Pap tests, sometimes referred to as pap smears, are a method used to sample cells found in the cervix for growth irregularities and presence of disease. Medical authorities, including the Centers for Disease Control and the Mayo Clinic, recommend a pap test be done every two to three years after the first sexual encounter, or after the 21st birthday for females who have never experienced sexual intercourse. Sexually active females should be tested every year, according to the Mayo Clinic.
The Test
The pap test indicates the presence of normal and abnormal cells. The test is done by a doctor, nurse or medical technician by scraping cells from the cervix that is located at the lower tip of the uterus. Proper collection of cells is critical to an accurate test reading. The cells are then placed, or smeared, on a glass laboratory slide and put into a plastic sleeve or case to prevent contamination. The cells are examined under a microscope for atypical squamous cell abnormalities by trained technicians who look for disease characteristics.
Partner Tests
If abnormal cells are present, additional tests are done to determine the cause. Doctors use the terms "dysplasia," "squamous intraepithelial lesions," "atypical squamous" cells, or "cervical intraepithelial neoplasia" to describe abnormalities. Additional testing may be done on the slide, or the patient may need to return for another office visit to collect additional cell samples. The most frequently found abnormal conditions are presence of the human papillomavirus (HPV), a collection of over 30 sexually transmitted viruses, according to the National Cancer Institute.
Pap Test Reporting
Pap tests are reported using the Bethesda System of standardized terms to indicate results. "Negative for intraepithelial lesion or malignancy" means that the test found no abnormal results. "Lesion" means the presence of abnormal cells. "Intraepithelial" is the cell layer of the cervix surface. Testing resulting in abnormal squamous cells is labeled to indicate the degree of abnormal cell invasion. The categories range from simple cell abnormalities to high-grade lesions that require immediate medical attention.
Bethesda System Categories
The first Bethesda category identifies cells of undetermined significance (ASC-US). This group is generally not of great concern. The second category is a high-grade squamous intraepithelial lesion (ASC-H), which shows a high percentage of precancer risk. Atypical glandular cells (AGC) are sometimes found at the opening of the cervix but do not usually indicate cancer is evident at the time of the test. Endocervical adenocarcinoma in situ (AIS) category establishes that precancer is evident in the glandular cells. Low-grade squamous intraepithelial lesion (LSIL) indicates that something (usually HPV) has caused abnormal cell growth on the cervix. High-grade squamous intraepithelial lesion (HSIL) is interpreted as major abnormal precancerous cell growth that is likely to lead to invasive cancer.
Pelvic Examination
Most pap tests are taken as a regular part of a pelvic exam. This general examination looks at the bladder, fallopian tubes, rectum, vagina, uterus and ovaries to detect any growth, hardness, enlargement, or shrinkage. A visual exam of the organs is done and then the medical practitioner will manually examine the organs that are not visible.
