Adolescent Medicine

Pap Test

What is a Pap test?

A Pap test (sometimes called a Pap smear) is a way to examine cells collected from the cervix, or the "mouth" of the womb (located at the top of the vagina), for the presence of:

• infection
• inflammation
• abnormal cells
• cancer

Why is a Pap test suggested for females?

A Pap test, along with a pelvic examination, is an important part of a female's routine healthcare because it may detect abnormalities that can lead to invasive cancer. Most invasive cancers of the cervix can be detected early if females have Pap tests and pelvic examinations regularly. As with many types of cancer, cancer of the cervix is more likely to be successfully treated if it is detected early.

But, the Pap test is not only useful in detecting cancerous cells, it can detect other changes in the cervix and vagina, including dysplasia, or pre-cancer cells. Inflammation in the cervical area may also be detected. Inflammation may be caused by:

• yeast infections
• trichomoniasis infections
• bacteria
• viruses
• medications or other chemicals
• hormones
• pregnancy
• miscarriage (or abortion)

Who should have Pap tests?

A woman should always consult with her physician about when and how often a Pap test and pelvic examination should be performed.

According to the National Cancer Institute (NCI), the American Cancer Society (ACS), and the American College of Obstetricians and Gynecologists (ACOG), general guidelines include:

• Cervical cancer screening should begin approximately three years after a woman begins having sexual intercourse, but no later than at 21 years old.

• Experts recommend waiting approximately three years following the initiation of sexual activity because transient human papillomavirus (HPV) infections and cervical cell changes that are not significant are common and it takes years for a significant abnormality or cancer to develop. Cervical cancer is extremely rare in women under the age of 25.
  
  
• Women should have a Pap test at least once every three years.
  
  
• The American Cancer Society (ACS) and the American College of Obstetricians and Gynecologists (ACOG) recommend annual cervical cytology screening with regular Pap tests or biannual (every two years) screening with liquid-based tests (Thinprep) until age 30. Women under age 30 have a higher likelihood than older women of acquiring high-risk types of HPV that cause premalignant cervical disease, which should be ruled out before extending the testing intervals.
  
  
• ACS and ACOG recommend that at or after age 30, women who have had three normal test results in a row may get screened every two to three years. However, women with certain risk factors such as human immunodeficiency virus (HIV) infection, a weak immune system, in utero DES exposure, or a previous diagnosis of cervical cancer may need more frequent screening.
  
  
• Women 65 to 70 years of age who have had at least three normal Pap tests and no abnormal Pap tests in the last 10 years may decide, upon consultation with their healthcare provider, to stop cervical cancer screening.
  
  
• Women who have had a total hysterectomy (removal of the uterus and cervix) do not need to undergo cervical cancer screening, unless the surgery was done as a treatment for cervical precancer or cancer.
  
  
• Women should seek expert medical advice about when they should begin screening, how often they should be screened, and when they can discontinue cervical screenings, especially if they are at higher than average risk of cervical cancer due to factors such as HIV infection.

Thinprep - a Pap test alternative:

Thinprep is an alternate way of testing cervical cells for abnormalities. The Thinprep test has been approved by the US Food and Drug Administration (FDA) and is occasionally used by physicians.

Adolescents and abnormal Pap test results:

When abnormal cells are identified on a Pap test, additional testing is generally recommended in order to determine if the abnormality requires treatment. However, a 2006 report from the American College of Obstetricians and Gynecologists (ACOG) recommends that abnormal Pap test results in adolescents may be managed somewhat differently.

Most cervical lesions of a lower grade will go away without treatment in adolescents. Thus, ACOG's current recommendation is to repeat the Pap test at 6- or 12-month intervals for a year after the original abnormal Pap test, depending on the individual situation of the adolescent involved. However, the plan of action for further testing and treatment after abnormal results from a Pap test will depend on the type of abnormality found and the adolescent's general health status.