap smear, you can get dressed and continue with your day. The samples are placed in a sterile container and are sent to a laboratory for examination. Ask your doctor when to expect your results.
How often should a Pap smear be done?
ACOG guidelines recommend a Pap smear for women aged 21 and over, every three years. For those between 30-65, combined Pap smears and HPV tests are recommended every five years. Once women reach 65 and have had regular Pap smears with no alarming findings for a sustained period, screening can be discontinued.
Are there potential risks from a Pap smear?
While the Pap smear itself has no risks, if the test results come back revealing cancerous or precancerous cells, your doctor may recommend more invasive procedures like biopsies and colposcopies. False negative tests are also possible, meaning the test did not detect cancerous or precancerous cells that were actually present. A false negative can be the result of several factors, including:
An insufficient amount of cells collected by the swab
A very small amount of abnormal cells
The abnormal cells are hidden by blood or inflammatory cells
Current cervical cancer screening guidelines
While there are many different published guidelines, both ACOG and the United States Preventive Services Task Force (USPSTF) agree on the guidelines that were discussed above and our office abides by these guidelines.
Why screen for cervical cancer?
Cervical cancer is often asymptomatic until it has reached an advanced stage. Pap smears are the best way to detect it at an early stage.
Abnormal Pap Smear Results
An atypical Pap smear outcome suggests that there are uncommon cell transformations in the cervix. These abnormalities may stem from different causes such as infections, inflammation, hormonal irregularities, or untypical cell growth, which could be precancerous or cancerous.
It's important to keep in mind that irregular Pap smear results do not necessarily mean cancer, but prompt evaluation and treatment are crucial to ensure your continued health.
Types of abnormal results
Abnormal test results from a Pap smear are sorted according to cell changes in the cervix and may fall into various categories, such as:
ASCUS (Atypical Squamous Cells of Undetermined Significance): A minor cell abnormality that may or may not require follow-up.
LSIL (Low-grade Squamous Intraepithelial Lesion): A mild cell change resulting from human Papillomavirus (HPV) infection. This may also be called mild dysplasia.
HSIL (High-grade Squamous Intraepithelial Lesion): Moderate to severe cell changes in the cervix that can indicate a precancerous condition. Dubbed moderate or severe dysplasia.
ASC-H (Atypical Squamous Cells - cannot exclude HSIL): This points to cell changes in the cervix indicative of moderate to severe dysplasia.
AGC (Atypical Glandular Cells): Signifying changes in the glandular cells within the cervix, AGC can be a red flag of more severe conditions like cervical or endometrial cancer.
What to expect if your Pap smear Results are abnormal
In the case of an abnormal Pap smear result, changes in your cervix cells may need further evaluation. Rest assured that this does not necessarily mean you have cervical cancer or another severe condition. Here are some possible outcomes of an abnormal Pap smear:
Follow-up: Your doctor may suggest additional testing such as colposcopy to get a closer examination of your cervix.
Treatment: Abnormal cervical cell changes can be treated by therapy that removes or monitors the cells gradually over time
Further screening: To ensure the general welfare of your cervix health, a doctor may suggest more frequent Pap smears in the future.
Frequently Asked Questions
How accurate are cervical screening test results?
Cervical screening tests, such as the Pap smear and HPV test, are known for being quite reliable in detecting cervical cancer and precancerous changes in the cervix. Nevertheless, like all medical exams, there is a chance of receiving false-negative or false-positive results. However, the test itself is quick and easy.
How long will it take to get my test results?
Pap smear results are usually ready within one to two weeks after the test.
Are HPV tests better than Pap smears?
Both HPV tests and Pap smears are crucial tools for detecting cervical cancer. Pap smears look for abnormal cells while HPV tests look for the specific papilloma viruses that cause cervical cancer. HPV tests may be more sensitive but can lead to a higher rate of false positive results and unnecessary follow up testing. Furthermore, HPV tests may not be accessible or convenient everywhere.
What is a colposcopy?
A colposcopy is a procedure in which a healthcare provider inspects the cervix, vagina, and vulva using a magnifying speculum. This device magnifies the area, enabling the provider to get a better view of the cervix than via a regular Pap smear.
When can I stop getting cervical cancer screenings?
As a general rule, women should maintain regular screenings for cervical cancer until they reach 65 years of age, provided that they have undergone routine screenings in the past and have not experienced any unusual results. Once they turn 65, women who have received normal outcomes on their last three evaluations and have no cervical cancer or precancerous conditions in their medical history may be able to discontinue cervical cancer screenings.
Interested in scheduling a screening? Visit our Women’s Health page to book your appointment.