Abnormal Pap Test: Exams And Tests

Content provided by Healthwise

Exams and Tests

You will have a Pap test as part of your routine gynecologic exam. A Pap test is used to identify abnormal cell changes on your cervix and to screen for cervical cancer. Pap test screening is the most effective way to detect early abnormal cervical cell changes.

Women over 30 years old may have a screening test for HPV infection at the same time they have their Pap test.³

Pap test screening schedule

The recommended Pap test screening schedule is based on your age and risk factors.^{1 4} Testing should start 3 years from the time you begin to have sexual intercourse, but no later than age 21. Women should have Pap tests every 1 to 3 years. Studies show that healthy women who have normal Pap tests for 3 years in a row are unlikely to develop moderate to severe cervical cell changes within 3 years. Discuss this with your doctor to determine whether you can safely extend your Pap test screening to every 2 to 3 years.⁵

Women who have gone through menopause have an increased risk of false-positive Pap test results. For this reason, postmenopausal women with previous normal Pap tests may be advised to have Pap tests less frequently than every year.⁶

Women who have had a hysterectomy that included removal of the cervix do not need any more Pap tests if both of the following are true:

• The hysterectomy was done for a problem other than cancer.
• Regularly scheduled Pap tests have shown that the woman has not had precancerous cell changes in the cervix or vagina in at least 10 years.

Abnormal Pap test result

An abnormal Pap test classifies cells according to their degree of abnormality using the Bethesda system (TBS). Further evaluation decisions are guided by the kinds of changes seen in the cells.

Following an abnormal Pap test result, additional tests may be needed to determine whether an infection is present or to determine the severity of cervical cell changes. These additional tests include:

• Colposcopy. A colposcopy uses a magnifying instrument called a colposcope to look at the vagina and the cervix . Cell abnormalities (dysplasia) that might be missed by the naked eye can be seen with the colposcope.
• Cervical biopsy. A cervical biopsy removes a small piece of the cervix so the tissue can be examined under a microscope.
• Cone biopsy. This is an extensive form of a cervical biopsy. It is called a cone biopsy because a cone-shaped wedge of tissue is removed from the cervix and examined under a microscope. A cone biopsy may also serve as treatment by removing the abnormal cervical cells.
• Human papillomavirus (HPV) DNA test. HPV testing is done to identify high-risk types of HPV infection. If your abnormal Pap test is caused by HPV, knowing whether you have a high-risk type of HPV can help guide your evaluation and treatment decisions.

For more information, see:

What follow-up will I need if my Pap test shows minor cell changes?

For information on tests to diagnose a specific infection, see the specific topic:

• Genital Warts (Human Papillomavirus)
• Chlamydia
• Gonorrhea
• Syphilis
• Genital Herpes
• Trichomoniasis
• Bacterial Vaginosis
• Vaginal Yeast Infections

What to think about

Some new testing methods, such as computer-automated review of Pap tests and liquid-based collection, are being used in many areas of the United States. Liquid-based collection methods allow testing for HPV at the same time as a Pap test, but these methods are not available everywhere and may be more costly.

Studies have shown that women who are overweight or obese are less likely to have regular Pap test screening and therefore may be at higher risk for undetected cervical cell changes. It is important for every woman to have regular gynecologic examinations.

The terms used to report Pap test results vary depending on which classification system is used. The Bethesda system (TBS) is used by most labs in North America. Other classification systems are used around the world.

• The Bethesda system (TBS) classifies cervical cell changes by type of abnormality, such as atypical squamous cells (ASC).
• Older classification systems use the term dysplasia to describe cervical cell changes or describe the changes as mild, moderate, or severe.
• Comparing classification systems allows you and your doctor to understand the severity of your cervical cell changes.

Last updated:	January 12, 2007
Author:	Shannon Erstad, MBA/MPH
Reviewed By:	Joy Melnikow, MD, MPH - Family Medicine, Ross Berkowitz, MD - Obstetrics and Gynecology
Editors:	Kathleen M. Ariss, MS, Pat Truman, MATC