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Pap SmearsA Pap smear is a screening test that collects cells from the cervix of the uterus for examination by a cell expert. ‘Pap’ is short for Papanicolaou, the physician who identified and proved the value of this test. The test is completed by placing an instrument in the vagina (a speculum) which allows the health care provider to view the cervix. A spatula and small brush are used to sample the cells on the surface and in the canal of the cervix, and these cells are transferred to a fluid medium for transport to a Cytology laboratory where the cells are scrutinized by an expert. Most Pap smears are reported as normal but the value of the test is to identify cell changes that could be pre-cancerous. If the presence of abnormal cells is confirmed, there is an opportunity to eliminate these cells before they become cancer. The Pap smear is not a perfect test. It is possible that abnormal cells are present and are not picked up by the spatula or brush, or that the cells are not transferred to the fluid or seen in the laboratory. However, the cell changes that ultimately lead to cancer usually take many years to become cancer so repeated tests (yearly) are recommended. When abnormal cells are identified on Pap smear, it is not assumed that the full extent of the abnormality is known. The usual next step after an abnormal Pap smear is Colposcopy, which is a more in depth examination of the cervix accomplished in the office. (See the section on Abnormal Pap Smears for more information.) It is recommended by the American College of Obstetricians and Gynecologists that women start having regular Pap smears 3 years after first intercourse or at 21 years of age, whichever comes first, and continue annually. Abnormal Pap Smears(See above for general information about Pap Smears) The Pap smear is not a perfect test. It is possible that abnormal cells are present and are not picked up by the spatula or brush, or that the cells are not transferred to the fluid or seen in the laboratory. However, the cell changes that ultimately lead to cancer usually take many years to become cancer so repeated tests (yearly) are recommended. When abnormal cells are identified on a Pap smear, the recommended next course of action depends on the specific result. There are degrees of abnormality that may be reported, including: The next step in care varies (depending on the result as above) from a more thorough sampling of the cells in the canal of the cervix, to HPV testing, to an examination called Colposcopy. Colposcopy is scheduled in the office and involves an in-depth examination of the cervix; sometimes including a biopsy to confirm the Pap and visual findings. Further management will then depend on these results. The initial report of an abnormal Pap smear is not cause for panic. It by no means indicates that you have cervical cancer but it does require vigilant follow up so that if you are at risk for cancer, we can have the opportunity to minimize that risk.
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