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According to the American Cancer Society (ACS), American Society for Colposcopy and Cervical Pathology (ASCCP), and American Society for Clinical Pathology, screening for cervical cancer by pap smear is recommended every 3 years among women age 21. The pre-cancerous changes (called dysplasias or cervical or endocervical intraepithelial neoplasia) are usually caused by sexually transmitted human papillomaviruses (HPVs). It is generally recommended that sexually active females seek pap smear testing annually, although guidelines may vary from country to country. About 5% to 7% of pap smears produce abnormal results, such as dysplasia, possibly indicating a pre-cancerous condition. Samples are collected from the outer opening or os of the cervix using an Aylesbury spatula or (more frequently with the advent of liquid-based cytology) a plastic-fronded broom. The sample is stained using the Papanicolaou technique, in which tinctorial dyes and acids are selectively retained by cells. The sample is then screened by a specially trained and qualified cytotechnologist using a light microscope. The techniques based around placing the sample into a vial containing a liquid medium which preserves the cells have been increasingly used. Once placed into the vial, the sample is processed at the laboratory into a cell thin-layer, stained, and examined by light microscopy. Some[2], but not all studies[1][3], report increased sensitivity from the liquid based smears.
Micrograph of a Pap test showing a low-grade intraepithelial lesion (LSIL) and benign endocervical mucosa. The Bethesda system (TBS) is a system for reporting cervical or vaginal cytologic diagnoses,[4] used for reporting Pap smear results.
The presence of HPV indicates that the person has been infected, the majority of women who get infected will successfully clear the infection within 18 months.
Based on solid evidence, screening with HPV DNA or HPV RNA detects high-grade cervical dysplasia, a precursor lesion for cervical cancer. Magnitude of Effect: In one prospective, clustered, randomized trial, HPV testing was superior to other strategies for preventing cervical cancer mortality. Regarding the role of HPV testing, randomized controlled trials have compared HPV to colposcopy.


Based on solid evidence, HPV testing identifies numerous infections that will not lead to cervical dysplasia or cervical cancer.
Based on solid evidence, screening every 5 years with the Pap test and the HPV DNA test (cotesting) in women 30 years and older is more sensitive in detecting cervical abnormalities, compared with the Pap test alone. Based on solid evidence, HPV and Pap cotesting is associated with more false-positives than the Pap test alone.
Based on solid evidence, screening is not helpful in women who do not have a cervix as a result of a hysterectomy for a benign condition. Individuals and clinicians can use the annual Pap test screening visit as an opportunity to discuss other health problems and preventive measures. The possibility that vaccination might reduce the need for screening with cytology alone or in combination with HPV testing is not established. The first complaint was filed in September to the Centers for Medicare and Medicaid Services by a former Theranos employee. If results are abnormal, and depending on the nature of the abnormality, the test may need to be repeated in three to twelve months. Although many low grade cervical dysplasias spontaneously regress without ever leading to cervical cancer, dysplasia can serve as an indication that increased vigilance is needed. The terminology for who screens the sample varies according the country; in the UK, the personnel are known as Cytoscreeners, Biomedical scientists (BMS), Advanced Practitioners and Pathologists. These harms are greatest for younger women, who have a higher prevalence of LSIL, lesions that often regress without treatment. Additional clinical trials show that HPV testing is superior to other cervical cancer screening strategies.
This is especially true in women younger than 30 years, in whom rates of HPV infection may be higher.
Individuals, clinicians, and health systems should seek effective ways to facilitate the receipt of recommended preventive services at intervals that are beneficial to the patient.
It accused the company of instructing employees to continue to test patients' blood using Theranos' devices even though there was evidence of "major stability, precision, and accuracy" issues. It said a study submitted by Theranos last year for a herpes test was extremely problematic because of improper research protocols.


The blood-testing company known for its finger-prick testing technology came under fire in October after The Wall Street Journal raised questions about the accuracy of the company's test results.
If the abnormality requires closer scrutiny, the patient may be referred for detailed inspection of the cervix by colposcopy. Endocervical and endometrial abnormalities can also be detected, as can a number of infectious processes, including yeast and trichomonas vaginalis. The stains chosen by Papanicolau were selected to highlight cytoplasmic keratinization, which actually has almost nothing to do with the nuclear features used to make diagnoses now. The latter two take responsibility for reporting the abnormal sample which may require further investigation. Harms are also increased in younger women because they have a higher rate of false-positive results.Additional diagnostic procedures were performed in 50% of women undergoing regular Pap testing. Aged ?21 years, no evidence supports or refutes the annual pelvic examination or speculum and bimanual examination.
While the tests were being run, parts of the devices used on the tests were modified, which can change the results to favor the company.
In October, the FDA also released a series of concerns about the company after visiting Theranos' labs. A worthwhile screening test requires a balance between the sensitivity and specificity to ensure that those having a disease are correctly identified as having it and equally importantly those not identifying those without the disease as having it. Food and Drug Administration approved an HPV DNA test that can be used alone for the primary screening of cervical cancer risk in women aged 25 years and older.
The decision whether or not to perform a complete pelvic examination should be a shared decision after a discussion between the patient and her health care provider.
Due to the liquid based pap smears having a false negative rate of 15-35%, the American College of Obstetricians and Gynecologists and American Society for Colposcopy and Cervical Pathology[12] have recommended the use of HPV testing in addition to the pap smear in all women over the age of 30.



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