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Papanicolaou Test (Pap Smear)

A procedure in which cells are scraped from the cervix for examination under a microscope. It is used to detect cancer and changes that may lead to cancer. A Papanicolaou test can also show conditions, such as infection or inflammation, that are not cancer.

PubMed Health Glossary
(Source: NIH - National Cancer Institute)

About Pap Smears

The Pap test is named after the Greek doctor George Nicolas Papanicolaou, who developed this method. It is also commonly called "smear test" or "cervical smear." Abnormal Pap test results do not mean that you have cancer. They often turn out to be a harmless inflammation or minor cell changes (also called dysplasia), which can clear up or go back to normal on their own. And even if pre-cancerous cell changes are found, the abnormal tissue can usually be removed completely, which will stop a tumor from developing.

Cervical cancer (also called cervical carcinoma) takes many years to develop. Pap tests are done at regular intervals to detect any new cell abnormalities too.

Minor or moderate abnormalities in the cervix usually go back to normal by themselves over time. So in these cases, the doctor will probably recommend waiting a few months and doing another test later. If the abnormal cells have not disappeared after a longer period of waiting, or if they have progressed, more examinations are needed.

How are Pap tests done?

As in many other gynecological examinations, the gynecologist will insert an instrument (a speculum) into the woman's vagina to be able to see her cervix and its opening, which form the lower part of the womb.

The doctor will take samples of the cervical cells using a small spatula or brush. Samples will be taken from the opening of the cervix, which protrudes into the vagina, and from the cervical canal, which is deeper inside the womb. Taking this smear only takes a few seconds. It usually does not hurt, but it may feel slightly uncomfortable. The doctor will then transfer the material from the spatula or the brush onto a small glass slide.

The cells are preserved on the glass slide, and sent to a special laboratory for testing. There they are stained and examined under a microscope. In this procedure, called a "cytological examination", the lab doctor can detect abnormal cells and find out how much they have changed.
Institute for Quality and Efficiency in Heath Care

What works? Research summarized

Evidence reviews

Systematic review of the literature on postpartum care: selected contraception methods, postpartum Papanicolaou test, and rubella immunization

BACKGROUND: The postpartum period is a time when many routine interventions are provided to mothers. This review examined the published evidence for the effectiveness of selected contraceptive methods, Papanicolaou (Pap) tests, and rubella immunization.

Invitations and probably educational interventions increase the uptake of Pap smears

Cervical cancer is the second most common cancer world‐wide. Increasing the uptake of screening is of great importance in controlling this disease through early detection and treatment of pre‐cancerous changes before malignancy evolves. Methods of encouraging women to undergo cervical screening include invitations, reminders, education, message framing, counselling, risk factor assessment, procedures and economic interventions. These were all examined in this review. Evidence supports the use of invitations, and to a lesser extent, educational materials. It is likely other methods are advantageous, but the evidence is not as strong. Further research is required.

This review is no longer appropriate for update as liquid based cytology has superceded smear technology.

Cervical screening (pap smear) is an effective way of detecting pre‐cancerous abnormalities of the cervix (cervical intraepithelial neoplasia). Tests can be affected by the tester's skill and the design of the device used. Inadequate smears can produce incorrect results, causing stress and inconvenience to women having to undergo repeat screening. This review of trials found that the commonly used Ayre spatula is not as effective in collecting cells as the extended tip spatula. The most effective appears to be a combination of the cytobrush with an extended tip spatula.

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Summaries for consumers

Invitations and probably educational interventions increase the uptake of Pap smears

Cervical cancer is the second most common cancer world‐wide. Increasing the uptake of screening is of great importance in controlling this disease through early detection and treatment of pre‐cancerous changes before malignancy evolves. Methods of encouraging women to undergo cervical screening include invitations, reminders, education, message framing, counselling, risk factor assessment, procedures and economic interventions. These were all examined in this review. Evidence supports the use of invitations, and to a lesser extent, educational materials. It is likely other methods are advantageous, but the evidence is not as strong. Further research is required.

This review is no longer appropriate for update as liquid based cytology has superceded smear technology.

Cervical screening (pap smear) is an effective way of detecting pre‐cancerous abnormalities of the cervix (cervical intraepithelial neoplasia). Tests can be affected by the tester's skill and the design of the device used. Inadequate smears can produce incorrect results, causing stress and inconvenience to women having to undergo repeat screening. This review of trials found that the commonly used Ayre spatula is not as effective in collecting cells as the extended tip spatula. The most effective appears to be a combination of the cytobrush with an extended tip spatula.

Cervical cancer: Screening and prevention

Cervical cancer can be detected at an early stage by using Pap tests. This test is also used for prevention: It can detect cell changes before they develop into a tumor. The HPV test is another way to do screening.Some screening tests aim to detect diseases at an early stage. Diseases can often be treated more successfully if detected early rather than at a later stage. Other screening tests aim to prevent diseases by detecting abnormal cells before they turn into cancer. The Pap test of the cervix is used for both of these purposes: to detect cervical cancer at an early stage before it causes symptoms. And, more importantly, to help find abnormal cells on the cervix, monitor them, and possibly treat them before they develop into a tumor.Pap tests have been used in Germany since the 1970s. Together with a general improvement in living conditions and hygiene, they have probably contributed to the fact that the number of women who get cervical cancer has significantly decreased over the last few decades.The HPV test is another screening test. It looks for human papillomaviruses (HPV), the main cause of cervical cancer. Unlike the Pap test, HPV tests are currently not routinely used in cancer screening in Germany.

More about Papanicolaou Test

Photo of a young adult woman

Also called: Pap test, Cervical smear

See Also: Cervical Cancer: Prevention

Related articles:
Cervical Lesions (CIN)
Atypical Glandular Cells (AGC)

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