Pap Smear

This handout details the Pap smear test. It is a test of the cells that cover the cervix. It helps detect abnormal conditions of the cervix in their early states, thus reducing the risk of progression to cancer. This test can also detect other conditions that are not related to cancer.

What is the cervix?

The cervix is the lower portion of the uterus (womb) that opens into the vagina. It is the part of the womb that dilates or opens during labor to allow the baby to pass through the birth canal.

Why do you need to be concerned with the cervix?

The cervix is an area of a woman's body that can develop abnormal cells and can, in some women, develop cancer. Abnormal cells are called dysplasia or "precancer." Cancer of the cervix occurs when abnormal cervical cells are taken over by the malignant cells. Cervical cancer can spread to other female organs, such as the uterus, vagina, and ovaries. It can then spread to nearby organs such as the bladder, colon, and lymph nodes. If found early, cervical abnormalities can be treated to prevent cancer from developing.

Why do women get cervical dysplasia and cancer?

The exact cause of cervical abnormalities and cancer is unknown. There are several risk factors that can increase a woman's chance of having an abnormal cervix:

  • You and/or your partner have a genital wart virus infection. The virus is call Human Papilloma Virus.
  • You have or have had many sexual partners.
  • You had your first intercourse before the age of 18.
  • You do not use condoms with new partners.
  • You smoke cigarettes.
  • YOu have had a previous abnormal pap smear.
  • Your immune system is weak. For example, if you have AIDS or had an organ transplant and are on medications.
  • Your mother took the medication DES(diethylstilbestrol) during her pregnancy with you. This medication was believe to prevent miscarriage.

How many women have cervical cancer?

In the United States, 13,700 women develop cervical cancer and 4,900 will die from the disease (1998 data).

  • The overall rate of cancer is 8.3/100,000 women per year.
  • Cervical cancer is the second most common cancer worldwide.
  • In the United States it is the third most common gynecological cancer, after cancer of the uterus and ovaries.

What is the incidence of cervical cancer for me?

Your cervical cancer incidence depends on your ethnicity and your age. It also depends on any risk factors that you have.

Ethnic Group 
or Age
Incidence/100,000 Death/100,000
Vietnamese 43.0 Not available
Latina 16.2 3.4
Alaskan Native 15.8 Not Available
Korean 15.2 Not Available
African American 13.2 6.7
Caucasian 8.7 2.5
Japanese 5.8 1.5
Women < 65 years old 7.4 2.2
Women > 65 years old 16.8 9.3
Overall 8.3 2.9

Adapted from the National Cancer Institute

Are there any symptoms of abnormal cervical cells or cancer?

  • Most commonly, there are no symptoms.
  • Bleeding after intercourse or between periods.
  • Abnormal vaginal discharge or pain.

How are cervical abnormalities diagnosed?

A Pap smear is a test that screens for cervical cancer. During this test, a sample of the cervical cells is gently collected by using a spatula and a small brush. These cells are checked under a microscope for any abnormalities. The Pap smear only takes a few seconds. Most women tolerate it without any trouble.

How often should I have a Pap smear?

Health organizations, such as the American Cancer Society and the National Cancer Institute, recommend a Pap smear for women who are sexually active, have been sexually active, or have reached age 18. If three or more Pap smears have been normal, the test may be performed less often. Your doctor will evaluate your risk factors and then be able to make recommendations for you. Be sure to ask your doctor at your next visit!

What if my Pap smear is abnormal?

Your doctor will tell you what the results are and may suggest that the test be repeated. Your doctor may also suggest having a colposcopy. Colposcopy is an in-depth evaluation of the cervix using a special magnifying device, called a colposcope. Different solutions are applied to the cervix to highlight abnormal cells. A small sample of cells can then be removed for further analysis. This is called a biopsy.

How are abnormal cervical cells and cervical cancer treated?

These are treatment options if you have a pre-cancerous change of the cervix:

  • Repeating the Pap and/or colposcopy to follow the abnormality. this is acceptable for mild abnormalities.
  • Freezing the abnormal cells. This is called cryotherapy.
  • Laser treatment to destroy the abnormal cells.
  • Surgical removal of the abnormal cells. This is called Loop Electrosurgical Excision Procedure, also known as conization.
  • Surgical removal of the uterus and cervix. This is call a hysterectomy.

If you have cervical cancer, you will be referred to a medical specialist called a Gynecologic Oncologist. Options for treatment include surgery, radiation, and chemotherapy.


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