The PAP Test and HPV Screening
The PAP Test is a simple test that analyzes cells taken from your cervix. It tells your doctor if there are any abnormal cells on the cervix that may lead to cancer.
A PAP test is simple, fast, and painless. It is generally performed as part of your annual gynecological exam. The doctor uses a brush to scrape a small number of cells from the cervix. The cell sample is sent to a laboratory for testing. At the lab, the sample is carefully examined using a microscope to see if abnormal cells are present in your cervix.
Who Should Have a PAP Test?
PAP tests are an important part of your overall health care. When and how often you should have a PAP test depends on your age and health history. You should have annual PAP tests if:
• You are 21 years of age or older.
• You are or have been sexually active, even if you are younger than 21.
It is important to remember that you can have cervical cancer even if you are not sexually active or are not having menstrual periods. Most women should continue having annual PAP tests after menopause.
The PAP test is the best way to find cell changes that may lead to cancer of the cervix.
How Often Should You Have a PAP Test?
All women should have a routine pelvic exam every year. It is generally recommended that if you are under 30, you should have a PAP test every year. If you are over 30 and have had three normal PAP tests in a row, you can choose to continue to have annual PAP tests or choose to have a PAP test only every 2 or 3 years.
You should talk with your doctor about how often you should have a PAP test. If you have had a hysterectomy, talk with your doctor about whether or not you still need a PAP test.
Certain risk factors might mean that you should have a PAP test every year:
• If you have previously been treated for cancer
• If you have the HIV infection
• If you have a weakened immune system
• If you were exposed to the drug diethylstilbestrol (DES) before birth
The Test Results
Most labs in the United States use the “Bethesda System” to describe PAP test results. This standard system helps doctors plan any treatment that may be needed. Under this system, you PAP test results will be placed in one of several groups.
It is best to talk with your doctor about what the results of your PAP test mean and about any follow-up testing or treatment that may be needed.
• Normal (negative): Only normal cells are seen; there are no signs of cancer or precancer.
• Atypical Squamous Cells (ASC): Some cells were seen that cannot be called normal, but that do not meet the requirements to call them precancer. The abnormal cells may be caused by an infection, irritation, recent intercourse, or may be precancerous.
• Squamous Intraepithelail Lesion (SIL) Cells: Changes were seen in the cells that may show signs of precancer.
• Atypical Glandular Cells: Cell changes were seen that represent an abnormality that needs to be evaluated more closely.
• Cancer: Abnormal cells were seen that have spread deeper into the cervix or to other tissues; these cells have become cancer.
Follow Up Testing
If your PAP test shows the appearance of abnormal cells, your doctor will most likely recommend additional testing. Follow up testing may be as simple as a repeat PAP test. Sometimes an exam called a colposcopy is recommended. This exam uses a device like a microscope to look at your cervix. The exam is done in the doctor’s office.
Your doctor may also want to test for the human papillomavirus (HPV). HPV is a group of related viruses, a few of which are linked to changes in the cells of your cervix.
Recent studies have shown that some types of HPV cause cancer of the cervix. For this reason, your doctor may recommend that you have a genetic test that looks for certain high-risk types of the HPV known to cause cancer.
This recommendation is most often made for women over 30. Women under 30 are not good candidates for this HPV DNA test because they often test positive for HPV that will clear up on its own.
Talk to your doctor about the vaccine that is available that protects against the two types of HPV that most often lead to precancer of the cervix.