PAP Tests
Pap Testing
What is the Pap test?
Since its introduction over 50 years ago, the Pap test has been the single, greatest contributor to the decline in cervical cancer. In fact, from the mid-1950’s, until the early 1990’s, cervical cancer deaths were reduced by more than 70%. And that rate continues to decline today.
For illustrative purposes only. Will provide with other images.
Types of Pap Testing
Conventional Pap Smear
George Papanicolaou, for whom the Pap Test is named, developed the procedure in the 1930’s. Originally known as the Pap smear, the procedure involves collecting cells from the cervix (the lower, narrow part of the uterus which leads to the vagina) and smearing the cells onto a glass slide. Once the Pap smear slide is prepared, a cytotechnologist reviews the slide under a microscope to determine if cells are normal or abnormal.
Liquid Based Pap Testing
In the United States today approximately 90% of Pap tests are done using “Liquid based technology” in place of the traditional “Pap smear”. Liquid-based Pap tests have been shown to improve the detection of cervical cell abnormalities. Instead of “smearing” the cells onto a slide, the collected cells are placed in a vial of preservative solution and the vial is sent to the laboratory. The collected cells are placed onto a slide in the laboratory using technology that clears obscuring debris and prepares a thin layer of cells for the cytotechnologist to review under a microscope.
In 1996, the FDA approved the first liquid-based Pap test known as the ThinPrep® Pap test. Surepath®, a second liquid-based Pap test, was FDA approved in 1999.
With the conventional Pap smear method, cells can be obscured by blood, mucus, and inflammation.
Vs.
The ThinPrep Pap Test method preserves the cells and minimizes cell overlap, blood, mucus, and inflammation.
In addition to improved detection of abnormalities, a benefit of Liquid-based Pap tests is the ability to do additional testing on the cells collected in the vial. The ThinPrep® Pap test is the only Liquid-based Pap test that has FDA approval to do testing for HPV, Chlamydia and Gonorrhea on the cells collected in the vial. The presence or absence of an infection is important information that will assist your Healthcare provider to make appropriate decisions regarding your follow-up care after your Pap test.
Imaged Directed Pap Testing
A significant advancement in cervical cancer detection in recent years is the introduction of “Imaged Directed Pap Testing”. Until it’s introduction, all Pap tests were “manually” screened by a cytotechnologist or pathologist using a traditional microscope. With Imaged Directed Pap Testing, all cells on the slide are first scanned by a computer that will then “direct” the Cytotechnologist to areas on the slide with potentially abnormal cells. Currently, the ThinPrep® Pap test and Imaging System is the only FDA approved system allowing for individual slide analysis of this type. (For more information, see Imaged Directed Pap Testing).
How is a Pap Test Performed?
The Pap test is performed to collect cervical cells for evaluation and is an essential part of a regular gynecologic exam. When you have your Pap test, you will be positioned on an exam table and a “speculum” will be gently inserted to open the vagina. The speculum allows the physician or nurse to view the cervix and upper vagina. Once the physician can see the cervix, a “broom” device or a brush/spatula combination will be used to collect the cells. While the technique is a little different depending on the device chosen, in general, the physician will gently rotate the device in the endocervix (the cervical canal) and the ectocervix (the portion of the cervix extending into the vagina) to collect squamous and glandular cells. (See Cervical Cancer, for more information).
How often should I have a Pap?
Cervical cancer is preventable if abnormal cell changes are detected through regular pap tests. Guidelines regarding the frequency of Pap testing have recently been updated and include the following recommendations:
A woman should have her first Pap test within three years after first sexual intercourse or at age 21, whichever comes first. For women ages 21 to 30, Pap tests are recommended annually. After age 30, women who test negative three years in a row on their Pap test can begin being tested every two to three years. If a woman over age 30 tests negative on both the Pap test and the HPV test (“HPV DNA with Pap test”), she may be screened using the combined test every three years. Women ages 21 to 30 who are HIV-positive or otherwise immunosuppressed, who were exposed to the synthetic hormone diethylstilbestrol (DES) in utero, or who have previously been diagnosed with cervical cancer may be required to have Pap tests more frequently. In addition, women who have undergone hysterectomy with removal of the cervix who have no history of cancerous cell growth may discontinue routine Pap screening.
What Can I Do to Prepare for My Pap test?
There are several steps you can take to ensure you get the best possible results from your Pap test. Schedule your appointment for a time when you are NOT menstruating. The best time to schedule your exam is 10 to 14 days following the first day of your last period. Avoid vaginal medication, lubricants, vaginal contraceptives, or douches for 48 hours before your exam. Do not have sexual intercourse for 24 to 48 hours before the exam
What Do My Results Mean?
Over 50 million Pap tests are performed every year in the United States and most are found to be normal. However, about 3.5 million (6 percent) are abnormal and require medical follow-up by your Healthcare provider.
Pap test results are classified and reported according to the “Bethesda 2001 Guidelines”:
http://bethesda2001.cancer.gov/terminology.html.
Pap test samples that have no cell abnormalities are reported as:
“Negative for intraepithelial lesion or malignancy.”
Samples with cell abnormalities are divided into the following categories:
Atypical squamous cells are findings that are unclear, and not a definite abnormality:
1. ASC–US—atypical squamous cells of undetermined significance. The cell changes are often related to an HPV infection and may return to normal once the HPV infection resolves.
2. ASC–H—atypical squamous cells cannot exclude a high-grade squamous intraepithelial lesion. ASC–H may be at higher risk of being “precancerous” as compared to ASC-US.
Atypical glandular cells:
1. AGC—atypical glandular cells. Glandular cells are mucus-producing cells found in the endocervical canal (opening in the center of the cervix) or in the lining of the uterus.
2. AIS—endocervical adenocarcinoma in situ. Precancerous cells are found in the glandular tissue.
Squamous intraepithelial lesion (SIL) is another term that is used to describe abnormal changes in the cells on the surface of the cervix. The word squamous describes thin, flat cells that form the outer surface of the cervix. The word lesion refers to abnormal tissue. An intraepithelial lesion means that the abnormal cells are present only in the layer of cells on the surface of the cervix.
SIL is classified as “Low Grade” or “High Grade”
1. LSIL—low-grade squamous intraepithelial lesion. Low-grade means there are early changes in the size and shape of cells. The word lesion refers to an area of abnormal tissue. Intraepithelial refers to the layer of cells that forms the surface of the cervix. LSILs are considered mild abnormalities usually caused by an HPV infection.
2. HSIL—high-grade squamous intraepithelial lesion. High-grade means that there are more marked changes in the size and shape of the abnormal cells and look very different from normal cells. HSILs are considered more severe abnormalities and have a greater chance of progressing to invasive cancer.
An abnormal Pap result does not necessarily mean that you have cancer. Your physician can discuss your specific results with you and recommend appropriate follow up or treatment. For more information about Pap results, go to www.nccc-online.org/resources/links.html.
