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The Papanicolaou test (also called Pap smear, Pap test, cervical smear, or smear test) is a screening test used in to detect pre-cancerous and cancerous processes in the endocervical canal (transformation zone) of the female reproductive system.
In taking a Pap smear, a speculum is used to open the vaginal canal and allow the collection of cells from the outer opening of the cervix of the uterus and the endocervix. In general, in countries where Pap smear screening is routine, it is recommended that females who have had sex seek regular Pap smear testing. Women should wait a few years after they first have intercourse before they start screening. Most women who contract HPV do so soon after becoming sexually active.[2][citation needed] It takes an average of a year, but can take up to four years, for a woman's immune system to control the initial infection. Pap smear screening is still recommended for those who have been vaccinated against HPV,[9] since the vaccines do not cover all of the HPV types that can cause cervical cancer. More frequent Pap smears may be needed to follow-up after an abnormal Pap smear, or after treatment for abnormal Pap or biopsy results, or after treatment for cancer. Getting a pap smear should not cause pain,[12] but it can if the patient has certain untreated vaginal problems such as cervical stenosis or vaginismus, or if the person performing it is too harsh, or uses the wrong size speculum. Many health care providers are under the false impression that only sterile water, or no lubricant at all, should be used to lubricate the speculum. The health care worker begins by inserting a speculum into the woman's vagina, which spreads the vagina open and allows access to the cervix.
The sample is stained using the Papanicolaou technique, in which tinctorial dyes and acids are selectively retained by cells. In some cases, a computer system may prescreen the slides, indicating those that do not need examination by a person or highlighting areas for special attention. Micrograph of a Pap test showing a low-grade intraepithelial lesion (LSIL) and benign endocervical mucosa. As liquid based preparations (LBPs) become a common medium for testing, atypical result rates have increased. Endocervical and endometrial abnormalities can also be detected, as can a number of infectious processes, including yeast, herpes simplex virus and trichomoniasis. Estimates of the effectiveness of the United Kingdom's call and recall system vary widely, but it may prevent about 700 deaths per year in the UK. Since the population of the UK is about 61 million, the maximum number of women who could be receiving Pap smears in the UK is around 15 million to 20 million (eliminating the percentage of the population under 20 and over 65).
For information on other cervical screening tests and Human Papillomavirus testing, see cervical screening.
The endocervix may be partially sampled with the device used to obtain the ectocervical sample, but, due to the anatomy of this area, consistent and reliable sampling cannot be guaranteed. In the developed world result of cervical biopsy guided by colposcopy is the "gold standard" for diagnosing cervical abnormalities after an abnormal pap smear. International Agency for Research on Cancer - Resource about screening, including that of Cervical Cancer.
Pap test, and check out Pap test on Wikipedia, Youtube, Google News, Google Books, and Twitter on Digplanet. The Papanicolaou test (abbreviated as Pap test, known earlier as Pap smear, cervical smear, or smear test) is a method of cervical screening used to detect potentially pre-cancerous and cancerous processes in the cervix (opening of the uterus or womb). A Pap smear is performed by opening the vaginal canal with a speculum, then collecting cells at the outer opening of the cervix at the transformation zone (where the outer squamous cervical cells meet the inner glandular endocervical cells). Women should wait a few years after they first have intercourse before they start screening, and should not be screened before age 21.
Most people who contract HPV do so soon after becoming sexually active.[3][citation needed][dead link] It takes an average of a year, but can take up to four years, for a person's immune system to control the initial infection. Since the population of the UK is about 61 million, the maximum number of people who could be receiving Pap smears in the UK is around 15 million to 20 million (eliminating the percentage of the population under 20 and over 65). Pap tests can usually be performed during pregnancy up to at least 24 weeks of gestational age.[24] Pap tests during pregnancy have not been associated with increased risk of miscarriage.


Obtaining a pap smear should not cause much pain,[28] but it can if the person has certain untreated vaginal problems such as cervical stenosis or vaginismus, or if the person performing it is too harsh, or uses the wrong size speculum. Yet it's not comfortable, for two reasons which work together: the cervix is full of nociceptors,[29] and the brush used to collect cells has to be stiff enough to scrape them off of the surrounding tissue. People with underlying pain or tissue diseases that can react to nociceptors (pain nerves) being scraped or to excessive cold in the mucous membranes should take appropriate precautions and discuss the process ahead of time with their providers, in writing if necessary. For other cervical screening tests and Human Papillomavirus testing, see Cervical screening. Conventional Papa€”In a conventional Pap smear, samples are smeared directly onto a microscope slide after collection. Liquid based cytologya€”The sample of (epithelial) cells is taken from the Transitional Zone; the squamo-columnar junction of the cervix, between the ecto and endocervix. In addition, Human Papilloma Virus (HPV) test may be performed either as indicated for abnormal Pap results, or in some cases dual testing is done, where both a Pap smear and HPV test are done at the same time (also called Pap co-testing). The test was invented by and named after the prominent Greek doctor Georgios Papanikolaou who started his research in 1923.
Papanicolaou's name was repeatedly submitted to the Nobel Committee and rejected every time.
In the developed world, cervical biopsy guided by colposcopy is considered the "gold standard" for diagnosing cervical abnormalities after an abnormal pap smear.
In Taiwan most middle and upper-class people have access to the Pap test and can choose to have one done annually. The finding of coccoid bacteria on a pap test is of no consequence with otherwise normal test findings and no infectious symptoms. Boulware LE, Marinopoulos S, Phillips KA, Hwang CW, Maynor K, Merenstein D, Wilson RF, Barnes GJ, Bass EB, Powe NR, Daumit GL (2007). Saslow D, Solomon D, Lawson HW, Killackey M, Kulasingam SL, Cain J, Garcia FA, Moriarty AT, Waxman AG, Wilbur DC, Wentzensen N, Downs LS, Spitzer M, Moscicki AB, Franco EL, Stoler MH, Schiffman M, Castle PE, Myers ER (2012). Screening during this period may show this immune reaction and repair as mild abnormalities, which are usually not associated with cervical cancer, but could cause the woman stress and result in further tests and possible treatment.
However, Pap smears can be performed during a woman's menstrual period, especially if the physician is using a liquid-based test; if bleeding is extremely heavy, endometrial cells can obscure cervical cells, and it is therefore inadvisable to have a Pap smear if bleeding is excessive. The health care provider then collects a sample of cells from the outer opening or os of the cervix by scraping it with an Aylesbury spatula. The broom is not as good a collection device, since it is much less effective at collecting endocervical material than the spatula and brush.[13] The broom is used more frequently with the advent of liquid-based cytology, although either type of collection device may be used with either type of cytology.
The sample is then usually screened by a specially trained and qualified cytotechnologist using a light microscope. However it is not very sensitive at detecting these infections, so absence of detection on a Pap does not mean absence of the infection. About one-quarter of US cervical cancers were in women that had an abnormal Pap smear, but did not get appropriate follow-up (woman did not return for care, or clinician did not perform recommended tests or treatment). A medical practitioner performing 200 tests each year would prevent a death once in 38 years, while seeing 152 women with abnormal results, referring 79 for investigation, obtaining 53 abnormal biopsy results, and seeing 17 persisting abnormalities lasting longer than two years. This would indicate that the use of Pap smear screening in the UK saves the life of 1 person for every approximately 20,000 people tested (assuming 15,000,000 are being tested yearly).
As abnormal endocervical cells may be sampled, those examining them are taught to recognize them.
Cells may exfoliate onto the cervix and be collected from there, so as with endocervical cells, abnormal cells can be recognised if present but the Pap Test should not be used as a screening tool for endometrial malignancy. There are digital atlases of coloscopy, histology and cytology, the rationale of screening and setting up of a screening programme. Abnormal findings are often followed up by more sensitive diagnostic procedures, and, if warranted, interventions that aim to prevent progression to cervical cancer. The person may also be referred for HPV DNA testing, which can serve as an adjunct to Pap testing.


American Congress of Obstetricians and Gynecologists (ACOG) and others recommend starting screening at age 21 (since that is a few years after initial sex for most American women).[2][13] Many other countries wait until age 25 or later to start screening. Screening during this period may show this immune reaction and repair as mild abnormalities, which are usually not associated with cervical cancer, but could cause the person stress and result in further tests and possible treatment.
About one-quarter of US cervical cancers were in people that had an abnormal Pap smear, but did not get appropriate follow-up (person did not return for care, or clinician did not perform recommended tests or treatment).
A medical practitioner performing 200 tests each year would prevent a death once in 38 years, while seeing 152 people with abnormal results, referring 79 for investigation, obtaining 53 abnormal biopsy results, and seeing 17 persisting abnormalities lasting longer than two years. However, Pap smears can be performed during a person's menstrual period, especially if the physician is using a liquid-based test; if bleeding is extremely heavy, endometrial cells can obscure cervical cells, and it is therefore inadvisable to have a Pap smear if bleeding is excessive.
So it can be uncomfortable, but it's generally quick, and the information obtained may be critical. A smaller speculum, lidocaine gel, and warming the instruments and lubricant ahead of time, along with extra time in the exam room and gentle technique, can all contribute to reducing the risk to manageable levels.
The spotting is usually from the scrape on the cervix and the diarrhea may be due to indirect stimulation of the lower intestine during the exam. The broom is not as good a collection device, since it is much less effective at collecting endocervical material than the spatula and brush.[31] The broom is used more frequently with the advent of liquid-based cytology, although either type of collection device may be used with either type of cytology.
The Nobel Committee delegated the in-depth investigation of Papanicolaou's merits and demerits to the late Professor Santesson, who was at that time the head of pathology at the Stockholm Cancer Institute (the Radiumhemmet). However, if there is enough inflammation to obscure the detection of pre-cancerous and cancerous processes, it may indicate treatment with a broad-spectrum antibiotic for streptococci and anaerobic bacteria (such as metronidazole and amoxicillin) before repeating the smear.
The test aims to detect potentially pre-cancerous changes (called cervical intraepithelial neoplasia (CIN) or cervical dysplasia), which are usually caused by sexually transmitted human papillomaviruses.
The patient may also be referred for HPV DNA testing, which can serve as an adjunct to Pap testing. Cervical cancer usually takes time to develop, so delaying the start of screening a few years poses little risk of missing a potentially precancerous lesion. A number of studies have shown that using a small amount of water-based gel lubricant does not interfere with, obscure, or distort the PAP smear.
Papanicolaou chose stains that highlighted cytoplasmic keratinization, which actually has almost nothing to do with the nuclear features used to make diagnoses now. The terminology for who screens the sample varies according to the country; in the UK, the personnel are known as cytoscreeners, biomedical scientists (BMS), advanced practitioners and pathologists. If only 10,000,000 are actually tested each year, then it would save the life of 1 person for every approximately 15,000 people tested. The test aims to detect potentially pre-cancerous changes (called cervical intraepithelial neoplasia (CIN) or cervical dysplasia; the squamous intraepithelial lesion system (SIL) is also used to describe abnormalities), which are caused by human papillomavirus, a sexually transmitted DNA virus.
The cells taken are suspended in a bottle of preservative for transport to the laboratory, where using Pap stains it is analysed. The test remains an effective, widely used method for early detection of pre-cancer and cervical cancer. The cells are placed on a glass slide and taken to the laboratory to be checked for abnormalities.
The latter two take responsibility for reporting the abnormal sample which may require further investigation.
At this point, these techniques have not been validated by large-scale trials and are not in general use.
The nucleus in koilocytes is typically irregular, indicating possible cause for concern; requiring further confirmatory screens and tests.
While the test may also detect infections and abnormalities in the endocervix and endometrium, it is not designed to do so.



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