The Pap test is used to detect abnormal growth of cervical cells at an early stage so that treatment can be started when the condition is easiest to treat. This microscopic analysis of cells can detect cervical cancer, "precancerous" changes, inflammation (vaginitis), infections, and some sexually transmitted diseases (STDs). The Pap test can occasionally detect endometrial (uterine) cancer or ovarian cancer, although it was not designed for this purpose.
Women should begin to have Pap tests at the age of 18 or whenever they start having sex. Young people are more likely to have multiple sex partners, which increases their risk of certain diseases that can cause cancer, such as human papillomavirus (HPV), but the American Cancer Society suggests the test benefits women of every age. Doctors have varying opinions about how often a woman should have a Pap test. The American Cancer Society states that after three consecutive negative examinations, a doctor may decide that a woman without symptoms of gynecologic problems may be examined less frequently, usually every three years. Many other doctors, however, recommend annual Pap tests for all their patients.
Women with certain risk factors should always have yearly tests. Those at highest risk for cervical cancer are women who started having sex before age 18, those with many sex partners (especially if they did not use condoms, which protect against STDs), those who have had STDs such as genital herpes or genital warts, and those who smoke. Women older than 40 also should have the test yearly, especially in the event of bleeding after menopause. Women who have had a positive test result in the past may need screening every six months. Women who have had cervical cancer or precancer should have regular Pap smears.
Other women also benefit from the Pap test. Women over age 65 account for 25% of all cases of cervical cancer and 41% of deaths from this disease. Women over age 65 who have never had a Pap smear benefit the most from a Pap smear. Even a woman who has had a hysterectomy (removal of the uterus) should continue to have regular Pap tests at the discretion of the woman and the provider. If the surgery was for cancer, she may need to be examined more often than once a year. (Some
women have the cervix left in place after hysterectomy.) Finally, a pregnant woman should have a Pap test as part of her first prenatal examination.
The Pap test is a screening test. It identifies women who are at increased risk of cervical dysplasia (abnormal cells) or cervical cancer. Only an examination of the cervix with a special lighted instrument (colposcopy) and samples of cervical tissue (biopsies) can actually diagnose these problems.
Laura J. Ninger, The Gale Group Inc., Gale, Detroit,