Pap Tests: When you need them and when you don’t

Pap Tests: When you need them and when you don’t

A Pap test is a test of cells of the cervix. The cervix is the opening between the vagina and the uterus. The Pap test looks for cells that are not normal and can cause cervical cancer.

You may receive a regular pap test if you are between the ages of 21 to 69 – but it may not always be necessary. Here’s why:

Pap tests usually don’t help if you are low-risk.

Many people have a very low risk for cervical cancer.

• Cervical cancer is rare if you are younger than 21, even if you are sexually active. Abnormal cells in this age group usually return to normal without treatment.
• Cervical cancer is rare if you are over 69 and have had regular Pap tests with normal results.
• Pap tests are not useful for anyone who has had their cervix removed during a hysterectomy, unless the hysterectomy was done because there were cancer or pre-cancer cells in the cervix.

Pap tests can have risks.

A Pap test can be uncomfortable and cause a little bleeding.

The test may show something that does not look normal but would go away on its own. Abnormal results cause anxiety. And they can lead to repeat Pap tests and follow-up treatment that you may not need.

So, when do I need a Pap test?

That depends on your age, your medical history, and your risks.

• Ages 21 to 29: Most provincial and territorial guidelines recommend that if you are at least 21 years of age and are sexually active you should have a Pap test every three years.
• Ages 30 to 69: The guidelines from the Canadian Task Force on Preventive Health Care and others say that you should have the Pap test every three years.
• Age 70 or older: You do not need any more Pap tests if your three previous tests have been normal.

How can you protect yourself against cervical cancer?

The best way to protect yourself against cervical cancer is to protect yourself against human papilloma virus (HPV). HPV is a sexually transmitted infection that can cause cervical cancer.

Get the HPV vaccine.

• The HPV vaccine is recommended for people before becoming sexually active, usually around age 11 or 12.
• If you have not been vaccinated and are sexually active, speak with your health care provider about the vaccine.
• You will still need regular Pap tests because the vaccine does not protect against all types of HPV that can cause cancer.

Reduce your risk.

• Use condoms. Condoms help reduce the risk of getting HPV. You are less likely to be infected and to infect partners. However, condoms do not prevent all infections.
• Use spermicidal gels. They also help protect against HPV.
• If you feel you are at risk for a sexually transmitted infection, you should visit your health care provider for testing and an examination.

Don’t smoke. The risk of developing cervical cancer increases with the length of time if you smoke and the number of cigarettes smoke per day.

Take these steps to make your Pap test as accurate as possible.

• Make your appointment for at least five days after your menstrual period stops.
• For 48 hours before the test: Do not have sex, and do not use douches, tampons, birth control foams or gels, vaginal creams, moisturizers or lubricants, or vaginal medicines.

The Importance of a Pap Smear for Women

If you’re not sure when you’re due for a Pap smear, you aren’t alone. Pap smear guidelines have changed over the past few years and keeping track of them can be confusing. 

You may not need to get tested as often as you used to, but Pap smears are still a crucial preventive measure, says Kevin Edmonds, M.D., an obstetrician and gynecologist at Piedmont.

Women should start getting Pap smears at 21, Dr. Edmonds says, and they should continue getting them every three years until they’re 65. If a screening detects abnormalities, a patient may need to get tested more frequently.  

What is a Pap smear?

A Pap smear examines the cells of a woman’s cervix to see if they are healthy. The test emerged from the studies of Dr. George Papanicolaou in the 1930s. 

Pap tests can detect the earliest signs of cervical cancer, the fifth most common cancer worldwide and the eighth most common cancer in American women. Your chances of developing cervical cancer peak in your 30s and again in your 50s.

The importance of screenings

Although new recommendations call for fewer Pap smears across a woman’s lifetime, Dr. Edmonds emphasizes the importance of receiving them. 

“You’re keeping up with your medical screening” by getting a Pap smear, he says. If a woman skips tests, she may be putting herself at risk.

“You could be missing something that could potentially, over a long period of time, be detrimental to your health,” Dr. Edmonds says. 

Shifts in screening guidelines

So why did screening guidelines change? Abnormalities in cervical cells take a while to evolve, and cancers may not develop for a decade or more. In fact, some abnormalities simply disappear on their own. 

“We found out that we were intervening and subsequently, having women undergo unnecessary testing and procedures,” Dr. Edmonds says. 

If your Pap smear results are normal, your chances of developing cancer in the following three years are very low. But precancerous cells may develop in that time, which is why you should get another screening in three years. 

If you do have a Pap smear that shows abnormalities, Dr. Edmonds says, don’t assume the worst.

“An abnormal pap smear doesn’t mean cancer,” he says. The patient may need a follow-up test, which could lead to additional screenings or procedures. 

HPV and cervical cancer

An abnormal smear may be the result of human papillomavirus, or HPV. This virus can cause cervical cancer in women, but it doesn’t show any symptoms, so women should take steps to protect themselves in advance.

The Gardasil vaccine can prevent some HPV strains (including the one that causes pre-cancerous cells and cancer in the cervix). It can also guard against genital warts. Girls as young as 9 can receive the vaccine. 

HPV is extremely common, and approximately eight in 10 women will become infected with it in their lifetimes. Dr. Edmonds recommends that patients receive the Gardasil vaccine and schedule regular pap smears if they’re 21 or older. 

Pap tests and annual well-woman exams

Even though women may need less frequent Pap smears, they still need to visit their gynecologist for annual exams, Dr. Edmonds says. 

A Pap smear is not the same test as a pelvic exam, which can help doctors find abnormalities beyond just the cervix. Additionally, women can discuss birth control, hormone issues and other important topics at their annual exams. 

Dr. Edmonds recommends that women who want to protect themselves use condoms during sex, which reduce the spread of HPV and other sexually transmitted infections.  

Routine exams such as Pap tests can greatly reduce your risk of contracting and dying from cervical cancer, so talk with your doctor about how often you need to be screened. For more information on Pap tests, visit Piedmont Gynecology.

Need to make an appointment with a Piedmont physician? Save time, book online.

The Importance of a Yearly Pap Smear

Regular preventive care is one of the most important ways to maintain your health over time. If you wait to see a doctor only when you notice a problem, it may be too late.

Cervical cancer screening is especially important for women’s health — but how and when it should be done has been the subject of some recent debate.

Current guidelines from the American Society of Obstetricians and Gynecologists (ACOG) recommend that women should have a Pap smear every two years starting at age 21. After age 30, you may decrease the frequency to every three years if you’ve had three normal Pap test results in a row and if your immune system has not been weakened by a virus or recent health condition.

Other organizations, however, including the American Cancer Society, suggest that women over 30 should be screened using a combination of both the traditional Pap and the HPV (human papillomavirus) test — which, according to a recent study published in the journal Lancet Oncology, may detect abnormal cervical lesions earlier and more accurately than the Pap test alone.

More research is needed to determine how the HPV test should be incorporated into our screening program, but experts say it’s not likely to replace the Pap anytime soon. For now, both ACOG and the U.S. Preventive Services Task Force say Pap smears are a woman’s best bet for early detection of cervical cancer.

“Pap smears can detect early precancerous changes on the cervix,” explains Johnathan Lancaster, MD, PhD, chair of the department of women’s oncology and director of the center for women’s oncology at H. Lee Moffitt Cancer Center and Research Institute, in Tampa, Fl. “These changes can be easily treated, thus dramatically reducing the risk of progression to cervical cancer.”

What Problems Can a Pap Smear Detect?

“Pap smears are not designed to detect cervical cancer,” says Dr. Lancaster. “They are designed to detect cervical dysplasia, or precancerous changes [in the cervix].” When abnormal cells are detected by Pap smear, your doctor can take steps to figure out the culprit behind these changes and treat the condition before it turns into cancer.

How Often Should I Have a Pap Smear?

“Like all medical tests, Pap smears are not 100 percent accurate,” he says. “This reinforces the importance of having regular Paps, so that even if one Pap misses an early abnormal change, it’s likely to be picked up at the next Pap.”

What if I Have an Abnormal Pap Smear?

An abnormal Pap smear means abnormal cells have been identified on your cervix. Depending on the type of cells found, your doctor may recommend repeating the test in four to six months, Lancaster says. Other times, they may choose to perform a colposcopy in order to get a better look at the cervix and take tissue samples to biopsy so they can determine what types of cells are present.

During a colposcopy, a thin tube with a very small camera attached to it is gently inserted into the vagina, up to your cervix. During a biopsy, your doctor removes a small piece of tissue from your cervix to analyze it under a microscope. The results of these tests can determine the nature of the problem and guide treatment.

When Should I Start and Stop Getting Yearly Pap Smears?

The American College of Obstetricians and Gynecologists recommends women begin getting Pap smears within three years of the first time they have sexual intercourse, or by age 21, whichever comes first, says Lancaster.

“Some women may discontinue Pap smears after age 65, but this needs to be a highly individualized decision based on risk factors and decided in conjunction with their gynecologist,” Lancaster says.

How Should I Prepare for a Pap Smear?

Lancaster says the presence of any substance in the vagina can lower the accuracy of a Pap smear. He recommends women avoid douching or engaging in sexual intercourse for two to three days prior to having a Pap smear to get more accurate results. Lancaster also says it’s preferable that women not be menstruating when having a Pap smear, since this too can interfere with the accuracy of the test.

What Happens During a Pap Smear?

Pap smears are generally painless and usually done during a pelvic exam. The doctor will position you on the exam table and insert a device called a speculum into your vagina; the speculum opens the vaginal area wider, giving the doctor a better view of the cervical area. The doctor will then swab your cervix with a brush or cotton swab to collect cells from its surface, and then send the cells off for analysis to see if there are any abnormal cells present.

Although Pap smears can seem like an uncomfortable nuisance, they are critical to keeping women of all ages healthy. Talk to your doctor to determine how often you should have a Pap smear.

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
include:

• 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
conditions:

• 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
  tissue

• 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
  questions.

• 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
  using.

• 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
  clotting.

• 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
practices.

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.

How often do I need a Pap smear?

Q-and-A with Margot Watson, M.D., Signature OB/GYN

A Pap smear is used to screen women for cervical cancer. Years ago, women had a Pap smear at each annual visit, but today Pap smears have improved and we know cervical cancer takes many years to develop. Women should start Pap smear screening at age 21. Between the ages of 21-29, women whose Pap smears are normal only need it repeated every three years. Women ages 30 and over should have testing for the human papillomavirus (HPV) with their Pap smear.  HPV is the cause of cervical cancer. Women under age 30 are not tested for the virus because 80 percent of sexually active women will have this virus. Most women clear it once they are in their 30s. Once we confirm that the virus is not present, that patient can extend the duration between her Pap smears even further, to every five years (though she should still have an annual gynecological exam). In the event that we do detect precancerous cells on a woman’s cervix, or if she tests positive for HPV, she will need more frequent testing.

We strongly recommend that both girls and boys be vaccinated against HPV at age 12. We can make cervical cancer much less common in just one generation!

Pap smears typically continue throughout a woman’s life, until she reaches the age of 65, unless she has had a hysterectomy. If so, she no longer needs Pap smears unless it is done to test for cervical or endometrial cancer). At that point, if a patient has had two normal Pap smears in the past 10 years and she has not had any seriously precancerous cells in the past 20 years, she can stop screening altogether.

Signature OB/GYN follows these standards, as recommended by the American College of Obstetricians and Gynecologists. We ensure that our patients are undergoing all of the tests they should have, but we also want to make sure patients are not undergoing tests that aren’t necessary. We educate our patients and encourage them to ask us questions, so that they are clear on what tests they should have done, at what age, and  why.     

Why Annual Pap Smears Are History – But Routine Ob-Gyn Visits Are Not

In the recent past, women were advised to visit their ob-gyn every year for a Pap test, as well as a pelvic exam and breast exam. The Pap test, also called a Pap smear, is a screening test for cervical cancer.

Fast forward to today, and our advice has changed. Women should still visit their ob-gyn each year, and I’ll outline why that’s so important below. But we no longer advise women to have an annual Pap test. A big reason for the change: We now better understand the way cervical cancer develops over time – we know it takes many years to develop – so we’ve expanded the time between screenings.

We also now have two screening options to detect cervical cancer, the Pap test and the HPV test. (HPV stands for human papillomavirus – a virus that can cause cervical cancer. ) With both tests, cells are taken from the cervix and tested. The Pap test looks for abnormal cells that may develop into cancerous cells over time. The HPV test looks for the strains of HPV that are most likely to cause cancer.

Here’s a quick summary of ACOG guidelines for cervical cancer screening (read this FAQ for the full details):

• Women age 21 to 29 should have a Pap test every 3 years. HPV testing is not recommended.

• Women age 30 to 65 should have both a Pap test and an HPV test every 5 years. You also can talk with your ob-gyn about having a Pap test alone every 3 years.

• After age 65, you can stop having cervical cancer screenings if you have never had abnormal cervical cells or cervical cancer, and you’ve had three negative Pap tests in a row. (You also can stop screening if you’ve had two negative Pap and HPV tests in a row in the past 10 years, with at least one test in the past 5 years. ),

Exceptions to the guidelines

You may need more frequent screenings if you

• have a history of cervical cancer

• are HIV positive

• have a weakened immune system,

• were exposed before birth to diethylstilbestrol (DES, a hormone given to pregnant women between 1940 and 1971)

If you have had a hysterectomy, you still may need screening. And if you’ve had the HPV vaccine, you should still follow the guidelines. The vaccine doesn’t protect you against every type of HPV.

Doctor’s notes

Most women are exposed to HPV in the course of normal sexual activity if they’ve had more than one sexual partner. The reason we don’t do Pap tests before age 21 is because the likelihood of someone that young getting cervical cancer is very low. After age 65, the likelihood of having an abnormal Pap test also is low.

Why you should see your ob-gyn every year

Whether or not you are due for cervical cancer screening, you should still make your visit to the ob-gyn an annual one. Your annual visit is a good time for you and your ob-gyn to share information and talk about your wishes for your health care.

During your visit, you and your ob-gyn can talk about any number of common concerns, such as problems with sex or birth control, pelvic pain, or abnormal bleeding.

You also can talk together about whether you need a breast exam or pelvic exam. Plus, you can discuss testing for STIs (sexually transmitted infections), getting the vaccines you need, having your blood pressure checked, and other general medical issues.

The annual visit to your ob-gyn is crucial for your overall health, and cervical cancer screening is just one small – but important – part of that.

Published: October 2020

Last reviewed: October 2020

Copyright 2021 by the American College of Obstetricians and Gynecologists. All rights reserved. Read copyright and permissions information.

This information is designed as an educational aid for the public. It offers current information and opinions related to women’s health. It is not intended as a statement of the standard of care. It does not explain all of the proper treatments or methods of care. It is not a substitute for the advice of a physician. Read ACOG’s complete disclaimer.

Pap Tests | Choosing Wisely

When you need them—and when you don’t

A Pap test is a test of cells in the cervix. The cervix is the opening between the vagina and the uterus. The Pap test looks for cells that are not normal and can cause cancer of the cervix. This is also called cervical cancer.

Most women ages 21 to 65 need regular Pap tests. But teenage girls and older women usually don’t need them. Here’s why:

Pap tests usually don’t help low-risk women.

Many women have a very low risk for cervical cancer.

• Cervical cancer is rare in women younger than 21, even if they are sexually active. Abnormal cells in younger women usually return to normal without treatment.
• Cervical cancer is rare in women over 65 who have had regular Pap tests with normal results.
• Pap tests are not useful for women who have had their cervix removed during a hysterectomy, unless the hysterectomy was done because there were cancer or pre-cancer cells in the cervix.

Pap tests can have risks.

A Pap test can be uncomfortable and cause a little bleeding.

The test may show something that does not look normal but would go away on its own. Abnormal results cause anxiety. And they can lead to repeat Pap tests and follow-up treatment that you may not need.

The tests cost money.

A Pap test is done during a pelvic exam. Although costs vary across the country and even from practice to practice, any money spent on an unnecessary test is money wasted.

So, when do I need a Pap test?

That depends on your age, your medical history, and your risks.

• Ages 21 to 30: You should have a Pap test every three years. Cervical cancer takes 10 to 20 years to develop, so you don’t need the test each year. You do not need a Pap test before age 21, even if you are sexually active.
• Ages 30 to 65: The new guidelines from the American Cancer Society and others say that you can have the Pap test every five years—as long as you have a test for the human papillomavirus, or HPV, at the same time. HPV is a sexually transmitted infection that can cause cervical cancer.
• Age 65 or older: You do not need Pap tests if your recent ones have been normal. If you have risk factors for cervical cancer, ask your doctor how often you need a Pap test. Risk factors include: pre-cancer cells in your cervix, a history of cervical cancer, or a weak immune system.

This report is for you to use when talking with your healthcare provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.

© 2016 Consumer Reports. Developed in cooperation with the American Academy of Family Physicians.

08/2016

H-Clinic Infectious Disease Expert

11.12.2020

A smear for oncocytology (Pap smear, Pap test in gynecology, Pap smear, screening for cervical cancer, smear for cytology, smear for atypical cells) is the leading screening method for diagnosing diseases of the cervix, which allows to assess the state of the mucous membrane of the cervix, the presence of background changes in the epithelium, as well as atypical, precancerous cells and cervical cancer.

The “gold standard” of cytological diagnostics of cervical cancer in the world is liquid oncocytology – a modified method of cytological smear, when the biomaterial is transferred not onto glass, as was done before, but as a whole, together with a cytobrush, into a container with a liquid medium, after which the composition is washed with a special method from elements that complicate cytological diagnosis (mucus, leukocytes, erythrocytes, detritus, elements of inflammation) and the sample is subjected to microscopic examination. And also, which is important, the cytologist receives 100% of the collected material, which makes the study more correct. An increase in the accuracy of cytological diagnostics when performing a liquid PAP test is achieved by overcoming all errors associated with the preparation of a smear.

The advantages of this method are that its sensitivity is significantly higher than the traditional smear on glass and is 98%. All this makes the cytological examination more informative and the conclusion more reliable.As a result, the proportion of false-negative results of cytological examination decreases and the reliability of diagnostics of diseases of the cervix uteri is significantly increased.

The leading factor in the development of cervical cancer is the presence of oncogenic types of human papillomavirus in the cervical epithelium (in 99.7% of cases of cervical cancer, papillomavirus DNA was isolated from tumor samples). In this regard, a combined HPV-PAP liquid test is currently used, which allows assessing not only the state of the cervix at the cellular level, but also detecting the presence of papillomaviruses, indicating their type and viral load, because it is on it that the activity of the virus and the degree of risk.

Using molecular biological methods, more than 100 serotypes of human papillomaviruses are identified, but at least 19 types are currently classified as oncogenic risk viruses: 16, 18 types – which are the most highly oncogenic, accounting for 70% of all cases of detected cervical cancer , in addition, high-risk papillomaviruses include 31, 33 types, medium-risk – 30, 35, 39, 45, 52, 53, 56, 58 types, low-risk – 6, 11, 40, 42, 43, 44, 61 types.

For a long time, cervical cancer has consistently ranked 5th in the structure of cancer incidence among women in Russia. In 2018, 17,766 cases were identified. Moreover, over the years, the growth rate of cases of cervical cancer is only gaining momentum. For 10 years, this indicator has grown by 4.47% percent and the average growth rate was about 2.19% per year. In the same 2018, 6392 women died from cervical cancer. Moreover, there is a clear increase in mortality in the age group among women 35-59 years old.Thus, the picture is more than sad – every day we lose 17 young women from cervical cancer. The entire civilized world has been vaccinating its population against HPV for more than 15 years, critically reducing the risks of cervical cancer (vaccination against human papillomavirus in more than 100 countries of the world is included in the national vaccination calendar). In Russia, the vaccine is administered at the request of the patient (or the consent of the girl’s mother), in the list of compulsory vaccinations (national vaccination calendar), this vaccination has not yet been included.

Considering the etiological factor of cervical cancer and the incidence and mortality rates in Russia, it is difficult to overestimate the vaccine prophylaxis of human papillomavirus infection. Vaccination eliminates the root cause, and screening reduces not only mortality, but also the incidence of cervical cancer, since thanks to modern diagnostic methods, the doctor can identify not only background processes that can lead to cancer, but also diagnose precancerous conditions of the cervix and carry out the necessary treatment on time . ..

So, what are the indications for passing the HPV-PAP liquid test?

According to current recommendations, screening for cervical cancer should be started within 1 year after the onset of sexual activity, but no later than 21 years. Women aged 21 to 29 years should be screened at least once every 3 years using a cytological examination only (provided that the results of 3 consecutive smears are without atypical and intraepithelial changes).Women aged 30 to 65 years should undergo combined cytological screening plus screening for HPV – typing at least once every 1-5 years or at least every 1-3 years if the screening includes only cytological examination (also in the presence of 3 consecutive negative smears for cytology (PAP test) and HPV).

Screening in women over 65 can be discontinued as recommended, provided:

➢ if there are three or more registered consecutive negative results in the last 10 years,

➢ with a negative analysis for HPV,

➢ absence of aggravating factors, such as:

▪ history of cervical disease;

▪ immunocompromising diseases or conditions, for example, the presence of HIV infection, severe autoimmune diseases;

▪ a history of transplantation or chemotherapy.

HIV-positive women should take a PAP test as soon as possible after diagnosis. Also, screening for women with HIV infection should be started within 1 year from the date of sexual intercourse, regardless of the mode of transmission of HIV infection, but no later than 21 years of age.

Further, with a negative PAP test (no intraepithelial and / or malignant changes), the next Pap smear should be performed at least 6-12 months later.

If the results of 3 registered consecutive smears are free of atypical and epithelial changes, repeated cytological smears should be performed at least after 3 years.

Combined HPV-PAP testing, according to current recommendations, should be performed in women aged 30 and older.

Also, according to the recommendations, with a negative PAP test and analysis for HPV infection, it is permissible for women over 30 to undergo an HPV-PAP test every 3 years.

With a negative PAP test, but the presence of human papillomavirus infection (with the exception of 16 or 16/18 types), women with HIV-positive status need to undergo a liquid HPV-PAP test at least once every 12 months.

Women who are HIV-positive should be screened for oncocytology and HPV typing throughout their lives.

If HPV 16 or 18 types and / or atypical epithelial changes are detected, colposcopy is necessary – visual examination of the cervical epithelium at 7.5-40 times magnification.A correctly evaluated colposcopic picture allows you to identify the affected area and perform a targeted biopsy of a suspicious area of ​​the cervix. In the future, after receiving a histological result, the doctor decides on further tactics and algorithm of management and treatment.

Preparation for the delivery of a cytological smear from the cervix is ​​simple and not difficult:

It is not recommended to take the PAP test during menstruation and less than 5 days before it

Avoid sexual activity within 48 hours prior to the study

Do not use a vaginal access ultrasound within 24 hours of the study

Do not use vaginal medications / products within 24-48 hours prior to the study

It is not recommended to take the PAP test in the presence of sexually transmitted infections, microflora disorders and inflammation of the vaginal mucosa, as well as during the treatment of these diseases

It should always be remembered that there is a possibility of false negative cytological results of the PAP test, therefore it is very important to regularly re-examine and follow the recommendations of your doctor – gynecologist.

Author: Yulia Sergeevna Rukavtsova, gynecologist of the H-Clinic University Clinic

Medical editor: Head of the University Clinic, Ph.D., infectious disease doctor Danila Sergeevich Konnov.

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Cytological examination of scrapings of the cervix and cervical canal (Papanicolaou staining, Rar test)

Study material
See description

Papanicolaou staining method is a specially developed method that allows detecting early precancerous diseases of the cervix with the highest degree of reliability.

Cervical cancer takes the third place in the structure of malignant neoplasms of the reproductive system. Until 1992, the incidence of cervical cancer was decreasing, but now there is again a tendency towards an increase in this pathology. The development of the tumor occurs gradually, over several years, therefore, preventive examinations of women using the cytological method of research are very important.

At present, Papanicolaou staining of cellular material – the Pap test – is used in screening programs to detect cervical cancer, precancerous and background conditions.Papanicolaou staining method allows assessing the degree of cytoplasmic maturation, stains nuclei with atypia well. The term “atypia” has different interpretations in different countries: in central Europe it is defined as malignancy, in the WHO nomenclature – “less than dysplastic intraepithelial changes.”

The RAR test has a number of features. An important point is the correct taking of the material and its fixation. The cellular material is taken with brushes of a special configuration in the “mirrors” in order to avoid the ingress of foreign material.The transfer of material should be quick, without drying; quick fixation of a wet smear in 96% ethanol is required. Papanicolaou staining of smears goes through a number of stages, then the cell material enclosed in the balm is subjected to cytological analysis.

Test material: scrapings from the endocervix, exocervix, as well as mixed scrapings applied to a glass slide.

Literature

1. V. I. Kulakov et al. “Modern approaches to the diagnosis of papillomavirus infection of the genitalia of women and their importance for screening for cervical cancer.Gynecology”. 2000; 1 (2): 4 – 8.

90,000 Smear for cytology of the cervix (Papanicolaou oncocytology) (PAP smear)

What is it for

Pap smear (PAP smear, smear for cervical cytology) is a modern method for diagnosing abnormalities in the cervical cells. Allows you to catch the initial precancerous changes and carry out simple and effective treatment at an early stage.

A Pap smear is recommended once a year for all women who are sexually active.HPV infection, precancerous changes, and early stages of cancer may not show up in any way.

With the help of a PAP smear, atypical cells of the cervix and cervical canal can be detected. Various bacterial, fungal and viral infections can be detected during the analysis.

The PAP smear also detects precancerous diseases of the cervix, which prevents the development of cancer. Also, this study serves to detect cervical cancer at the earliest stages, when the disease is treatable.Also, a PAP smear is used to monitor the state of the mucous membrane of the cervix when detecting changes, detecting HPV (HPV, human papillomavirus).

This is part of a routine pelvic exam. During the examination, the doctor receives a certain amount of cells from the cervix with a small spatula and a soft-bristled brush, with the help of which a smear is made on a glass plate. After taking a sample, the glass is stained in a special way. Unlike oncocytological smears, when conducting a Pap smear, a specially selected composition of fixatives and paints is used, which makes it possible to identify early precancerous diseases of the cervix with the highest degree of reliability.

The presence of certain types of HPV (human papillomavirus), allocated to the HPV group of high oncogenic risk, are associated with an increased risk of cervical cancer. Therefore, the doctor may prescribe a PAP smear along with the determination of HPV by PCR.

According to the recommendations of The American College of Obstetricians and Gynecologists (ACOG), women from 21 to 29 years old are recommended to have a PAP smear once every two years, over 30 years old – a PAP smear and HPV once every 3 years, if both results are good.The U.S. The Preventive Services Task Force (USPSTF) and the American Cancer Society recommend screening every 3 years.

A more frequent analysis is indicated for women with HIV infection, immunodeficiency, after treatment for cancer or precancerous diseases (CIN 2, CIN 3), with frequent change of sexual partners, and also with various gynecological diseases (bleeding, pain, inflammatory diseases, discharge, itching). Also, more frequent screening is indicated if changes in previous results of a PAP smear are detected or papillomavirus is detected.

We recommend annual screening for all women who are sexually active.

Value of analyzes

The conclusion on the PAP smear is issued according to the international classification of The Bethesda system (TBS) .

A normal PAP smear result means no precancerous lesions, cancerous cells, or signs of infection or inflammation are found.

If changes in the PAP smear are detected, additional research methods are shown.In case of infection – PCR diagnostics, bacteriological studies, in case of precancerous changes and the presence of cancer cells – colposcopy, cervical biopsy.

Downloads

Booklet “Cancer of the cervix. PAP smear “

90,000 Cervical cancer. What do you need to know ?!

Cervical cancer is a preventable malignant tumor because it is preceded by a long precancerous process. Cervical cancer is a type of cancer that only affects women. A timely visit to a gynecologist, a midwife will help to find out in time about the development of this disease. In this article, you will learn about the main types of diagnostics available to every modern woman, what is cervical cancer, methods of preventing it.

What is cervical cancer?

The lower part of the uterus is called the cervix. Most cancers begin in the cells lining the cervix – normal cells slowly begin to degenerate into precancerous ones.Over time, precancerous cells turn into cancerous cells, which is why regular check-ups are so important.

Why does cervical cancer occur?

This disease is not inherited, but is caused by specific types of human papillomavirus (HPV) that can become infected during life. There are more than 100 types of HPV, but only 15 of them are oncogenic and cause cervical cancer (CC). The most dangerous and common among them are 16, 18, 31 and 33 types of the virus.

The peak incidence of cervical cancer occurs between the ages of 45 and 65, but in recent years, the disease has been increasing in young women between the ages of 18 and 29.

Causes of the disease

Often, a cancerous tumor occurs in the fair sex who:

– take hormonal drugs for a long time;

– at an early age, up to the age of 16, began to have an active sex life;

– have done a lot of abortions;

– got pregnant early, before the age of 16, and had an early first birth;

– suffer from venereal and inflammatory diseases;

– frequent change of sexual partners;

– the simultaneous presence of several sexual partners in both men and women;

– non-observance of the rules of personal hygiene;

– long-term endometriosis, as well as erosion, dysplasia and leukoplakia of the cervix;

– smoking and alcohol abuse;

– immunodeficiency states;

– deficiency in the diet of vitamins A and C.

How is cervical cancer diagnosed

Diagnosis of this disease begins in the gynecologist’s office, in the examination room.

According to statistics, cervical cancer is in third place among cancer diseases in women.

To detect it at an early stage, a smear is taken for oncocytology.

The analysis can recognize cancer cells even in the initial stage of development, when the disease is still asymptomatic.

And one of the medical rules says: the sooner the disease is recognized, the better the chances of a full recovery.

A smear for oncocytology is an analysis that a gynecologist, midwife takes from a woman from the vagina and cervix. After that, the biomaterial is subject to research.

There are several types of screening:

– Leishman Method

– Papanicolaou method (Pap test)

– Liquid Cytology

With the first two screening methods of smear for oncocytology, the epithelium taken for analysis is smeared on a glass slide, and then sent to a specialist for research. In the laboratory, the size, shape and composition of the cells are studied, after which one or another conclusion is made. The difference between the Leishman and Pap test methods lies only in the complexity of the staining mechanism of the biomaterial, these studies are called “cytological examination of a smear from the surface of the cervix and cervical canal.” The cytogram can be ready in 10 days.

In the third method of examining a smear for oncocytology, the material taken is placed in a specific liquid medium.Cyto-preparations (cells) purified with the help of special equipment are concentrated in one place, forming an even layer. The taken epithelium does not dry out during transportation to the laboratory, therefore, the reliability of the analysis increases several times. It is carried out in specialized clinics and medical centers.

A smear for oncocytology can be taken on any day of the menstrual cycle, except for the period itself. In the KGBUZ “Kamenskaya CRH” it is absolutely free, you just have to come to the examination room, the medical outpatient clinic, the FAP, or the antenatal clinic.

After taking the material for oncocytology, during the examination with gynecological mirrors, the gynecologist determines the state of the cervix and the presence of all kinds of neoplasms on it. Then the appointment of a colposcopy is possible. During the study, a biopsy can be done. A biopsy is the removal of a piece of tissue for subsequent histological examination. If the gynecologist’s suspicions are confirmed, then the patient is immediately sent for a consultation with an oncologist.

How does cervical cancer manifest?

It is important to remember that the early stages of the disease do not manifest themselves in any way, the symptoms appear when the disease has already reached the later stages. In Russia, more than 45% of cases of cervical cancer are detected already in the late, advanced stages, when surgical intervention is required. With the progression of the disease, there may be profuse watery or bloody vaginal discharge, which, as a rule, appears after intercourse, lifting of weight in the period between menstruation, after established menopause. In the later stages, weakness, pain in the lower abdomen, and urinary disorders appear.

How to protect yourself from cervical cancer?

The main way to prevent this formidable disease is examinations by an obstetrician-gynecologist with the obligatory taking of smears for cytological examination for tumor cells, starting from the age of 20 or from the moment of onset of sexual activity and at least once a year. If you have HPV of any type, then an examination should be carried out every six months.

Process for preparing cells for gynecological examinations

This material is an instruction manual for the use of TriPath products in preparing cells for gynecological examinations using liquid cytology. CYTOVET uses the key points of this manual to conduct liquid cytology studies in animals.

Original instruction – https: // cytovet.ru / download / manual_method-LBC.pdf

Intended use

Used for in vitro diagnostics.

The method is a process for the preparation of cell preparations on a liquid basis. It is intended to replace the traditional method of preparing Pap smears, used in screening studies for the detection of cervical cancer.

Medium for collecting and transporting gynecological specimens tested in amplified DNA assays BD ProbeTec ™ Chlamydia trachomatis (CT) Q ^I and Neisseria gonorrhoeae (NG) Q ^I is a Liquid Preservative Fluid Preservative.For instructions on using the SurePath® Preservative Fluid to prepare samples used in these assays, see the package insert of the assay kits.

Overview and Description

Pap smear screening for cervical cancer involves microscopic examination of ecto- and endocervical cell specimens on slides and Pap smears. Cervical cytological screening using a Pap smear has reduced the mortality rate from invasive cervical carcinoma by 50-70%.Since cervical cytological examination is a screening study, all detected pathologies should be confirmed by histological examination.

For an accurate Pap smear diagnosis, it is essential that sampling and sample preparation procedures are followed. For complete accuracy, randomization and uniform sampling of a portion of the sample is extremely important. The traditional Pap smear procedure does not involve stirring the sample before preparing the slide.Because the cells on the sampling device are submerged in mucus, the cells that are transferred to the slide may not be a representative sample of all cells in the smear taken. The cells are transferred onto a slide depending on where they were on the sampling device. Many cells remain on the sampling device.

The heterogeneity of the typical cervical smear sample makes conventionally prepared smears difficult to prepare, examine and interpret.Often large areas of conventionally prepared slides are covered with impurities, inflammatory cells, and epithelial cell laminae that can hide valuable diagnostic material. In addition, if the smear is not captured immediately after preparation, cell morphology may become distorted as it dries (air artifacts).

The described method is a method for converting a liquid suspension of a taken smear of cervical cells into a uniformly stained homogeneous micropreparation of SurePath® without destroying the cell clusters required for diagnosis.The process includes preservation of cells, their randomization, enrichment of diagnostic material, pipetting and sedimentation to create a cell preparation. The micropreparation obtained as a result of this process can be used for routine cytological screening studies and categorization according to the Bethesda classification.

Principles of the Method

The liquid cytology method is a process for preparing cell preparations of cervical cells on a liquid basis.

Gynecological specimens are collected by qualified medical personnel using a brush-type device (eg Cervex Brush®) or an endocervical combination brush-spatula device (eg Cytobrush® Plus GT or Pap Perfect® from MedScand (USA) Inc.) with removable heads. The head of the device is removed from the handle and placed in a vial of SurePath® Preservative Fluid. The bottle is closed with a stopper, a label is attached and sent, accompanied by the appropriate documents, to the laboratory for processing.

Cytobrush Plus spatula.

In the laboratory, the preserved sample is vortexed and then transferred to a PrepStain® Density Reagent tube. The enrichment stage, consisting of sedimentation of the drug on a centrifuge through a dense reagent, partially removes from the drug impurities unnecessary for diagnosis and excess inflammatory cells.After centrifugation, the tube with the enriched cell component is reconstituted with deionized water, and the cell material is resuspended using a pipette dispenser by sequential collection and release of fluid. The sample material is then transferred to a PrepStain® Settling Chamber placed on a SurePath® PreCoat slide. The cells are precipitated by gravity during a short incubation period. The excess material is discarded. The SurePath® PreCoat Slide is stained, clarified and covered with a coverslip. The cells are arranged in a circle with a diameter of 13 mm. The microscope is studied under a microscope by a qualified cytotechnologist or pathologist, taking into account other information about the patient.

PreCoat Slides (SurePath® PreCoat Slides).

Limitations

• Gynecological specimens for the preparation of manual preparations must be collected using an approved whisk device in accordance with the manufacturer’s standard swabbing procedure.
• Preparation and Testing TriPath Imaging®, Inc. liquid-based training may only be performed by persons trained by TriPath or other organizations authorized by TriPath to provide such training.
• Use only materials supplied or recommended by TriPath Imaging®, Inc. to assure device performance. Used materials must be properly disposed of in accordance with the organization’s regulations and applicable laws.
• All materials are for single use only and cannot be reused.
• SurePath® liquid-based cytology tests require 8. 0 ± 0.5 ml of sample collected in the SurePath® Preservative Fluid Collection Vial.

Warnings

• SurePath® Preservative Fluid contains an aqueous solution of denatured ethyl alcohol and is not intended for oral consumption.The mixture contains small amounts of methyl and isopropyl alcohols, which, if swallowed, can be hazardous to health and cause blindness.
• PrepStain® Density Reagent contains sodium azide. Sodium azide can react with copper and lead pipes to form highly explosive metal azides. When disposing of, wash off with plenty of water to prevent azide build-up.

Precautions

• The guidelines for good laboratory practice and all procedures recommended for liquid cytology should be followed.
• All reagents are stable until the expiration date indicated when stored under recommended storage conditions.
• Bacterial contamination of reagents may cause incorrect results.
• Replacing SurePath® PreCoat specimen slides with other slides may result in suboptimal results.
• Avoid splashing or spraying liquids. Wear appropriate hand and eye protection and protective clothing.
• SurePath® Preservative Fluid is bactericidal and has been tested against the following microbes: Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, Candida albicans, Mycobacterium tuberculosis and Aspergillus .However, the universal precautions for the handling of body fluids should be followed at all times.

Extra aliquot collection

The liquid preservative swab is available in enough volume to collect up to 0.5 ml of a homogeneous mixture of cells and fluid for additional testing prior to performing the SurePath® Pap test. The volume remaining after sampling is sufficient for the Pap test.

Although there is no evidence of the effect of taking an aliquot from a liquid preservative swab on the quality of a sample for cytological examination, in rare cases, during this process, an uneven distribution of the corresponding diagnostic material is possible. If the test results do not match the patient’s medical history, healthcare providers may need to collect a new sample. Moreover, cytological examination solves clinical problems other than testing for sexually transmitted diseases (STDs), thus aliquot sampling may be inappropriate for some clinical situations. If necessary, a separate specimen may be collected for STD testing instead of taking an aliquot from a liquid preservative swab.

Aliquots of samples with low cell saturation in the SurePath® Preservative Fluid Collection Vial may contain insufficient material to perform the SurePath® Pap test.

An aliquot must be taken prior to performing the SurePath® Pap test. Only one aliquot may be taken from the liquid preservative swab vial prior to the Pap test, regardless of the volume of the aliquot.

Collection vial with a liquid preservative (SurePath® Preservative Fluid Collection Vial).

Smear for oncocytology of the cervix in St. Petersburg, Vyborgsky district

What is a smear for oncocytology?

Oncocytology smear is a microscopic analysis of cellular material taken from the cervix. In connection with the constant growth in the number of oncological diseases, the most important role is assigned to research, which makes it possible to detect the disease at the earliest stages.

Among oncological diseases in women, the most common diagnosis is cervical cancer.Analysis of a smear for cervical oncocytology answers many questions, but its main task is to identify possible cancer cells or to recognize precancerous processes , i.e. phenomena that can cause cervical cancer.

This study also helps to recognize many viral and inflammatory processes , such as human papillomavirus infection, dysplasia, etc., already at the initial stage. The overwhelming majority of these diseases are successfully treated if they are detected in a timely manner.

Who is the study shown to?

1. Conducting a smear for oncocytology of the cervix is ​​recommended for everyone who has: cervical erosion, menstrual irregularities, oncogenic papillomavirus. In these cases, the analysis should be carried out every six months.

2. Also, the analysis is obligatory should be passed when registering a pregnant woman. Due to the high hormone levels during pregnancy, which can accelerate the development of precancerous conditions, the doctor at our clinic will most likely recommend retesting in the second and third trimester.

3. Doctors recommend regular annual examinations for women:

• with multiple sexual partners
• after prolonged use of contraceptives
• with chronic infections (herpes, chlamydia)
• with chronic inflammation of the pelvic organs
• with early onset life
• in case of multiple births.

Our clinic recommends doing an analysis for oncocytology as part of the annual preventive examination by a gynecologist.

How is a smear taken for oncocytology?

Preparation

The study can be performed on any day, except for the period of menstruation.

If inflammatory processes are accompanied by bloody discharge, then the analysis should be postponed, as it may give unreliable results.

Colpitis and cervicitis are contraindications to analysis for oncocytology, because the changes in cells they cause can be recognized as a precancerous process.

Within two days before the examination, we recommend not to have sexual intercourse, do not use tampons, vaginal creams, douches, since all these factors can greatly affect the reliability of the results obtained.

Analysis

The analysis itself is carried out in the gynecological office and takes a few seconds. The sampling of the epithelium of the cervix and its canal is carried out using a soft special brush (spatula) with a light, slightly perceptible touch.The obtained epithelium samples are placed on a glass slide and sent to the laboratory of our clinic in St. Petersburg.

Oncocytology smear results

Final test results are usually ready in 10-12 days. The process evaluates the shape, size, structure and composition of the harvested epithelial tissue. There are two research methods: Leishman and Papanikolaou (Pap test).

As a result of oncocytological analysis, the result of the research is indicated: “positive” or “negative”.A negative result means the absence of any atypical cells in the collected biomaterial. This result indicates the health of the cervix. A positive finding indicates that unusual cells were found on the surface of the cervix or in its canal.

Let’s see what diseases the received test results can talk about:

• Inflammation . They are manifested by a large number of leukocytes and cells of infectious agents (fungi, Trichomonas, etc.)P.). Abnormal cells recover after anti-inflammatory therapy.
• Human papillomavirus infection . It is often found only in oncocytology. With this disease, the cells on the cervix become smaller and change their structure. By the presence of these cells, the doctor can diagnose HPV.
• Dysplasia of varying severity . The diagnosis is made if atypical cells are found in the selected biomaterial.
• Cancer.The diagnosis is made if atypical cancer cells are found. Requires colposcopy (examination of the walls of the vagina and cervix under a microscope) and other additional examinations.

Oncocytological study is an analysis that allows you to establish the final diagnosis with a high degree of confidence and, if necessary, start treatment on time.

See also: Diagnosis of infertility, Treatment of infertility, Reception of a gynecologist, Diagnosis and treatment of STIs, Gynecological smear.

Cytological examination of cervical biomaterial (Papanicolaou staining, Rar test)

Study material
See description

Papanicolaou staining method is a specially developed method that allows detecting early precancerous diseases of the cervix with the highest degree of reliability.

Cervical cancer takes the third place in the structure of malignant neoplasms of the reproductive system. Until 1992, the incidence of cervical cancer was decreasing, but now there is again a tendency towards an increase in this pathology. The development of the tumor occurs gradually, over several years, therefore, preventive examinations of women using the cytological method of research are very important.

At present, Papanicolaou staining of cellular material – the Pap test – is used in screening programs to detect cervical cancer, precancerous and background conditions.Papanicolaou staining method allows assessing the degree of cytoplasmic maturation, stains nuclei with atypia well. The term “atypia” has different interpretations in different countries: in central Europe it is defined as malignancy, in the WHO nomenclature – “less than dysplastic intraepithelial changes.”

The RAR test has a number of features. An important point is the correct taking of the material and its fixation. The cellular material is taken with brushes of a special configuration in the “mirrors” in order to avoid the ingress of foreign material.The transfer of material should be quick, without drying; quick fixation of a wet smear in 96% ethanol is required. Papanicolaou staining of smears goes through a number of stages, then the cell material enclosed in the balm is subjected to cytological analysis.

Test material: scrapings from the endocervix, exocervix, as well as mixed scrapings applied to a glass slide.

Literature

1. V.KulakovI. et al. “Modern approaches to the diagnosis of papillomavirus infection of the genitalia of women and their importance for screening for cervical cancer. Gynecology”.