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What does a routine Pap test show?

Asked by A. Williams, Michigan

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What exactly does a routine Pap smear screen do? Does it screen for human papillomavirus, cancers or both? Since I have no risk of sexually transmitted diseases because my spouse and I have had sexual contact only with one another, is a Pap smear a pointless procedure, for me in particular? Can a Pap smear detect cancers other than those caused by HPV or other STDs? What other reasons, if any, are there for me to get a Pap smear, and what other tests or procedures should a healthy, monogamous 27-year-old have at the OB/GYN? And how often should she have them?

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Conditions Expert Dr. Otis Brawley Chief Medical Officer,
American Cancer Society

Expert answer

Dear Mrs. Williams,

The Pap smear looks for cervical dysplasia, or abnormal cell growth, which can progress to cervical cancer. The smear can also diagnose cervical cancer.

A device is used to lightly scrape the cervix; the scrapings are then rubbed across a glass slide. The slide is treated with preservatives and stains and examined under a microscope for evidence of precancerous or cancerous cells. A suspicious Pap test leads to a colposcopy, in which the doctor examines the cervix under a microscope.

Most women age 21 and above, and all women within three years of starting sexual activity, should get a Pap test annually for a few years and every three years after three normal Pap tests.

The age a woman can stop getting Pap tests is up for debate. Most agree that after a string of consistently normal exams, a woman should stop between 65 and 70. A woman who has had a hysterectomy and her cervix removed for noncancerous reasons does not need a Pap test.

A newer, liquid-based cytology is offered by some physicians, usually at a higher cost, and an even more expensive test for HPV of the cervix is also offered.

All of these tests are useful, but I believe a well-done traditional Pap smear is sufficient for most women. The liquid-based cytology may have advantages in the future as the number of medical technologists who can read glass-slide cytology, which looks at single cells and small clusters of cells within stained tissue slices, declines.

Most, but not all, cervical cancers are caused by human papilloma viruses, which are usually sexually transmitted. I say usually because finger to genital and oral to genital contact can transmit HPV to the genitals. HPV has been spread through multiple users of vaginal devices such as sex toys.

There is other value to the pelvic examination. The Pap test comes with a visual inspection of the pelvis, cervix and vagina, which sometimes diagnoses other problems, and the bimanual examination allows for an assessment of the ovaries and uterus.

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