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Pap smear can detect: Pap test: Can it detect ovarian cancer?

Pap Test | Johns Hopkins Medicine

What is a Pap test?

For a Pap test, your healthcare provider will collect and examine cells
from your cervix. The cervix is the opening to the uterus. He or she will
do this test to screen for cervical cancer and other problems.

It’s important to talk with your healthcare provider about when and how
often you should have a Pap test. Experts base screening guidelines on your
age and risk factors for

cervical cancer


American College of Obstetricians and Gynecologists (ACOG), guidelines

  • If you are at least age 21, you should start cervical cancer
    screening, even if you are not yet sexually active.

  • If you are younger than 30, you can likely be tested for cervical
    cancer every other year instead of yearly.

  • If you are older than 30 and have had 3 normal Pap tests in a row,
    you can be tested once every 3 years.

  • If you are at high risk for cervical cancer, you may need more
    screenings more often the guidelines suggest. Especially if you
    have a weak immune system or have been treated for abnormal
    cervical cells in the past.

  • If you are 65 to 70 years old and have had at least 3 normal Pap
    tests in a row and are not sexually active, and
    have had no abnormal Pap tests in the past, you may decide with
    your healthcare provider to stop cervical cancer screening.

  • If you’ve had both your uterus and cervix removed (total
    hysterectomy), you do not need cervical cancer screening unless
    you’ve had past surgery for cervical cancer or pre-cancer.

Why might I need a Pap test?

A Pap test, along with a pelvic exam, is an important part of your routine
healthcare. It can help find abnormal cells that can lead to cancer. Your
healthcare provider can find most cancers of the cervix early if you have
regular Pap tests and pelvic exams. Cancer of the cervix is more likely to
be successfully treated if it is found early.

The Pap test is useful for finding cancerous cells, and other cervical and
vaginal problems such as precancerous cells and inflammation.

Your healthcare provider may use a Pap test to diagnose the following

  • Inflammation

  • Infection

  • Abnormal cells

  • Precancerous cells

  • Cancer

Your healthcare provider may do a test for the

human papilloma virus (HPV)

at the same time as a Pap test. Infection with HPV is the most important
risk factor for cervical cancer in women over age 30.

Your healthcare provider may have other reasons to recommend a Pap test.

What are the risks for a Pap test?

Tell your healthcare provider if you are allergic to or sensitive to latex.

Tell your healthcare provider if you are pregnant or think you might be.

There may be other risks based on your condition. Be sure to discuss any
concerns with your healthcare provider before the procedure.

Certain things may interfere with a Pap test including:

  • Menstruation

  • Use of things, such as vaginal creams, jellies, medicines, or
    spermicidal foams, for 2 to 3 days before the Pap test, as these
    substances may alter the pH of the cells or hide abnormal cells

  • Douching for 2 to 3 days before a Pap test as douching can wash
    away surface cells

  • Sex within 24 hours before the test may cause inflammation of the

  • Infections

  • Certain medicines, such as tetracycline

How do I get ready for a Pap test?

  • Your healthcare provider will explain the procedure and you can ask

  • Tell your healthcare provider if you are sensitive to or are
    allergic to any medicines, latex, or tape.

  • Generally, you do not need to do anything to prepare for this test.

  • Tell your healthcare provider of all medicines (prescription and
    over-the-counter) and herbal supplements that you are taking.

  • Tell your healthcare provider when you had your last period, and
    what type of birth control or hormone therapy, if any, you are

  • Tell your healthcare provider if you have a history of bleeding
    disorders or if you are taking any blood-thinning medicines
    (anticoagulants), aspirin, or other medicines that affect blood

  • Tell your healthcare provider if you are pregnant or think you
    could be.

  • Do not use vaginal medicines, spermicidal foams, creams, or
    jellies, or douche for 2 to 3 days before the test or for the time
    set by your health care provider. Avoid sex within 24 hours before
    the test.

  • You will be asked to empty your bladder before the procedure.

  • Follow any other instructions your provider gives you to get ready.

What happens during a Pap test?

Procedures may vary based on your condition and your healthcare provider’s

Generally, a Pap test follows this process:

  1. You will be asked to undress from the waist down and put on or
    cover up with a hospital gown.

  2. You will lie on an exam table, with your feet in stirrups.

  3. Your healthcare provider will insert an instrument called a
    speculum into your vagina. This will spread the walls of the vagina
    apart to show the cervix.

  4. Your healthcare provider will use a small brush, swab or spatula to
    gently remove cells from the cervix and back of the vagina. He or
    she will place the cells in a vial of liquid or smear the cells on
    a glass microscope slide.

  5. If you need an HPV test, your provider will take a sample of cells
    for this test as well.

  6. If you have symptoms of a vaginal infection, your provider may take
    a sample of vaginal for testing.

  7. Most often, your healthcare provider will do a pelvic exam after
    the Pap test.

  8. Your provider will send the specimen to a lab for further study.

What happens after a Pap test?

You may rest for a few minutes after the procedure before going home.
Scraping the cervix may cause a small amount of bleeding. You may want to
wear a sanitary pad for any spotting that may occur.

Tell your healthcare provider if you have any of the following:

Pap test results usually take a few days. Ask your healthcare provider how
you will be hear back about the results.

Your healthcare provider may give you other instructions after the
procedure, based on your situation.

Pap Smear > Fact Sheets > Yale Medicine


Before the Pap smear was introduced in the 1940s by George Papanicolaou, after whom it was named, cervical cancer was the No. 1 killer of women in the United States. Now, the Pap smear has become a routine screening for women. For example, the Pap test can detect abnormal cell growth, the presence of the human papillomavirus virus (HPV), as well as other conditions like cervical cancer. Yale Medicine Pathology offers specialized expertise in the interpretation of Pap tests.

What is a Pap smear?

A Pap test is a routine collection of cells from a woman’s cervix, the lower end of the uterus that connects to the vagina.

According to Angelique W. Levi, MD, a Yale Medicine pathologist, the Pap test has evolved significantly over time. Today’s Pap test not only shows that a woman has or may develop cervical cancer, but it can also be used to test for a wide range of other diseases, including human papilloma virus (HPV) and other sexually transmitted diseases that have major implications for a woman’s health and longevity.

“There is a significant association between HPV infection and cervical cancer,” Dr. Levi says. “It’s the most common reason why atypical cells may develop into dysplastic lesions and ultimately, cervical cancer.”

It’s recommended that sexually active women receive a Pap smear every 1-3 years, depending on each woman’s risk profile, such as age, sexual history and HPV status. The procedure to collect cells from the cervix can be uncomfortable but not usually painful. Dr. Levi says that the samples are obtained during a pelvic exam through a tool that is like a small broom or brush. The specimen is then put into a tube containing a preservative liquid and sent to the pathology lab. There, it will be examined for abnormal cells that indicate a raised risk for cancer.

How does a pathologist analyze a Pap test?

In the pathology lab, the cervical cells are put on a glass slide using automated machinery. A specific staining procedure, called the Pap stain, is applied. This makes it easier to distinguish cells at different stages of maturation, as well as abnormal cells from normal ones.

“We look at anywhere between 5,000 and 50,000 cells on a particular slide,” Dr. Levi says. “At Yale, the slides are screened not just by humans, but also by machines equipped with software that brings our attention to areas of particular concern.”

Areas where cells appear irregular are flagged by an automated computer-based screening system, and then re-screened manually by a team of highly trained cytotechnologists for in-depth analysis. If a specific type of abnormality is identified, it is graded according to specific criteria that will be used to create a treatment plan.

“We follow a series of steps and use a classification system that has been developed over the past decade to standardize grading of the abnormal cells,” Dr. Levi says.

What happens after the Pap smear has been evaluated?

Once the cells have been studied and classified, the pathologist creates a report for the gynecologist. 

Follow-up tests may include molecular testing to pinpoint the origins of abnormal cells. They may also include colposcopy, which involves a visual examination of the cervix and a small tissue sample for biopsy. If a lesion has been identified, the patient may need to undergo surgery for removal of cancerous or precancerous tissue. Many gynecology offices are equipped with the technology to do these additional diagnostic and therapeutic procedures, or they may be performed in an outpatient clinic.

At Yale Medicine, upon clinician request, specimens can be screened for 13 types of high-risk HPV strains, and may be further characterized by molecular testing for specific genotypes.

“We also perform molecular testing to identify different microorganisms which may cause vaginosis,” a group of common symptoms with many etiologies, ranging from bacterial to fungal infection, due to Gardnerella vaginalis and Candida species to organisms transmitted with intercourse such as herpes, trichomoniasis, chlamydia or gonorrhea, Dr. Levi says.

What makes Yale Medicine’s approach to Pap tests unique?

Yale Medicine has state-of-the-art equipment for cutting-edge molecular testing, Dr. Levi says. “We are often a beta site for new technology as it is being developed,” she says. Better equipment yields more accurate results. In addition to automated screening systems, “we have an invaluable team of 10 certified cytotechnologists who have on average a decade of screening experience,” Dr. Levi says.

The experienced team supports the intense quality control and quality assurance practices in the cytopathology laboratory at Yale Medicine, above and beyond national standards. “Our high standards play a large part in minimizing or eliminating interpretive errors,” Dr. Levi says. “Many commercial and private laboratories cannot afford in this in the era of cost-cutting measures of healthcare delivery.” 

Yale Medicine’s team of pathologists have subspecialty training and board certification in cytopathology. This specialty of pathology focuses on the identification and diagnosis of disease at the cellular level. 

Additionally, Yale Medicine’s pathologists focus their clinical or basic science research in areas of special interest. Dr. Levi specializes in cervicovaginal cytopathology, the discipline around Pap tests.

“Here at Yale, all the people who are reviewing samples are of the same high caliber. We all hold ourselves to the same high standard,” Dr. Levi says. 

Pap smear (Pap test) | CorSwiss

Who created the Pap smear text?

Contents of the page

  • 1 Who created the Pap smear text?
  • 2 What is a Pap smear?
    • 2.1 How is the Pap test done?
    • 2.2 How do I prepare for the test?
    • 2.3 When and for whom is the examination indicated?

The Pap test was introduced by Dr. George Papanicolaou, a Greek American scientist whose research focused on the effect of ovarian hormones on the epithelium of the female genital tract. At 19In 26, he reported that tumor cells were found in the vaginal secretions of women with cervical cancer. In 1944, he published his seminal paper, Diagnosis of Uterine Cancer by Vaginal Pap smears, and his observations were immediately confirmed by other scientists and studies.

What is a Pap smear?

A Pap smear is a test to help prevent or detect cervical cancer at an early stage. The cervix is ​​the lower narrow end of the uterus that opens into the vagina. During a Pap smear, a health worker collects cells from the cervix and sends them to a laboratory.

In the laboratory, cells are examined under a microscope for cancer or signs that they may become cancerous. Cells that can become cancerous are called precancerous. Identifying and treating precancerous conditions can help prevent cervical cancer. A Pap smear is also a reliable way to detect cancer at an early stage, when it is easier to treat.

Other names for Pap smear: Pap test, cervical cytology, Pap test, Pap smear test, vaginal smear method.

Diagnosis in Switzerland also includes a test to detect cervical cancer, as well as to prevent its development in the early stages. The Pap test detects abnormalities in the cells of the cervix before they develop into cancer. Sometimes the collected cells are also tested for HPV, a virus that can cause changes in cells that can lead to cancer.

How is a Pap test done?

In clinics in Switzerland, a Pap smear is often done as part of a gynecological examination. During a gynecological examination, the doctor examines the uterus, ovaries, and genital area. She also takes a Pap test.

This is how a Pap test is done:

  • To take a Pap smear, the doctor first inserts a small diagnostic tool (speculum) into the vagina.
  • Then, using a special spatula or small brush, gently scrape some of the cells of the mucous membrane from the cervix or directly from the cervix. The pap smear takes a few seconds and is usually painless for women.
  • The sample is placed on a glass slide and sent to a laboratory for examination under a microscope. It then evaluates whether the cells look healthy or have changed noticeably. Alternatively, so-called thin-layer cytology can also be carried out, in which the sample is cleared of blood and mucus residues before examination.

In most cases, the gynecologist will receive a Pap test result within a week. If there are noticeable changes, the gynecologist contacts the patient to discuss the result and further actions.

How will prepare for the test?

You should not have a Pap smear during your period. A good time to take the test is about five days after the last day of your period. Two or three days before the study it is impossible:

  • Use swabs
  • Use birth control creams in the vagina
  • Use of other creams or drugs in the vagina
  • have vaginal sex

When and for whom is the examination indicated?

All women without exception:

  • from the beginning of sexual activity – 1 time per year;
  • upon reaching the age of 30, a combined test is recommended: Pap test + human papillomavirus test – every 3 years;
  • sexually transmitted infections – at any age.

Pap test. What do the abbreviations say?




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Pap test. What do the abbreviations say?

Every woman who has ever been to a gynecologist knows that at the reception they will definitely take smears from her, including for a cytological examination. In many cases, only after a comprehensive examination of the cervix – extended colposcopy, smears for flora and cytology, and, if necessary, a biopsy – the specialist will be able to establish a diagnosis and prescribe the optimal method of treatment.

The term “dysplasia” or “neoplasia” will no longer surprise women, even those who are far from medicine. They understand that we are talking about the presence of atypical cells, which can be in both malignant and benign processes.

And yet, when you hold the result of a smear with incomprehensible abbreviations in your hands, there is always excitement.

Inna Subbotina, an oncogynecologist at the Israeli Oncology Hospital LISO D , will tell you what cytological screening is and why every woman should undergo it.

Inna Vitalievna, tell us what is the PAP test and how often should it be taken?

— Pap test, also called cytological screening, helps to detect and treat moderate and severe precancerous conditions of the cervix in a timely manner. Regular screening at the onset of sexual activity significantly reduces the risk of developing cervical cancer. In most countries of the world, it is recommended to take a Pap test every three years from the age of 21, but Ukrainian doctors consider it expedient to start it in Ukraine earlier, from the age of 18, and complete it at 65, as in most countries of the world. This is due to certain epidemiological features: early onset of sexual activity, the prevalence of various forms of immunodeficiency, an extremely low level of HPV vaccination and a large number of cases of smoking among women.

Do I need to prepare for a Pap test?

– It is better to be examined on the first dry days after menstruation. For women who take birth control pills, it does not matter which day of the cycle to take the test, and women in menopause can take it on any convenient day. 48 hours before the test, you should exclude sexual intercourse, do not use vaginal suppositories, irrigation, gels and creams.

The Pap test is a painless procedure. Some women may experience discomfort and aching pain in the lower abdomen during the sampling. This is fine.

Cellular material is taken with a special brush, which is placed in a container with a fixing transport solution or applied in a thin layer on a glass slide. Cotesting (simultaneous cytological examination and determination of the human papillomavirus (HPV) by the polymerase chain reaction method) makes the first, but confident steps in Ukraine.

What might be the results of this study? What is recommended for each of them?

– For a descriptive cytological conclusion, the Bethesda classification is used, according to which the results are interpreted:

  • ASCUS – inflammation or mild dysplasia of unclear significance;
  • LSIL low-grade squamous intraepithelial lesion (traditional cytology CIN I (Cervical Intraepithelial Neoplasia) or “mild dysplasia”;
  • HSIL – high grade squamous intraepithelial lesion (traditional cytology CIN III/ CIN III) or “moderate-severe dysplasia”;
  • NILM – absence of intracellular lesions or malignancy, that is, the “norm”.

Often, women and especially young girls come with an incomprehensible result of a cytological examination of the cervix and with an exciting question “What to do next?” Upon receipt of any of the results of the PAP test, there are absolutely clear and scientifically based methods of additional examination and patient management tactics, which are based on international recommendations and evidence-based medicine data.

If you receive a “Poor Bethesda Cytology” result, it is recommended that you repeat the Pap test in 2-4 months (regardless of age).

Conclusion ASCUS (Atipical Squamous Cells of Undetermined Significance, atypical squamous cells of unknown significance) – characterizes such structural changes in cells that are qualitatively and quantitatively insufficient for making a diagnosis of CIN. This means that the cytological picture does not allow differentiating changes in the squamous epithelium between reactive and dysplastic, that is, precancerous. In most patients with these results, the cellular composition normalizes during follow-up, but 10-20% progress to dysplasia. However, the risk of developing severe CIN III dysplasia in women with ASCUS and a negative result for HPV (-) does not exceed 1-2%, therefore, such patients are observed without the use of invasive examination methods, and the tactics of observation depend on age and the presence or absence of highly oncogenic types of HPV in study of urogenital secretions.

Screening result ASC-H (Atypical Squamous Cells Can not Exlude HSIL) – regardless of HPV status, extended colposcopy is recommended, and biopsy, cervical curettage is indicated for any signs of damage. In women of peri- and menopausal age, if the transition zone of the squamous and columnar epithelium of the cervix is ​​NOT visualized colposcopically, and curettage did not provide reliable information, conization of the cervix can be considered as a diagnostic measure. Such an intervention should be performed by an expert-level specialist. Further tactics depend on the results of histological examination.

Pap test with a result of CIN I or LSIL (Low-grade Intraepithelial Lesion, mild epithelial damage) – cytological changes due to HPV (koilocytosis) and non-specific inflammatory changes. CIN I often regresses on its own, therefore, in this group of patients, dynamic monitoring tactics are most often used. However, it is imperative to perform an HPV test to determine further tactics.

For women with CIN I and HPV (-), cytological control after 6 months is recommended, a double cotesting test after 12 months is possible. If after 12-18 months. based on the results of observation, we obtain NILM – it is recommended to move on to routine screening.

For women with CIN I / HPV (+), colposcopy is recommended, and if a severe lesion of the cervical epithelium is detected, a biopsy, and in its absence, repeated cytological control after 6 months. or double test after 12 months. In such patients, it is necessary to create conditions for the elimination of HPV: it is recommended to stop smoking, if necessary, to treat chronic infections, correct the vaginal microbiome – candidiasis, bacterial vaginosis, chronic herpes infection, etc. It is worth remembering that 12-25% of HPV ( +) Women with CIN I may progress to more severe CIN within 4 years.

In the presence of a cytological conclusion of CIN II and CIN III or HSIL, in 70-80% of cases, patients have CIN II / III in the histological material after biopsy and cervical curettage, and in 1-3% – invasive cancer. Therefore, regardless of HPV status, colposcopy is always recommended by a trained specialist, biopsy of altered areas under colposcopy control, endocervical curettage in non-pregnant women, followed by a morphological study of the material obtained. A colposcopic examination of the vagina is also recommended. In cases with a cytological result of CIN II/III, if colposcopy shows no changes or a mild lesion is detected, biopsy and endocervical curettage (if not performed before) and/or diagnostic cone biopsy are recommended.

As an exception, girls under 21 years of age. The risk of invasive cancer is extremely low, and colposcopy and cytology should be repeated after 3-6 months, provided that the colposcopy is adequate, that is, the transformation zone is visualized, and endocervical curettage is negative.

Human immunodeficiency virus (HIV) testing is always recommended prior to invasive procedures, as these women are at increased risk for cervical neoplasia.

What to do if there is a histological confirmation of mild or moderate and severe cervical dysplasia?

— If a low-grade LSIL lesion (mild dysplasia, CIN I) is detected on biopsy and if colposcopy results are satisfactory (the type 1 transformation zone is fully visible), two approaches are possible: observation, which is recommended in most cases, or active treatment, which may be considered for signs of long-term persistence of CIN I.

Surveillance is the best management strategy, especially for young women and those planning pregnancy. It consists in cytological control + HPV testing + colposcopy every 6 months until there is cytological and colposcopic evidence of regression of mild dysplasia. It is worth noting that in patients with untreated CIN I, there is a 13% risk of detecting CIN II, CIN III during two years of follow-up.

Surgical, namely excisional treatment of CIN I may be offered to patients with long-term persistence of the lesion for more than 18 months, especially those with a positive HPV status and in women older than 30 years; patients who do not have reproductive plans and refuse to undergo regular control gynecological examination; women with a positive HIV status.

With histological confirmation of HSIL, that is, CIN II and CIN III, the treatment tactics are more likely to be surgical. However, it is worth remembering that about 40% of cases of CIN II can regress within 2 years, especially in young women. CIN III regression is extremely rare.

Treatment recommendations for severe CIN III dysplasia are unanimous: mandatory removal of the pathologically altered part of the cervix, i. e. excision / conization in non-pregnant patients. The only exception is HSIL (CIN II) in girls under 21 years of age, in the absence of a positive HIV status, since young patients are more likely to regress. In this category of patients, it is also desirable to conduct an immunohistochemical study of the proliferative activity index using monoclonal antibodies to the p16 or p16 / Ki67 protein to clarify the biological potential of dysplastic changes in the cervical epithelium. Observation is possible in the absence of p16 overexpression for no more than 12 months. With persistence of HSIL (CIN II) and HPV (+) for more than 12 months. The use of excisional treatments is recommended. Surgical treatment of HSIL (CIN II / III) can be performed by trained experts under colposcopy guidance.

Since the cervix is ​​covered not only with a flat, but also with a cylindrical glandular epithelium, which is located in the cervical canal, accordingly, oncological problems also occur here.

Cytological conclusion of the PAP test – AGC (cervical intraepithelial lesion of glandular cells) and AIS (adenocarcinoma in situ) in each case requires consultation of a cytologist, oncogynecologist, gynecologist of an expert level.

Atypical glandular cells in a cytological smear may be of endocervical origin, i.e. from the cervix, or endometrial, i.e. from the uterine cavity. Therefore, all patients in this group are recommended extended colposcopy and cervical curettage. Examination over the age of 35 includes mandatory endometrial curettage or hysteroscopy, especially in the presence of concomitant extragenital pathology (obesity + diabetes mellitus + hypertension), pathological uterine bleeding and a family history burdened with cancer.

If there is atypia of glandular cells or AIS on biopsy, but no evidence of invasive cancer, cervical conization may be considered as the method of choice in young patients with reproductive plans for the future, however, women who have realized their reproductive function and do not plan to give birth in the future are recommended hysterectomy – removal of the uterus, especially with histologically confirmed AIS, taking into account the high probability of incomplete removal of the lesion during conization (up to 26%) or invasive cancer (1. 2%), frequent relapses of the disease after treatment, the multifocal nature of the disease, and the uninformative cytological manifestations of AIS.

Remember that with early detection of cervical cancer, the disease has a favorable prognosis for treatment and full recovery, so you should take care of your own health first of all!

You can undergo an examination by a gynecologist, pass all the necessary tests, do a Pap test and, if necessary, undergo treatment for identified precancerous diseases at the Israeli Oncology Hospital LISOD. The best oncogynecologists will give a detailed consultation on the results of the tests and prescribe an effective treatment.

Sign up for a consultation:

0-800-500-110 — free of charge within Ukraine;

+ 38-044-277-8-277.

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