Pap Test FAQ


What is a Pap test?

The Pap test is the most successful laboratory screening method used to identify women who may have a premalignant disease and are at high risk of developing cervical cancer. This is done by collecting cells from the cervix and examining them under a microscope, looking for specific morphologic clues as to the health of the cells present.

Who should have a Pap test and how often?

Recent (2012) guidelines set forth by the American Society for Colposcopy and Cervical Pathology, a consensus document agreed upon by professional and government agencies, recommend the following intervals for screening Pap tests:

  • No Pap test screening for women aged 20 and younger
  • Start Pap test screening at age 21
  • Screen every 2-3 years for women aged 21-29
  • Co-test with high-risk HPV and Pap test at age 30
    • If both are negative and patient has not had abnormal Paps or HPV test in last 10 years, extend co-test screening to every 5 years
  • Can stop routine Pap and HPV co-testing at age 65 if no abnormal history is present
What is the difference between screening and diagnostic Pap tests?

Screening Pap tests are routine tests collected and evaluated for preventive health visits. Diagnostic Pap tests are performed after a patient has been diagnosed with a cervical abnormality and is being actively followed and treated. Diagnostic Pap tests may also be ordered when the patient’s visit is due to abnormal signs or symptoms, such as abnormal bleeding.

How is a Pap test done?

The Pap test is a quick and generally painless procedure. A clinician, usually a doctor or a nurse practitioner, performs this test in the clinic. The clinician inserts a speculum into the vaginal canal. The excess mucus on the cervical opening is removed with a cotton swab, and the clinician gently scrapes a sample of cells from the cervix. The cellular material is either spread (smeared) on a glass slide and fixed, or washed in a liquid-based preparation. The sample of cells is then looked at under the microscope by a board certified cytotechnologist.

Is there anything I should or should not do before my Pap test?

There are a few general recommendations for obtaining optimum results. The test should not be done during menses as menstrual bleeding interferes with the appearance of cells and makes interpretation more difficult. The test should be delayed for 48 hours after the following circumstances:

  • Sexual intercourse
  • Use of a douche
  • Use of a tampon
  • Use of medicine or spermicidal foams
  • Use of jellies or vaginal cream

All of these may wash away or hide any abnormal cells that would show up on the Pap test.

How is a Pap test evaluated?

The Pap test is received in a laboratory from your clinic or doctor. A cytotechnologist then examines the cells using a microscope. If abnormal cells are seen, a cytopathologist (MD) re-examines the abnormal cells and renders an interpretation.

How is a Pap test reported?

The results of the Pap test are reported to the clinician within a week. The clinician would then contact the patient. The Pap test reports follow the standard guidelines outlined by The Bethesda System.

If a Pap test is considered abnormal, does this mean I have cancer?

An abnormal test result does not mean you have cervical cancer, unless it specifically states “Positive for Malignancy.” An abnormal Pap result indicates that there is some degree of cellular change in the cervix’s squamous or glandular cells.

What does this Pap test diagnosis mean?

Negative for Intraepithelial Lesion or Malignancy (NILM): The Pap test revealed no abnormal cell changes. All squamous and glandular cells seen have normal-appearing cellular material. Recommendations will vary depending on your individual risk factors.

Atypical Squamous Cells of Undetermined Significance (ASC-US): Squamous cells do not appear completely normal, but it is uncertain what the cellular changes mean. This diagnosis is suggestive of a squamous intraepithelial lesion but quantitatively and/or qualitatively insufficient for a definitive diagnosis. Sometimes the changes are related to bacterial action, drying artifact or HPV. The recommendation for this diagnosis depends on the patient’s age and clinical history. It will range among repeating in 12 months, reflex HPV testing, or colposcopy.

Atypical Squamous Cells, which cannot exclude a High-grade lesion (ASC-H): Cellular changes of ASC-H do not appear normal, but it is uncertain what the cellular changes mean. Cells categorized as ASC-H have abnormality changes that cannot be definitively diagnosed as high-grade SIL. This diagnosis carries an increased risk of being precancerous. The recommendation for this diagnosis is to perform colposcopy and any other procedures deemed necessary to make a definitive diagnosis.

Low-grade Squamous Intraepithelial Lesion (LSIL): This refers to changes in the size, shape and number of cells on the surface of the cervix. Some of these lesions return to normal on their own without treatment. LSIL is commonly referred to as mild dysplasia or cervical intraepithelial neoplasia 1 (CIN 1). The recommendation varies depending on age, and ranges between repeating the Pap in 12 months or referral to colposcopy and biopsy.

High-grade Squamous Intraepithelial Lesion (HSIL): Cells in this category look very different from normal cells, and they are less likely to return to normal without treatment. They are more likely to develop into cancer if left untreated. HSIL encompasses moderate dysplasia (cervical intraepithelial neoplasia 2– CIN2) and severe dysplasia or carcinoma-in-situ (CIN3). The recommendation for this diagnosis is colposcopy, biopsy, and any other additional procedures to aid in determining the degree of abnormality present.