Pap smear test
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Jun 21, 2011
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About This Presentation
The Papanicolaou test (also called Pap smear, Pap test, cervical smear, or smear test) is a screening test used in gynecology to detect premalignant and malignant (cancerous) processes in the ectocervix. http://docturs.com/dd/pg/groups/2392/cervical-smear-test-pap-test/
Slide Content
Pap smear testPap smear test
Given by: Given by: docturs.com
Given by: Given by: docturs.com
IntroductionIntroduction
The Papanicolaou test (also called Pap smear, Pap test, cervical The Papanicolaou test (also called Pap smear, Pap test, cervical
smear, or smear test) is a screening test used in gynecology to smear, or smear test) is a screening test used in gynecology to
detect premalignant and malignant (cancerous) processes in the detect premalignant and malignant (cancerous) processes in the
ectocervix. Significant changes can be treated, thus preventing ectocervix. Significant changes can be treated, thus preventing
cervical cancer. The test was invented by and named after the cervical cancer. The test was invented by and named after the
prominent Greek doctor Georgios Papanikolaou. An anal Pap smear prominent Greek doctor Georgios Papanikolaou. An anal Pap smear
is an adaptation of the procedure to screen and detect anal cancers.is an adaptation of the procedure to screen and detect anal cancers.
In taking a Pap smear, a speculum is used to gather cells from the In taking a Pap smear, a speculum is used to gather cells from the
outer opening of the cervix of the uterus and the endocervix. The outer opening of the cervix of the uterus and the endocervix. The
cells are examined under a microscope to look for abnormalities. cells are examined under a microscope to look for abnormalities.
The test aims to detect potentially pre-cancerous changes (called The test aims to detect potentially pre-cancerous changes (called
cervical intraepithelial neoplasia (CIN) or cervical dysplasia), which cervical intraepithelial neoplasia (CIN) or cervical dysplasia), which
are usually caused by sexually transmitted human papillomaviruses are usually caused by sexually transmitted human papillomaviruses
(HPVs). (HPVs).
Continue…Continue…
The Papanicolaou test (also called Pap smear, Pap test, cervical The Papanicolaou test (also called Pap smear, Pap test, cervical
smear, or smear test) is a screening test used in gynecology to smear, or smear test) is a screening test used in gynecology to
detect premalignant and malignant (cancerous) processes in the detect premalignant and malignant (cancerous) processes in the
ectocervix. Significant changes can be treated, thus preventing ectocervix. Significant changes can be treated, thus preventing
cervical cancer. The test was invented by and named after the cervical cancer. The test was invented by and named after the
prominent Greek doctor Georgios Papanikolaou. An anal Pap smear prominent Greek doctor Georgios Papanikolaou. An anal Pap smear
is an adaptation of the procedure to screen and detect anal cancers.is an adaptation of the procedure to screen and detect anal cancers.
In taking a Pap smear, a speculum is used to gather cells from the In taking a Pap smear, a speculum is used to gather cells from the
outer opening of the cervix of the uterus and the endocervix. The outer opening of the cervix of the uterus and the endocervix. The
cells are examined under a microscope to look for abnormalities. cells are examined under a microscope to look for abnormalities.
The test aims to detect potentially pre-cancerous changes (called The test aims to detect potentially pre-cancerous changes (called
cervical intraepithelial neoplasia (CIN) or cervical dysplasia), which cervical intraepithelial neoplasia (CIN) or cervical dysplasia), which
are usually caused by sexually transmitted human papillomaviruses are usually caused by sexually transmitted human papillomaviruses
(HPVs). (HPVs).
Continue…Continue…
Continue…Continue…
The test remains an effective, widely used method for early The test remains an effective, widely used method for early
detection of pre-cancer and cervical cancer. The test may also detection of pre-cancer and cervical cancer. The test may also
detect infections and abnormalities in the endocervix and detect infections and abnormalities in the endocervix and
endometrium.endometrium.
In general, in countries where Pap smear screening is routine, it is In general, in countries where Pap smear screening is routine, it is
recommended that females, aged 18 to 65, who have had sex, seek recommended that females, aged 18 to 65, who have had sex, seek
regular Pap smear testing. Guidelines on frequency vary from regular Pap smear testing. Guidelines on frequency vary from
annually to every five years. If results are abnormal, and depending annually to every five years. If results are abnormal, and depending
on the nature of the abnormality, the test may need to be repeated on the nature of the abnormality, the test may need to be repeated
in six to twelve months. If the abnormality requires closer scrutiny, in six to twelve months. If the abnormality requires closer scrutiny,
the patient may be referred for detailed inspection of the cervix by the patient may be referred for detailed inspection of the cervix by
colposcopy. The patient may also be referred for HPV DNA testing, colposcopy. The patient may also be referred for HPV DNA testing,
which can serve as an adjunct to Pap testing. Additional biomarkers which can serve as an adjunct to Pap testing. Additional biomarkers
which may be applied as ancillary test with Pap test are evolvingwhich may be applied as ancillary test with Pap test are evolving
The test remains an effective, widely used method for early The test remains an effective, widely used method for early
detection of pre-cancer and cervical cancer. The test may also detection of pre-cancer and cervical cancer. The test may also
detect infections and abnormalities in the endocervix and detect infections and abnormalities in the endocervix and
endometrium.endometrium.
In general, in countries where Pap smear screening is routine, it is In general, in countries where Pap smear screening is routine, it is
recommended that females, aged 18 to 65, who have had sex, seek recommended that females, aged 18 to 65, who have had sex, seek
regular Pap smear testing. Guidelines on frequency vary from regular Pap smear testing. Guidelines on frequency vary from
annually to every five years. If results are abnormal, and depending annually to every five years. If results are abnormal, and depending
on the nature of the abnormality, the test may need to be repeated on the nature of the abnormality, the test may need to be repeated
in six to twelve months. If the abnormality requires closer scrutiny, in six to twelve months. If the abnormality requires closer scrutiny,
the patient may be referred for detailed inspection of the cervix by the patient may be referred for detailed inspection of the cervix by
colposcopy. The patient may also be referred for HPV DNA testing, colposcopy. The patient may also be referred for HPV DNA testing,
which can serve as an adjunct to Pap testing. Additional biomarkers which can serve as an adjunct to Pap testing. Additional biomarkers
which may be applied as ancillary test with Pap test are evolvingwhich may be applied as ancillary test with Pap test are evolving
IndicationsIndications
Screening guidelines vary from country to country. In general, Screening guidelines vary from country to country. In general,
screening starts about the age of 20 or 25 and continues until about screening starts about the age of 20 or 25 and continues until about
the age of 50 or 60.the age of 50 or 60.
Women should wait a few years after they first have intercourse Women should wait a few years after they first have intercourse
before they start screening. For example, United States Preventive before they start screening. For example, United States Preventive
Services Task Force (USPSTF) recommends waiting three years. Services Task Force (USPSTF) recommends waiting three years.
American Congress of Obstetricians and Gynecologists (ACOG) American Congress of Obstetricians and Gynecologists (ACOG)
recommends starting screening at age 21 (since that is a few years recommends starting screening at age 21 (since that is a few years
after initial sex for most American women). Many other countries after initial sex for most American women). Many other countries
wait until age 25 or later to start screening. For instance, Great wait until age 25 or later to start screening. For instance, Great
Britain starts screening at age 25.Britain starts screening at age 25.
Most women contract HPV soon after becoming sexually active. It Most women contract HPV soon after becoming sexually active. It
takes an average of a year, but can take up to four years, for a takes an average of a year, but can take up to four years, for a
woman's immune system to control the initial infection. Screening woman's immune system to control the initial infection. Screening
during this period may show this immune reaction and repair as mild during this period may show this immune reaction and repair as mild
abnormalities, which are usually not associated with cervical cancer, abnormalities, which are usually not associated with cervical cancer,
but could cause the woman stress and result in further tests and but could cause the woman stress and result in further tests and
possible treatment. possible treatment.
Continue…Continue…
Screening guidelines vary from country to country. In general, Screening guidelines vary from country to country. In general,
screening starts about the age of 20 or 25 and continues until about screening starts about the age of 20 or 25 and continues until about
the age of 50 or 60.the age of 50 or 60.
Women should wait a few years after they first have intercourse Women should wait a few years after they first have intercourse
before they start screening. For example, United States Preventive before they start screening. For example, United States Preventive
Services Task Force (USPSTF) recommends waiting three years. Services Task Force (USPSTF) recommends waiting three years.
American Congress of Obstetricians and Gynecologists (ACOG) American Congress of Obstetricians and Gynecologists (ACOG)
recommends starting screening at age 21 (since that is a few years recommends starting screening at age 21 (since that is a few years
after initial sex for most American women). Many other countries after initial sex for most American women). Many other countries
wait until age 25 or later to start screening. For instance, Great wait until age 25 or later to start screening. For instance, Great
Britain starts screening at age 25.Britain starts screening at age 25.
Most women contract HPV soon after becoming sexually active. It Most women contract HPV soon after becoming sexually active. It
takes an average of a year, but can take up to four years, for a takes an average of a year, but can take up to four years, for a
woman's immune system to control the initial infection. Screening woman's immune system to control the initial infection. Screening
during this period may show this immune reaction and repair as mild during this period may show this immune reaction and repair as mild
abnormalities, which are usually not associated with cervical cancer, abnormalities, which are usually not associated with cervical cancer,
but could cause the woman stress and result in further tests and but could cause the woman stress and result in further tests and
possible treatment. possible treatment.
Continue…Continue…
Continue….Continue….
Cervical cancer usually takes time to develop, Cervical cancer usually takes time to develop,
so delaying the start of screening a few years so delaying the start of screening a few years
poses little risk of missing a potentially poses little risk of missing a potentially
precancerous lesion. For instance, screening precancerous lesion. For instance, screening
women under age 25 does not decrease women under age 25 does not decrease
cancer rates under age 30.cancer rates under age 30.
There is little or no benefit to screening There is little or no benefit to screening
women who have not had sexual contact. women who have not had sexual contact.
HPV can be transmitted in sex between HPV can be transmitted in sex between
women, so women who have only had sex women, so women who have only had sex
with other women should be screened, with other women should be screened,
although they are at somewhat lower risk for although they are at somewhat lower risk for
cervical cancer.cervical cancer.
Guidelines on frequency of screening vary - Guidelines on frequency of screening vary -
typically every three to five years for those typically every three to five years for those
who have not had previous abnormal smears. who have not had previous abnormal smears.
Some older recommendations suggested Some older recommendations suggested
screening as frequently as every one to two screening as frequently as every one to two
years, but acknowledge that most women can years, but acknowledge that most women can
be screened less often. Some guidelines be screened less often. Some guidelines
recommend more frequent screening for recommend more frequent screening for
younger women; for instance in Great Britain, younger women; for instance in Great Britain,
screening is recommended every 3 years for screening is recommended every 3 years for
women under 50, and every 5 years for those women under 50, and every 5 years for those
over.over.
Cervical cancer usually takes time to develop, Cervical cancer usually takes time to develop,
so delaying the start of screening a few years so delaying the start of screening a few years
poses little risk of missing a potentially poses little risk of missing a potentially
precancerous lesion. For instance, screening precancerous lesion. For instance, screening
women under age 25 does not decrease women under age 25 does not decrease
cancer rates under age 30.cancer rates under age 30.
There is little or no benefit to screening There is little or no benefit to screening
women who have not had sexual contact. women who have not had sexual contact.
HPV can be transmitted in sex between HPV can be transmitted in sex between
women, so women who have only had sex women, so women who have only had sex
with other women should be screened, with other women should be screened,
although they are at somewhat lower risk for although they are at somewhat lower risk for
cervical cancer.cervical cancer.
Guidelines on frequency of screening vary - Guidelines on frequency of screening vary -
typically every three to five years for those typically every three to five years for those
who have not had previous abnormal smears. who have not had previous abnormal smears.
Some older recommendations suggested Some older recommendations suggested
screening as frequently as every one to two screening as frequently as every one to two
years, but acknowledge that most women can years, but acknowledge that most women can
be screened less often. Some guidelines be screened less often. Some guidelines
recommend more frequent screening for recommend more frequent screening for
younger women; for instance in Great Britain, younger women; for instance in Great Britain,
screening is recommended every 3 years for screening is recommended every 3 years for
women under 50, and every 5 years for those women under 50, and every 5 years for those
over.over.
Continue….Continue….
Guidelines vary on when to stop screening. There is probably no Guidelines vary on when to stop screening. There is probably no
benefit screening women aged 60 or over whose previous tests benefit screening women aged 60 or over whose previous tests
have been negative. If a woman's last three Pap results were have been negative. If a woman's last three Pap results were
normal, she can stop at age 65, according to the USPSTF; ACS normal, she can stop at age 65, according to the USPSTF; ACS
says 70, ACOG says 65 or 70, England's NHS says 64. There is no says 70, ACOG says 65 or 70, England's NHS says 64. There is no
need to continue screening after a complete hysterectomy for need to continue screening after a complete hysterectomy for
benign disease.benign disease.
Pap smear screening is still recommended for those who have been Pap smear screening is still recommended for those who have been
vaccinated against HPV, since the vaccines do not cover all of the vaccinated against HPV, since the vaccines do not cover all of the
HPV types that can cause cervical cancer. Also, the vaccine does HPV types that can cause cervical cancer. Also, the vaccine does
not protect against HPV exposure before vaccination.not protect against HPV exposure before vaccination.
More frequent Pap smears may be needed to follow-up after an More frequent Pap smears may be needed to follow-up after an
abnormal Pap smear, or after treatment for abnormal Pap or biopsy abnormal Pap smear, or after treatment for abnormal Pap or biopsy
results, or after treatment for cancer.results, or after treatment for cancer.
Guidelines vary on when to stop screening. There is probably no Guidelines vary on when to stop screening. There is probably no
benefit screening women aged 60 or over whose previous tests benefit screening women aged 60 or over whose previous tests
have been negative. If a woman's last three Pap results were have been negative. If a woman's last three Pap results were
normal, she can stop at age 65, according to the USPSTF; ACS normal, she can stop at age 65, according to the USPSTF; ACS
says 70, ACOG says 65 or 70, England's NHS says 64. There is no says 70, ACOG says 65 or 70, England's NHS says 64. There is no
need to continue screening after a complete hysterectomy for need to continue screening after a complete hysterectomy for
benign disease.benign disease.
Pap smear screening is still recommended for those who have been Pap smear screening is still recommended for those who have been
vaccinated against HPV, since the vaccines do not cover all of the vaccinated against HPV, since the vaccines do not cover all of the
HPV types that can cause cervical cancer. Also, the vaccine does HPV types that can cause cervical cancer. Also, the vaccine does
not protect against HPV exposure before vaccination.not protect against HPV exposure before vaccination.
More frequent Pap smears may be needed to follow-up after an More frequent Pap smears may be needed to follow-up after an
abnormal Pap smear, or after treatment for abnormal Pap or biopsy abnormal Pap smear, or after treatment for abnormal Pap or biopsy
results, or after treatment for cancer.results, or after treatment for cancer.
QuickStats: Percentage of Women Aged >25 Years Who QuickStats: Percentage of Women Aged >25 Years Who
Had a Papanicolaou (Pap) Smear Test* During the Had a Papanicolaou (Pap) Smear Test* During the
Preceding 3 Years, by Age Group and Education Level -Preceding 3 Years, by Age Group and Education Level -
National Health Interview Survey, United States, 2005*National Health Interview Survey, United States, 2005*
The likelihood of having a Pap smear test during the preceding 3 years increased with
education level in each of the age groups. Overall, older women were less likely to be
tested; the lowest rate (46.1%) was among women aged >65 years who had not
completed high school. Nine out of 10 women aged 25 - 44 years with some college or
more reported having a Pap smear test during the preceding 3 years, the highest rate
of any group.
Had a Papanicolaou (Pap) Smear Test* During the Had a Papanicolaou (Pap) Smear Test* During the
Preceding 3 Years, by Age Group and Education Level -Preceding 3 Years, by Age Group and Education Level -
National Health Interview Survey, United States, 2005*National Health Interview Survey, United States, 2005*
The likelihood of having a Pap smear test during the preceding 3 years increased with
education level in each of the age groups. Overall, older women were less likely to be
tested; the lowest rate (46.1%) was among women aged >65 years who had not
completed high school. Nine out of 10 women aged 25 - 44 years with some college or
more reported having a Pap smear test during the preceding 3 years, the highest rate
of any group.
QuickStats: Percentage of Women Aged ≥18 Years Who QuickStats: Percentage of Women Aged ≥18 Years Who
had a Papanicolaou (Pap) Smear Test* During the had a Papanicolaou (Pap) Smear Test* During the
Preceding 3 Years, by Age Group and Poverty Status Preceding 3 Years, by Age Group and Poverty Status
-National Health Interview Survey, United States, 2008-National Health Interview Survey, United States, 2008
* Estimates are based on household interviews of a sample of the * Estimates are based on household interviews of a sample of the
civilian, noninstitutionalized U.S. population. Responses are based on a civilian, noninstitutionalized U.S. population. Responses are based on a
series of questions in the cancer screening supplement of the 2008 series of questions in the cancer screening supplement of the 2008
National Health Interview Survey, including "Have you ever had a Pap National Health Interview Survey, including "Have you ever had a Pap
smear or Pap test?" and "When did you have your most recent Pap smear or Pap test?" and "When did you have your most recent Pap
smear or Pap test?" All women were included, regardless of whether smear or Pap test?" All women were included, regardless of whether
they had had a hysterectomy.they had had a hysterectomy.
Poverty status is family income as a percentage of the federal poverty Poverty status is family income as a percentage of the federal poverty
level and takes into account family size and composition.level and takes into account family size and composition.
had a Papanicolaou (Pap) Smear Test* During the had a Papanicolaou (Pap) Smear Test* During the
Preceding 3 Years, by Age Group and Poverty Status Preceding 3 Years, by Age Group and Poverty Status
-National Health Interview Survey, United States, 2008-National Health Interview Survey, United States, 2008
* Estimates are based on household interviews of a sample of the * Estimates are based on household interviews of a sample of the
civilian, noninstitutionalized U.S. population. Responses are based on a civilian, noninstitutionalized U.S. population. Responses are based on a
series of questions in the cancer screening supplement of the 2008 series of questions in the cancer screening supplement of the 2008
National Health Interview Survey, including "Have you ever had a Pap National Health Interview Survey, including "Have you ever had a Pap
smear or Pap test?" and "When did you have your most recent Pap smear or Pap test?" and "When did you have your most recent Pap
smear or Pap test?" All women were included, regardless of whether smear or Pap test?" All women were included, regardless of whether
they had had a hysterectomy.they had had a hysterectomy.
Poverty status is family income as a percentage of the federal poverty Poverty status is family income as a percentage of the federal poverty
level and takes into account family size and composition.level and takes into account family size and composition.
Continue….Continue….
95% confidence interval.95% confidence interval.
In all age groups, women with a family In all age groups, women with a family
income of ≥200% of the poverty level were income of ≥200% of the poverty level were
more likely to have had a Pap test in the more likely to have had a Pap test in the
preceding 3 years than those who were preceding 3 years than those who were
poor (income <100% of poverty) or near poor (income <100% of poverty) or near
poor (income 100% to <200% of poverty). poor (income 100% to <200% of poverty).
Women who were poor or near poor were Women who were poor or near poor were
equally likely to have had a Pap test in the equally likely to have had a Pap test in the
preceding 3 years, in all age groups. preceding 3 years, in all age groups.
Women aged ≥65 years were less likely to Women aged ≥65 years were less likely to
have had a Pap test in the preceding 3 have had a Pap test in the preceding 3
years than were younger women, years than were younger women,
regardless of poverty status. regardless of poverty status.
95% confidence interval.95% confidence interval.
In all age groups, women with a family In all age groups, women with a family
income of ≥200% of the poverty level were income of ≥200% of the poverty level were
more likely to have had a Pap test in the more likely to have had a Pap test in the
preceding 3 years than those who were preceding 3 years than those who were
poor (income <100% of poverty) or near poor (income <100% of poverty) or near
poor (income 100% to <200% of poverty). poor (income 100% to <200% of poverty).
Women who were poor or near poor were Women who were poor or near poor were
equally likely to have had a Pap test in the equally likely to have had a Pap test in the
preceding 3 years, in all age groups. preceding 3 years, in all age groups.
Women aged ≥65 years were less likely to Women aged ≥65 years were less likely to
have had a Pap test in the preceding 3 have had a Pap test in the preceding 3
years than were younger women, years than were younger women,
regardless of poverty status. regardless of poverty status.
Types of screeningTypes of screening
Conventional cytologyConventional cytology
Liquid-based monolayer cytologyLiquid-based monolayer cytology
Human papillomavirus testingHuman papillomavirus testing
Testing in resource-poor areasTesting in resource-poor areas
Other optionsOther options
Visual inspection to detect pre-cancer or Visual inspection to detect pre-cancer or
cancercancer
Conventional cytologyConventional cytology
Liquid-based monolayer cytologyLiquid-based monolayer cytology
Human papillomavirus testingHuman papillomavirus testing
Testing in resource-poor areasTesting in resource-poor areas
Other optionsOther options
Visual inspection to detect pre-cancer or Visual inspection to detect pre-cancer or
cancercancer
Conventional cytologyConventional cytology
In the conventional Pap smear, the physician collecting the cells In the conventional Pap smear, the physician collecting the cells
smears them on a microscope slide and applies a fixative. In smears them on a microscope slide and applies a fixative. In
general, the slide is sent to a laboratory for evaluation.general, the slide is sent to a laboratory for evaluation.
Studies of the accuracy of conventional cytology reportStudies of the accuracy of conventional cytology report
sensitivity 72%sensitivity 72%
specificity 94%specificity 94%
In the conventional Pap smear, the physician collecting the cells In the conventional Pap smear, the physician collecting the cells
smears them on a microscope slide and applies a fixative. In smears them on a microscope slide and applies a fixative. In
general, the slide is sent to a laboratory for evaluation.general, the slide is sent to a laboratory for evaluation.
Studies of the accuracy of conventional cytology reportStudies of the accuracy of conventional cytology report
sensitivity 72%sensitivity 72%
specificity 94%specificity 94%
Liquid-based monolayer cytologyLiquid-based monolayer cytology
Since the mid-1990s, techniques based on placing the sample into a Since the mid-1990s, techniques based on placing the sample into a
vial containing a liquid medium that preserves the cells have been vial containing a liquid medium that preserves the cells have been
increasingly used. Two of the types are Sure-Path (TriPath Imaging) increasingly used. Two of the types are Sure-Path (TriPath Imaging)
and Thin-Prep (Cytyc Corp). The media are primarily ethanol-based and Thin-Prep (Cytyc Corp). The media are primarily ethanol-based
for Sure-Path and methanol for ThinPrep. for Sure-Path and methanol for ThinPrep.
Once placed into the vial, the sample is processed at the laboratory Once placed into the vial, the sample is processed at the laboratory
into a cell thin-layer, stained, and examined by light microscopy. into a cell thin-layer, stained, and examined by light microscopy.
The liquid sample has the advantage of being suitable for high-risk The liquid sample has the advantage of being suitable for high-risk
HPV testing and may reduce unsatisfactory specimens from 4.1% to HPV testing and may reduce unsatisfactory specimens from 4.1% to
2.6%. Proper sample acquisition is crucial to the accuracy of the 2.6%. Proper sample acquisition is crucial to the accuracy of the
test, as a cell that is not in the sample cannot be evaluated.test, as a cell that is not in the sample cannot be evaluated.
Studies of the accuracy of liquid based monolayer cytology report:Studies of the accuracy of liquid based monolayer cytology report:
sensitivity 61% to 66%, (although some studies sensitivity 61% to 66%, (although some studies
report increased sensitivity from liquid-based report increased sensitivity from liquid-based
smears)smears)
specificity 82% to 91%specificity 82% to 91%
Since the mid-1990s, techniques based on placing the sample into a Since the mid-1990s, techniques based on placing the sample into a
vial containing a liquid medium that preserves the cells have been vial containing a liquid medium that preserves the cells have been
increasingly used. Two of the types are Sure-Path (TriPath Imaging) increasingly used. Two of the types are Sure-Path (TriPath Imaging)
and Thin-Prep (Cytyc Corp). The media are primarily ethanol-based and Thin-Prep (Cytyc Corp). The media are primarily ethanol-based
for Sure-Path and methanol for ThinPrep. for Sure-Path and methanol for ThinPrep.
Once placed into the vial, the sample is processed at the laboratory Once placed into the vial, the sample is processed at the laboratory
into a cell thin-layer, stained, and examined by light microscopy. into a cell thin-layer, stained, and examined by light microscopy.
The liquid sample has the advantage of being suitable for high-risk The liquid sample has the advantage of being suitable for high-risk
HPV testing and may reduce unsatisfactory specimens from 4.1% to HPV testing and may reduce unsatisfactory specimens from 4.1% to
2.6%. Proper sample acquisition is crucial to the accuracy of the 2.6%. Proper sample acquisition is crucial to the accuracy of the
test, as a cell that is not in the sample cannot be evaluated.test, as a cell that is not in the sample cannot be evaluated.
Studies of the accuracy of liquid based monolayer cytology report:Studies of the accuracy of liquid based monolayer cytology report:
sensitivity 61% to 66%, (although some studies sensitivity 61% to 66%, (although some studies
report increased sensitivity from liquid-based report increased sensitivity from liquid-based
smears)smears)
specificity 82% to 91%specificity 82% to 91%
Human papillomavirus testing Human papillomavirus testing
Human papillomavirus (HPV) infection is a cause of nearly all cases of Human papillomavirus (HPV) infection is a cause of nearly all cases of
cervical cancer. Most women will successfully clear HPV infections within cervical cancer. Most women will successfully clear HPV infections within
18 months. Those that have a prolonged infection with a high-risk type 18 months. Those that have a prolonged infection with a high-risk type
(e.g. types 16, 18, 31, 45) are more likely to develop Cervical (e.g. types 16, 18, 31, 45) are more likely to develop Cervical
Intraepithelial Neoplasia, due to the effects that HPV has on DNA.Intraepithelial Neoplasia, due to the effects that HPV has on DNA.
Studies of the accuracy of HPV testing report:Studies of the accuracy of HPV testing report:
sensitivity 88% to 91% (for detecting CIN 3 or higher) to 97% sensitivity 88% to 91% (for detecting CIN 3 or higher) to 97%
(for detecting CIN2+)(for detecting CIN2+)
specificity 73% to 79% (for detecting CIN 3 or higher) to 93% specificity 73% to 79% (for detecting CIN 3 or higher) to 93%
(for detecting CIN2+)(for detecting CIN2+)
By adding the more sensitive HPV Test, the specificity may decline. By adding the more sensitive HPV Test, the specificity may decline.
However, the drop in specificity is not definite. If the specificity does However, the drop in specificity is not definite. If the specificity does
decline, the result is increased numbers of false positive tests and, for decline, the result is increased numbers of false positive tests and, for
many women that did not have disease, an increased risk for colposcopy many women that did not have disease, an increased risk for colposcopy
and treatment. A worthwhile screening test requires a balance between and treatment. A worthwhile screening test requires a balance between
the sensitivity and specificity to ensure that those having a disease are the sensitivity and specificity to ensure that those having a disease are
correctly identified as having it and those without the disease are not correctly identified as having it and those without the disease are not
identified as having it.identified as having it.
Human papillomavirus (HPV) infection is a cause of nearly all cases of Human papillomavirus (HPV) infection is a cause of nearly all cases of
cervical cancer. Most women will successfully clear HPV infections within cervical cancer. Most women will successfully clear HPV infections within
18 months. Those that have a prolonged infection with a high-risk type 18 months. Those that have a prolonged infection with a high-risk type
(e.g. types 16, 18, 31, 45) are more likely to develop Cervical (e.g. types 16, 18, 31, 45) are more likely to develop Cervical
Intraepithelial Neoplasia, due to the effects that HPV has on DNA.Intraepithelial Neoplasia, due to the effects that HPV has on DNA.
Studies of the accuracy of HPV testing report:Studies of the accuracy of HPV testing report:
sensitivity 88% to 91% (for detecting CIN 3 or higher) to 97% sensitivity 88% to 91% (for detecting CIN 3 or higher) to 97%
(for detecting CIN2+)(for detecting CIN2+)
specificity 73% to 79% (for detecting CIN 3 or higher) to 93% specificity 73% to 79% (for detecting CIN 3 or higher) to 93%
(for detecting CIN2+)(for detecting CIN2+)
By adding the more sensitive HPV Test, the specificity may decline. By adding the more sensitive HPV Test, the specificity may decline.
However, the drop in specificity is not definite. If the specificity does However, the drop in specificity is not definite. If the specificity does
decline, the result is increased numbers of false positive tests and, for decline, the result is increased numbers of false positive tests and, for
many women that did not have disease, an increased risk for colposcopy many women that did not have disease, an increased risk for colposcopy
and treatment. A worthwhile screening test requires a balance between and treatment. A worthwhile screening test requires a balance between
the sensitivity and specificity to ensure that those having a disease are the sensitivity and specificity to ensure that those having a disease are
correctly identified as having it and those without the disease are not correctly identified as having it and those without the disease are not
identified as having it.identified as having it.
Continue…Continue…
Regarding the role of HPV testing, randomized controlled trials have Regarding the role of HPV testing, randomized controlled trials have
compared HPV to colposcopy. HPV testing appears as sensitive as compared HPV to colposcopy. HPV testing appears as sensitive as
immediate colposcopy while reducing the number of colposcopies immediate colposcopy while reducing the number of colposcopies
needed. Randomized controlled trial have suggested that HPV testing needed. Randomized controlled trial have suggested that HPV testing
could follow abnormal cytology or could precede cervical cytology could follow abnormal cytology or could precede cervical cytology
examination.examination.
A study published in April 2007 suggested that the act of performing a A study published in April 2007 suggested that the act of performing a
Pap smear produces an inflammatory cytokine response, which may Pap smear produces an inflammatory cytokine response, which may
initiate immunologic clearance of HPV, therefore reducing the risk of initiate immunologic clearance of HPV, therefore reducing the risk of
cervical cancer. Women that had even a single Pap smear in their history cervical cancer. Women that had even a single Pap smear in their history
had a lower incidence of cancer. "A statistically significant decline in the had a lower incidence of cancer. "A statistically significant decline in the
HPV positivity rate correlated with the lifetime number of Pap smears HPV positivity rate correlated with the lifetime number of Pap smears
received.“received.“
HPV testing can reduce the incidence of grade 2 or 3 cervical HPV testing can reduce the incidence of grade 2 or 3 cervical
intraepithelial neoplasia or cervical cancer detected by subsequent intraepithelial neoplasia or cervical cancer detected by subsequent
screening tests among women 32–38 years old according to a screening tests among women 32–38 years old according to a
randomized controlled trial. The relative risk reduction was 41.3%. For randomized controlled trial. The relative risk reduction was 41.3%. For
patients at similar risk to those in this study (63.0% had CIN 2-3 or patients at similar risk to those in this study (63.0% had CIN 2-3 or
cancer), this leads to an absolute risk reduction of 26%. 3.8 patients cancer), this leads to an absolute risk reduction of 26%. 3.8 patients
must be treated for one to benefit (number needed to treat = 3.8). Click must be treated for one to benefit (number needed to treat = 3.8). Click
here to adjust these results for patients at higher or lower risk of CIN 2-3.here to adjust these results for patients at higher or lower risk of CIN 2-3.
Regarding the role of HPV testing, randomized controlled trials have Regarding the role of HPV testing, randomized controlled trials have
compared HPV to colposcopy. HPV testing appears as sensitive as compared HPV to colposcopy. HPV testing appears as sensitive as
immediate colposcopy while reducing the number of colposcopies immediate colposcopy while reducing the number of colposcopies
needed. Randomized controlled trial have suggested that HPV testing needed. Randomized controlled trial have suggested that HPV testing
could follow abnormal cytology or could precede cervical cytology could follow abnormal cytology or could precede cervical cytology
examination.examination.
A study published in April 2007 suggested that the act of performing a A study published in April 2007 suggested that the act of performing a
Pap smear produces an inflammatory cytokine response, which may Pap smear produces an inflammatory cytokine response, which may
initiate immunologic clearance of HPV, therefore reducing the risk of initiate immunologic clearance of HPV, therefore reducing the risk of
cervical cancer. Women that had even a single Pap smear in their history cervical cancer. Women that had even a single Pap smear in their history
had a lower incidence of cancer. "A statistically significant decline in the had a lower incidence of cancer. "A statistically significant decline in the
HPV positivity rate correlated with the lifetime number of Pap smears HPV positivity rate correlated with the lifetime number of Pap smears
received.“received.“
HPV testing can reduce the incidence of grade 2 or 3 cervical HPV testing can reduce the incidence of grade 2 or 3 cervical
intraepithelial neoplasia or cervical cancer detected by subsequent intraepithelial neoplasia or cervical cancer detected by subsequent
screening tests among women 32–38 years old according to a screening tests among women 32–38 years old according to a
randomized controlled trial. The relative risk reduction was 41.3%. For randomized controlled trial. The relative risk reduction was 41.3%. For
patients at similar risk to those in this study (63.0% had CIN 2-3 or patients at similar risk to those in this study (63.0% had CIN 2-3 or
cancer), this leads to an absolute risk reduction of 26%. 3.8 patients cancer), this leads to an absolute risk reduction of 26%. 3.8 patients
must be treated for one to benefit (number needed to treat = 3.8). Click must be treated for one to benefit (number needed to treat = 3.8). Click
here to adjust these results for patients at higher or lower risk of CIN 2-3.here to adjust these results for patients at higher or lower risk of CIN 2-3.
Testing in resource-poor areas Testing in resource-poor areas
Many resource-poor areas cannot provide regular screening, and Many resource-poor areas cannot provide regular screening, and
must rely on infrequent screening. A study of cervical cancer must rely on infrequent screening. A study of cervical cancer
screening of 131,746 women in rural India found that a single DNA screening of 131,746 women in rural India found that a single DNA
test reduced the number of advanced cervical cancers and deaths test reduced the number of advanced cervical cancers and deaths
over 8 years, while a single acetic acid examination or a single Pap over 8 years, while a single acetic acid examination or a single Pap
screening did not. However, the DNA test cost US $30–40, which screening did not. However, the DNA test cost US $30–40, which
was unaffordable in many regions, it is time-consuming, and was unaffordable in many regions, it is time-consuming, and
requires a sophisticated laboratory infrastructure. A simple, requires a sophisticated laboratory infrastructure. A simple,
affordable, and accurate test is being evaluated in China and other affordable, and accurate test is being evaluated in China and other
countries. The new test may become available on the market in countries. The new test may become available on the market in
2010 at significantly lower cost than current tests.2010 at significantly lower cost than current tests.
With HPV testing, there was a 50 percent reduction in the number of With HPV testing, there was a 50 percent reduction in the number of
deaths from cervical cancer compared to unscreened women. deaths from cervical cancer compared to unscreened women.
Compared to other methods, the research showed the HPV testing Compared to other methods, the research showed the HPV testing
reported the fewest false negatives.reported the fewest false negatives.
Many resource-poor areas cannot provide regular screening, and Many resource-poor areas cannot provide regular screening, and
must rely on infrequent screening. A study of cervical cancer must rely on infrequent screening. A study of cervical cancer
screening of 131,746 women in rural India found that a single DNA screening of 131,746 women in rural India found that a single DNA
test reduced the number of advanced cervical cancers and deaths test reduced the number of advanced cervical cancers and deaths
over 8 years, while a single acetic acid examination or a single Pap over 8 years, while a single acetic acid examination or a single Pap
screening did not. However, the DNA test cost US $30–40, which screening did not. However, the DNA test cost US $30–40, which
was unaffordable in many regions, it is time-consuming, and was unaffordable in many regions, it is time-consuming, and
requires a sophisticated laboratory infrastructure. A simple, requires a sophisticated laboratory infrastructure. A simple,
affordable, and accurate test is being evaluated in China and other affordable, and accurate test is being evaluated in China and other
countries. The new test may become available on the market in countries. The new test may become available on the market in
2010 at significantly lower cost than current tests.2010 at significantly lower cost than current tests.
With HPV testing, there was a 50 percent reduction in the number of With HPV testing, there was a 50 percent reduction in the number of
deaths from cervical cancer compared to unscreened women. deaths from cervical cancer compared to unscreened women.
Compared to other methods, the research showed the HPV testing Compared to other methods, the research showed the HPV testing
reported the fewest false negatives.reported the fewest false negatives.
Other options Other options
The Bill and Melinda Gates Foundation has funded an eight-year The Bill and Melinda Gates Foundation has funded an eight-year
study of a DNA test for the virus that causes cervical cancer. The study of a DNA test for the virus that causes cervical cancer. The
test manufactured by Qiagen for a low cost per test with results test manufactured by Qiagen for a low cost per test with results
available in only a few hours may allow reduction in use of annual available in only a few hours may allow reduction in use of annual
Pap smears. The test has been shown to work "acceptably well" on Pap smears. The test has been shown to work "acceptably well" on
women who take the swabs themselves rather than allowing a women who take the swabs themselves rather than allowing a
physician to test. This may improve the chances of early diagnosis physician to test. This may improve the chances of early diagnosis
for women who are unwilling to be screened due to discomfort or for women who are unwilling to be screened due to discomfort or
modesty.modesty.
The Bill and Melinda Gates Foundation has funded an eight-year The Bill and Melinda Gates Foundation has funded an eight-year
study of a DNA test for the virus that causes cervical cancer. The study of a DNA test for the virus that causes cervical cancer. The
test manufactured by Qiagen for a low cost per test with results test manufactured by Qiagen for a low cost per test with results
available in only a few hours may allow reduction in use of annual available in only a few hours may allow reduction in use of annual
Pap smears. The test has been shown to work "acceptably well" on Pap smears. The test has been shown to work "acceptably well" on
women who take the swabs themselves rather than allowing a women who take the swabs themselves rather than allowing a
physician to test. This may improve the chances of early diagnosis physician to test. This may improve the chances of early diagnosis
for women who are unwilling to be screened due to discomfort or for women who are unwilling to be screened due to discomfort or
modesty.modesty.
Visual inspection to detect pre-Visual inspection to detect pre-
cancer or cancercancer or cancer
In areas where Pap smear screening is not available or affordable, In areas where Pap smear screening is not available or affordable,
other methods of testing have been evaluated.other methods of testing have been evaluated.
Visual inspection of the cervix, using acetic acid (VIA) or Lugol’s Visual inspection of the cervix, using acetic acid (VIA) or Lugol’s
iodine (VILI) to highlight precancerous lesions so they can be iodine (VILI) to highlight precancerous lesions so they can be
viewed with the "naked eye", shifts the identification of precancer viewed with the "naked eye", shifts the identification of precancer
from the laboratory to the clinic. Such procedures eliminate the need from the laboratory to the clinic. Such procedures eliminate the need
for laboratories and transport of specimens, require very little for laboratories and transport of specimens, require very little
equipment and provide women with immediate test results. A range equipment and provide women with immediate test results. A range
of medical professionals - doctors, nurses, or professional midwives of medical professionals - doctors, nurses, or professional midwives
- can effectively perform the procedure, provided they receive - can effectively perform the procedure, provided they receive
adequate training and supervision. adequate training and supervision.
As a screening test, VIA may perform as well as or better than As a screening test, VIA may perform as well as or better than
cervical cytology in accurately identifying pre-cancerous lesions. cervical cytology in accurately identifying pre-cancerous lesions.
This has been demonstrated in various studies where trained This has been demonstrated in various studies where trained
physicians and mid-level providers correctly identified between 45% physicians and mid-level providers correctly identified between 45%
and 79% of women at high risk of developing cervical cancer. By and 79% of women at high risk of developing cervical cancer. By
comparison, the sensitivity of cytology has been shown to be comparison, the sensitivity of cytology has been shown to be
between 47 and 62%. between 47 and 62%.
cancer or cancercancer or cancer
In areas where Pap smear screening is not available or affordable, In areas where Pap smear screening is not available or affordable,
other methods of testing have been evaluated.other methods of testing have been evaluated.
Visual inspection of the cervix, using acetic acid (VIA) or Lugol’s Visual inspection of the cervix, using acetic acid (VIA) or Lugol’s
iodine (VILI) to highlight precancerous lesions so they can be iodine (VILI) to highlight precancerous lesions so they can be
viewed with the "naked eye", shifts the identification of precancer viewed with the "naked eye", shifts the identification of precancer
from the laboratory to the clinic. Such procedures eliminate the need from the laboratory to the clinic. Such procedures eliminate the need
for laboratories and transport of specimens, require very little for laboratories and transport of specimens, require very little
equipment and provide women with immediate test results. A range equipment and provide women with immediate test results. A range
of medical professionals - doctors, nurses, or professional midwives of medical professionals - doctors, nurses, or professional midwives
- can effectively perform the procedure, provided they receive - can effectively perform the procedure, provided they receive
adequate training and supervision. adequate training and supervision.
As a screening test, VIA may perform as well as or better than As a screening test, VIA may perform as well as or better than
cervical cytology in accurately identifying pre-cancerous lesions. cervical cytology in accurately identifying pre-cancerous lesions.
This has been demonstrated in various studies where trained This has been demonstrated in various studies where trained
physicians and mid-level providers correctly identified between 45% physicians and mid-level providers correctly identified between 45%
and 79% of women at high risk of developing cervical cancer. By and 79% of women at high risk of developing cervical cancer. By
comparison, the sensitivity of cytology has been shown to be comparison, the sensitivity of cytology has been shown to be
between 47 and 62%. between 47 and 62%.
Continue..Continue..
Cytology provides higher specificity (fewer false positives) than VIA. Like Cytology provides higher specificity (fewer false positives) than VIA. Like
cytology, one of the limitations of VIA is that results are highly dependent on cytology, one of the limitations of VIA is that results are highly dependent on
the accuracy of an individual's interpretation. This means that initial training the accuracy of an individual's interpretation. This means that initial training
and on-going quality control are of paramount importance. Increased false and on-going quality control are of paramount importance. Increased false
positives are particularly important in a screen-and-treat setting, since over-positives are particularly important in a screen-and-treat setting, since over-
treatment and resulting impairment of fertility is more likely.treatment and resulting impairment of fertility is more likely.
VIA can offer significant advantages over Pap in low-resource settings, VIA can offer significant advantages over Pap in low-resource settings,
particularly in terms of increased screening coverage, improved follow-up particularly in terms of increased screening coverage, improved follow-up
care and overall program quality. Due to the need for fewer specialized care and overall program quality. Due to the need for fewer specialized
personnel and less infrastructure, training, and equipment, with VIA public personnel and less infrastructure, training, and equipment, with VIA public
health systems can offer cervical cancer screening in more remote (and less health systems can offer cervical cancer screening in more remote (and less
equipped) health care settings and can achieve higher coverage. equipped) health care settings and can achieve higher coverage.
Furthermore, providers can share the results of VIA with patients Furthermore, providers can share the results of VIA with patients
immediately, making it possible to screen and treat women during the same immediately, making it possible to screen and treat women during the same
visit. visit.
This helps ensure that follow-up care can be provided on the spot and This helps ensure that follow-up care can be provided on the spot and
reduces the number of women who may miss out on treatment because reduces the number of women who may miss out on treatment because
they are not able to return to the clinic at another time. In a "screen and they are not able to return to the clinic at another time. In a "screen and
treat" project in Peru, for example, only 9% of women who screened positive treat" project in Peru, for example, only 9% of women who screened positive
failed to receive treatment in the single-visit approach, compared with 44% failed to receive treatment in the single-visit approach, compared with 44%
of women who were lost to treatment using a multi-visit model.of women who were lost to treatment using a multi-visit model.
Cytology provides higher specificity (fewer false positives) than VIA. Like Cytology provides higher specificity (fewer false positives) than VIA. Like
cytology, one of the limitations of VIA is that results are highly dependent on cytology, one of the limitations of VIA is that results are highly dependent on
the accuracy of an individual's interpretation. This means that initial training the accuracy of an individual's interpretation. This means that initial training
and on-going quality control are of paramount importance. Increased false and on-going quality control are of paramount importance. Increased false
positives are particularly important in a screen-and-treat setting, since over-positives are particularly important in a screen-and-treat setting, since over-
treatment and resulting impairment of fertility is more likely.treatment and resulting impairment of fertility is more likely.
VIA can offer significant advantages over Pap in low-resource settings, VIA can offer significant advantages over Pap in low-resource settings,
particularly in terms of increased screening coverage, improved follow-up particularly in terms of increased screening coverage, improved follow-up
care and overall program quality. Due to the need for fewer specialized care and overall program quality. Due to the need for fewer specialized
personnel and less infrastructure, training, and equipment, with VIA public personnel and less infrastructure, training, and equipment, with VIA public
health systems can offer cervical cancer screening in more remote (and less health systems can offer cervical cancer screening in more remote (and less
equipped) health care settings and can achieve higher coverage. equipped) health care settings and can achieve higher coverage.
Furthermore, providers can share the results of VIA with patients Furthermore, providers can share the results of VIA with patients
immediately, making it possible to screen and treat women during the same immediately, making it possible to screen and treat women during the same
visit. visit.
This helps ensure that follow-up care can be provided on the spot and This helps ensure that follow-up care can be provided on the spot and
reduces the number of women who may miss out on treatment because reduces the number of women who may miss out on treatment because
they are not able to return to the clinic at another time. In a "screen and they are not able to return to the clinic at another time. In a "screen and
treat" project in Peru, for example, only 9% of women who screened positive treat" project in Peru, for example, only 9% of women who screened positive
failed to receive treatment in the single-visit approach, compared with 44% failed to receive treatment in the single-visit approach, compared with 44%
of women who were lost to treatment using a multi-visit model.of women who were lost to treatment using a multi-visit model.
Continue…Continue…
VIA has successfully been paired with cryotherapy, a relatively VIA has successfully been paired with cryotherapy, a relatively
simple and inexpensive method of treating cervical lesions that can simple and inexpensive method of treating cervical lesions that can
be performed by primary care physicians and mid-level providers.be performed by primary care physicians and mid-level providers.
VIA has successfully been paired with cryotherapy, a relatively VIA has successfully been paired with cryotherapy, a relatively
simple and inexpensive method of treating cervical lesions that can simple and inexpensive method of treating cervical lesions that can
be performed by primary care physicians and mid-level providers.be performed by primary care physicians and mid-level providers.
How to Prepare for Your Pap How to Prepare for Your Pap
TestTest
If you are going to have a Pap test in the next two days, If you are going to have a Pap test in the next two days,
you should not - you should not -
Douche, which means rinsing the vagina Douche, which means rinsing the vagina
with water or another fluid.with water or another fluid.
Use a tampon.Use a tampon.
Have sex.Have sex.
Use a birth control foam, cream, or jelly.Use a birth control foam, cream, or jelly.
Use a medicine or cream in your vagina.Use a medicine or cream in your vagina.
Schedule your Pap test for a time when Schedule your Pap test for a time when
you are having your period.you are having your period.
TestTest
If you are going to have a Pap test in the next two days, If you are going to have a Pap test in the next two days,
you should not - you should not -
Douche, which means rinsing the vagina Douche, which means rinsing the vagina
with water or another fluid.with water or another fluid.
Use a tampon.Use a tampon.
Have sex.Have sex.
Use a birth control foam, cream, or jelly.Use a birth control foam, cream, or jelly.
Use a medicine or cream in your vagina.Use a medicine or cream in your vagina.
Schedule your Pap test for a time when Schedule your Pap test for a time when
you are having your period.you are having your period.
ProcedureProcedure
For best results, a Pap test should not occur when a woman is For best results, a Pap test should not occur when a woman is
menstruating. However, Pap smears can be performed during a menstruating. However, Pap smears can be performed during a
woman's menstrual period, especially if the physician is using a woman's menstrual period, especially if the physician is using a
liquid-based test; if bleeding is extremely heavy, endometrial cells liquid-based test; if bleeding is extremely heavy, endometrial cells
can obscure cervical cells, and it is therefore inadvisable to have a can obscure cervical cells, and it is therefore inadvisable to have a
Pap smear if bleeding is excessive.Pap smear if bleeding is excessive.
Getting a pap smear should not cause pain, but it can if the patient Getting a pap smear should not cause pain, but it can if the patient
has certain untreated vaginal problems such as cervical stenosis or has certain untreated vaginal problems such as cervical stenosis or
vaginismus, or if the person performing it is too harsh, or uses the vaginismus, or if the person performing it is too harsh, or uses the
wrong size speculum. The patient should speak up if they are in wrong size speculum. The patient should speak up if they are in
pain. Many women experience spotting or mild diarrhea afterward.pain. Many women experience spotting or mild diarrhea afterward.
The health care worker begins by inserting a speculum into the The health care worker begins by inserting a speculum into the
woman's vagina, which spreads the vagina open and allows access woman's vagina, which spreads the vagina open and allows access
to the cervix. The health care provider then collects a sample of to the cervix. The health care provider then collects a sample of
cells from the outer opening or os of the cervix by scraping it with an cells from the outer opening or os of the cervix by scraping it with an
Aylesbury spatula. An endocervical brush is rotated in the central Aylesbury spatula. An endocervical brush is rotated in the central
opening of the cervix. The cells are placed on a glass slide and opening of the cervix. The cells are placed on a glass slide and
taken to the laboratory to be checked for abnormalities.taken to the laboratory to be checked for abnormalities.
For best results, a Pap test should not occur when a woman is For best results, a Pap test should not occur when a woman is
menstruating. However, Pap smears can be performed during a menstruating. However, Pap smears can be performed during a
woman's menstrual period, especially if the physician is using a woman's menstrual period, especially if the physician is using a
liquid-based test; if bleeding is extremely heavy, endometrial cells liquid-based test; if bleeding is extremely heavy, endometrial cells
can obscure cervical cells, and it is therefore inadvisable to have a can obscure cervical cells, and it is therefore inadvisable to have a
Pap smear if bleeding is excessive.Pap smear if bleeding is excessive.
Getting a pap smear should not cause pain, but it can if the patient Getting a pap smear should not cause pain, but it can if the patient
has certain untreated vaginal problems such as cervical stenosis or has certain untreated vaginal problems such as cervical stenosis or
vaginismus, or if the person performing it is too harsh, or uses the vaginismus, or if the person performing it is too harsh, or uses the
wrong size speculum. The patient should speak up if they are in wrong size speculum. The patient should speak up if they are in
pain. Many women experience spotting or mild diarrhea afterward.pain. Many women experience spotting or mild diarrhea afterward.
The health care worker begins by inserting a speculum into the The health care worker begins by inserting a speculum into the
woman's vagina, which spreads the vagina open and allows access woman's vagina, which spreads the vagina open and allows access
to the cervix. The health care provider then collects a sample of to the cervix. The health care provider then collects a sample of
cells from the outer opening or os of the cervix by scraping it with an cells from the outer opening or os of the cervix by scraping it with an
Aylesbury spatula. An endocervical brush is rotated in the central Aylesbury spatula. An endocervical brush is rotated in the central
opening of the cervix. The cells are placed on a glass slide and opening of the cervix. The cells are placed on a glass slide and
taken to the laboratory to be checked for abnormalities.taken to the laboratory to be checked for abnormalities.
Continue…Continue…
A plastic-fronded broom is sometimes used in A plastic-fronded broom is sometimes used in
place of the spatula and brush. The broom is place of the spatula and brush. The broom is
not as good a collection device, since it is much not as good a collection device, since it is much
less effective at collecting endocervical material less effective at collecting endocervical material
than the spatula and brush. The broom is used than the spatula and brush. The broom is used
more frequently with the advent of liquid-based more frequently with the advent of liquid-based
cytology, although either type of collection cytology, although either type of collection
device may be used with either type of device may be used with either type of
cytology.cytology.
The sample is stained using the Papanicolaou The sample is stained using the Papanicolaou
technique, in which tinctorial dyes and acids technique, in which tinctorial dyes and acids
are selectively retained by cells. Unstained are selectively retained by cells. Unstained
cells cannot be seen with a light microscope. cells cannot be seen with a light microscope.
Papanicolaou chose stains that highlighted Papanicolaou chose stains that highlighted
cytoplasmic keratinization, which actually has cytoplasmic keratinization, which actually has
almost nothing to do with the nuclear features almost nothing to do with the nuclear features
used to make diagnoses now.used to make diagnoses now.
In some cases, a computer system may prescreen the slides, indicating those that In some cases, a computer system may prescreen the slides, indicating those that
do not need examination by a person or highlighting areas for special attention. The do not need examination by a person or highlighting areas for special attention. The
sample is then usually screened by a specially trained and qualified cytotechnologist sample is then usually screened by a specially trained and qualified cytotechnologist
using a light microscope. The terminology for who screens the sample varies according using a light microscope. The terminology for who screens the sample varies according
to the country; in the UK, the personnel are known as cytoscreeners, biomedical to the country; in the UK, the personnel are known as cytoscreeners, biomedical
scientists (BMS), advanced practitioners and pathologists. The latter two take scientists (BMS), advanced practitioners and pathologists. The latter two take
responsibility for reporting the abnormal sample which may require further responsibility for reporting the abnormal sample which may require further
investigation.investigation.
A plastic-fronded broom is sometimes used in A plastic-fronded broom is sometimes used in
place of the spatula and brush. The broom is place of the spatula and brush. The broom is
not as good a collection device, since it is much not as good a collection device, since it is much
less effective at collecting endocervical material less effective at collecting endocervical material
than the spatula and brush. The broom is used than the spatula and brush. The broom is used
more frequently with the advent of liquid-based more frequently with the advent of liquid-based
cytology, although either type of collection cytology, although either type of collection
device may be used with either type of device may be used with either type of
cytology.cytology.
The sample is stained using the Papanicolaou The sample is stained using the Papanicolaou
technique, in which tinctorial dyes and acids technique, in which tinctorial dyes and acids
are selectively retained by cells. Unstained are selectively retained by cells. Unstained
cells cannot be seen with a light microscope. cells cannot be seen with a light microscope.
Papanicolaou chose stains that highlighted Papanicolaou chose stains that highlighted
cytoplasmic keratinization, which actually has cytoplasmic keratinization, which actually has
almost nothing to do with the nuclear features almost nothing to do with the nuclear features
used to make diagnoses now.used to make diagnoses now.
In some cases, a computer system may prescreen the slides, indicating those that In some cases, a computer system may prescreen the slides, indicating those that
do not need examination by a person or highlighting areas for special attention. The do not need examination by a person or highlighting areas for special attention. The
sample is then usually screened by a specially trained and qualified cytotechnologist sample is then usually screened by a specially trained and qualified cytotechnologist
using a light microscope. The terminology for who screens the sample varies according using a light microscope. The terminology for who screens the sample varies according
to the country; in the UK, the personnel are known as cytoscreeners, biomedical to the country; in the UK, the personnel are known as cytoscreeners, biomedical
scientists (BMS), advanced practitioners and pathologists. The latter two take scientists (BMS), advanced practitioners and pathologists. The latter two take
responsibility for reporting the abnormal sample which may require further responsibility for reporting the abnormal sample which may require further
investigation.investigation.
ResultsResults
In screening a general or low-risk population, most Pap In screening a general or low-risk population, most Pap
results results
are normal.are normal.
In the United States, about 2-3 million abnormal Pap In the United States, about 2-3 million abnormal Pap
smear results are found each year. Most abnormal smear results are found each year. Most abnormal
results are mildly abnormal (ASC-US (typically 2-5% of results are mildly abnormal (ASC-US (typically 2-5% of
Pap results) or low-grade squamous intraepithelial Pap results) or low-grade squamous intraepithelial
lesion (LSIL) (about 2% of results)), indicating HPV lesion (LSIL) (about 2% of results)), indicating HPV
infection.[citation needed] Although most low-grade infection.[citation needed] Although most low-grade
cervical dysplasias spontaneously regress without ever cervical dysplasias spontaneously regress without ever
leading to cervical cancer, dysplasia can serve as an leading to cervical cancer, dysplasia can serve as an
indication that increased vigilance is needed.indication that increased vigilance is needed.
In a typical scenario, about 0.5% of Pap results are high-grade SIL (HSIL), In a typical scenario, about 0.5% of Pap results are high-grade SIL (HSIL),
and less than 0.5% of results indicate cancer; 0.2 to 0.8% of results indicate and less than 0.5% of results indicate cancer; 0.2 to 0.8% of results indicate
Atypical Glandular Cells of Undetermined Significance (AGC-NOS).Atypical Glandular Cells of Undetermined Significance (AGC-NOS).
As liquid based preparations (LBPs) become a common medium for testing, As liquid based preparations (LBPs) become a common medium for testing,
atypical result rates have increased. The median rate for all preparations with atypical result rates have increased. The median rate for all preparations with
low-grade squamous intraepithelial lesions using LBPs was 2.9% compared low-grade squamous intraepithelial lesions using LBPs was 2.9% compared
with a 2003 median rate of 2.1%. Rates for high-grade squamous with a 2003 median rate of 2.1%. Rates for high-grade squamous
intraepithelial lesions (median, 0.5%) and atypical squamous cells have intraepithelial lesions (median, 0.5%) and atypical squamous cells have
changed little.changed little.
In screening a general or low-risk population, most Pap In screening a general or low-risk population, most Pap
results results
are normal.are normal.
In the United States, about 2-3 million abnormal Pap In the United States, about 2-3 million abnormal Pap
smear results are found each year. Most abnormal smear results are found each year. Most abnormal
results are mildly abnormal (ASC-US (typically 2-5% of results are mildly abnormal (ASC-US (typically 2-5% of
Pap results) or low-grade squamous intraepithelial Pap results) or low-grade squamous intraepithelial
lesion (LSIL) (about 2% of results)), indicating HPV lesion (LSIL) (about 2% of results)), indicating HPV
infection.[citation needed] Although most low-grade infection.[citation needed] Although most low-grade
cervical dysplasias spontaneously regress without ever cervical dysplasias spontaneously regress without ever
leading to cervical cancer, dysplasia can serve as an leading to cervical cancer, dysplasia can serve as an
indication that increased vigilance is needed.indication that increased vigilance is needed.
In a typical scenario, about 0.5% of Pap results are high-grade SIL (HSIL), In a typical scenario, about 0.5% of Pap results are high-grade SIL (HSIL),
and less than 0.5% of results indicate cancer; 0.2 to 0.8% of results indicate and less than 0.5% of results indicate cancer; 0.2 to 0.8% of results indicate
Atypical Glandular Cells of Undetermined Significance (AGC-NOS).Atypical Glandular Cells of Undetermined Significance (AGC-NOS).
As liquid based preparations (LBPs) become a common medium for testing, As liquid based preparations (LBPs) become a common medium for testing,
atypical result rates have increased. The median rate for all preparations with atypical result rates have increased. The median rate for all preparations with
low-grade squamous intraepithelial lesions using LBPs was 2.9% compared low-grade squamous intraepithelial lesions using LBPs was 2.9% compared
with a 2003 median rate of 2.1%. Rates for high-grade squamous with a 2003 median rate of 2.1%. Rates for high-grade squamous
intraepithelial lesions (median, 0.5%) and atypical squamous cells have intraepithelial lesions (median, 0.5%) and atypical squamous cells have
changed little.changed little.
Continue..Continue..
Abnormal results are reported according to the Bethesda Abnormal results are reported according to the Bethesda
system[16]. They include:system[16]. They include:
Squamous cell abnormalities (SIL) Squamous cell abnormalities (SIL)
Atypical squamous cells of undetermined significance (ASC-Atypical squamous cells of undetermined significance (ASC-
US)US)
Low-grade squamous intraepithelial lesion (LGSIL or LSIL)Low-grade squamous intraepithelial lesion (LGSIL or LSIL)
Atypical squamous cells - cannot exclude HSIL (ASC-H)Atypical squamous cells - cannot exclude HSIL (ASC-H)
High-grade squamous intraepithelial lesion (HGSIL or HSIL)High-grade squamous intraepithelial lesion (HGSIL or HSIL)
Squamous cell carcinomaSquamous cell carcinoma
Glandular epithelial cell abnormalities Glandular epithelial cell abnormalities
Atypical Glandular Cells not otherwise specified (AGC or Atypical Glandular Cells not otherwise specified (AGC or
AGC-NOS)AGC-NOS)
Endocervical and endometrial abnormalities can also be detected, Endocervical and endometrial abnormalities can also be detected,
as can a number of infectious processes, including yeast, herpes as can a number of infectious processes, including yeast, herpes
simplex virus and trichomoniasis. However it is not very sensitive at simplex virus and trichomoniasis. However it is not very sensitive at
detecting these infections, so absence of detection on a Pap does detecting these infections, so absence of detection on a Pap does
not mean absence of the infection.not mean absence of the infection.
Abnormal results are reported according to the Bethesda Abnormal results are reported according to the Bethesda
system[16]. They include:system[16]. They include:
Squamous cell abnormalities (SIL) Squamous cell abnormalities (SIL)
Atypical squamous cells of undetermined significance (ASC-Atypical squamous cells of undetermined significance (ASC-
US)US)
Low-grade squamous intraepithelial lesion (LGSIL or LSIL)Low-grade squamous intraepithelial lesion (LGSIL or LSIL)
Atypical squamous cells - cannot exclude HSIL (ASC-H)Atypical squamous cells - cannot exclude HSIL (ASC-H)
High-grade squamous intraepithelial lesion (HGSIL or HSIL)High-grade squamous intraepithelial lesion (HGSIL or HSIL)
Squamous cell carcinomaSquamous cell carcinoma
Glandular epithelial cell abnormalities Glandular epithelial cell abnormalities
Atypical Glandular Cells not otherwise specified (AGC or Atypical Glandular Cells not otherwise specified (AGC or
AGC-NOS)AGC-NOS)
Endocervical and endometrial abnormalities can also be detected, Endocervical and endometrial abnormalities can also be detected,
as can a number of infectious processes, including yeast, herpes as can a number of infectious processes, including yeast, herpes
simplex virus and trichomoniasis. However it is not very sensitive at simplex virus and trichomoniasis. However it is not very sensitive at
detecting these infections, so absence of detection on a Pap does detecting these infections, so absence of detection on a Pap does
not mean absence of the infection.not mean absence of the infection.
EffectivenessEffectiveness
Prior to the introduction of the Pap test, carcinoma of the cervix was a Prior to the introduction of the Pap test, carcinoma of the cervix was a
leading cause of cancer death in women. Since the introduction of the leading cause of cancer death in women. Since the introduction of the
Pap test, deaths caused by carcinoma of the cervix have been reduced Pap test, deaths caused by carcinoma of the cervix have been reduced
by up to 99% in some populations wherein women are screened by up to 99% in some populations wherein women are screened
regularly. A regular program of pap smear screening, with appropriate regularly. A regular program of pap smear screening, with appropriate
follow-up, can reduce cervical cancer incidence by up to 80%.follow-up, can reduce cervical cancer incidence by up to 80%.
Failure of prevention of cancer by the Pap test can occur for many Failure of prevention of cancer by the Pap test can occur for many
reasons, including not getting regular screening, lack of appropriate reasons, including not getting regular screening, lack of appropriate
follow up of abnormal results, and sampling and interpretation errors. In follow up of abnormal results, and sampling and interpretation errors. In
the US, over half of all invasive cancers occur in women that have never the US, over half of all invasive cancers occur in women that have never
had a Pap smear; an additional 10 to 20% of cancers occur in women had a Pap smear; an additional 10 to 20% of cancers occur in women
that have not had a Pap smear in the preceding five years. About one-that have not had a Pap smear in the preceding five years. About one-
quarter of US cervical cancers were in women that had an abnormal Pap quarter of US cervical cancers were in women that had an abnormal Pap
smear, but did not get appropriate follow-up (woman did not return for smear, but did not get appropriate follow-up (woman did not return for
care, or clinician did not perform recommended tests or treatment).care, or clinician did not perform recommended tests or treatment).
Adenocarcinoma of the cervix has not been shown to be prevented by Adenocarcinoma of the cervix has not been shown to be prevented by
Pap tests. In the UK, which has a Pap smear screening program, Pap tests. In the UK, which has a Pap smear screening program,
Adenocarcinoma accounts for about 15% of all cervical cancers.Adenocarcinoma accounts for about 15% of all cervical cancers.
Prior to the introduction of the Pap test, carcinoma of the cervix was a Prior to the introduction of the Pap test, carcinoma of the cervix was a
leading cause of cancer death in women. Since the introduction of the leading cause of cancer death in women. Since the introduction of the
Pap test, deaths caused by carcinoma of the cervix have been reduced Pap test, deaths caused by carcinoma of the cervix have been reduced
by up to 99% in some populations wherein women are screened by up to 99% in some populations wherein women are screened
regularly. A regular program of pap smear screening, with appropriate regularly. A regular program of pap smear screening, with appropriate
follow-up, can reduce cervical cancer incidence by up to 80%.follow-up, can reduce cervical cancer incidence by up to 80%.
Failure of prevention of cancer by the Pap test can occur for many Failure of prevention of cancer by the Pap test can occur for many
reasons, including not getting regular screening, lack of appropriate reasons, including not getting regular screening, lack of appropriate
follow up of abnormal results, and sampling and interpretation errors. In follow up of abnormal results, and sampling and interpretation errors. In
the US, over half of all invasive cancers occur in women that have never the US, over half of all invasive cancers occur in women that have never
had a Pap smear; an additional 10 to 20% of cancers occur in women had a Pap smear; an additional 10 to 20% of cancers occur in women
that have not had a Pap smear in the preceding five years. About one-that have not had a Pap smear in the preceding five years. About one-
quarter of US cervical cancers were in women that had an abnormal Pap quarter of US cervical cancers were in women that had an abnormal Pap
smear, but did not get appropriate follow-up (woman did not return for smear, but did not get appropriate follow-up (woman did not return for
care, or clinician did not perform recommended tests or treatment).care, or clinician did not perform recommended tests or treatment).
Adenocarcinoma of the cervix has not been shown to be prevented by Adenocarcinoma of the cervix has not been shown to be prevented by
Pap tests. In the UK, which has a Pap smear screening program, Pap tests. In the UK, which has a Pap smear screening program,
Adenocarcinoma accounts for about 15% of all cervical cancers.Adenocarcinoma accounts for about 15% of all cervical cancers.
Continue..Continue..
Estimates of the effectiveness of the United Estimates of the effectiveness of the United
Kingdom's call and recall system vary widely, but it Kingdom's call and recall system vary widely, but it
may prevent about 700 deaths per year in the UK. A may prevent about 700 deaths per year in the UK. A
medical practitioner performing 200 tests each year medical practitioner performing 200 tests each year
would prevent a death once in 38 years, while would prevent a death once in 38 years, while
seeing 152 women with abnormal results, referring seeing 152 women with abnormal results, referring
79 for investigation, obtaining 53 abnormal biopsy 79 for investigation, obtaining 53 abnormal biopsy
results, and seeing 17 persisting abnormalities results, and seeing 17 persisting abnormalities
lasting longer than two years. At least one woman lasting longer than two years. At least one woman
during the 38 years would die from cervical cancer during the 38 years would die from cervical cancer
despite being screened.despite being screened.
Since the population of the UK is about 61 million, Since the population of the UK is about 61 million,
the maximum number of women who could be the maximum number of women who could be
receiving Pap smears in the UK is around 15 million receiving Pap smears in the UK is around 15 million
to 20 million (eliminating the percentage of the to 20 million (eliminating the percentage of the
population under 20 and over 65). This would population under 20 and over 65). This would
indicate that the use of Pap smear screening in the indicate that the use of Pap smear screening in the
UK saves the life of 1 person for every UK saves the life of 1 person for every
approximately 20,000 people tested (assuming approximately 20,000 people tested (assuming
15,000,000 are being tested yearly). If only 15,000,000 are being tested yearly). If only
10,000,000 are actually tested each year, then it 10,000,000 are actually tested each year, then it
would save the life of 1 person for every would save the life of 1 person for every
approximately 15,000 people tested.approximately 15,000 people tested.
Estimates of the effectiveness of the United Estimates of the effectiveness of the United
Kingdom's call and recall system vary widely, but it Kingdom's call and recall system vary widely, but it
may prevent about 700 deaths per year in the UK. A may prevent about 700 deaths per year in the UK. A
medical practitioner performing 200 tests each year medical practitioner performing 200 tests each year
would prevent a death once in 38 years, while would prevent a death once in 38 years, while
seeing 152 women with abnormal results, referring seeing 152 women with abnormal results, referring
79 for investigation, obtaining 53 abnormal biopsy 79 for investigation, obtaining 53 abnormal biopsy
results, and seeing 17 persisting abnormalities results, and seeing 17 persisting abnormalities
lasting longer than two years. At least one woman lasting longer than two years. At least one woman
during the 38 years would die from cervical cancer during the 38 years would die from cervical cancer
despite being screened.despite being screened.
Since the population of the UK is about 61 million, Since the population of the UK is about 61 million,
the maximum number of women who could be the maximum number of women who could be
receiving Pap smears in the UK is around 15 million receiving Pap smears in the UK is around 15 million
to 20 million (eliminating the percentage of the to 20 million (eliminating the percentage of the
population under 20 and over 65). This would population under 20 and over 65). This would
indicate that the use of Pap smear screening in the indicate that the use of Pap smear screening in the
UK saves the life of 1 person for every UK saves the life of 1 person for every
approximately 20,000 people tested (assuming approximately 20,000 people tested (assuming
15,000,000 are being tested yearly). If only 15,000,000 are being tested yearly). If only
10,000,000 are actually tested each year, then it 10,000,000 are actually tested each year, then it
would save the life of 1 person for every would save the life of 1 person for every
approximately 15,000 people tested.approximately 15,000 people tested.
Experimental techniquesExperimental techniques
In the developed world result of cervical biopsy In the developed world result of cervical biopsy
guided by colposcopy is the "gold standard" for guided by colposcopy is the "gold standard" for
diagnosing cervical abnormalities after an diagnosing cervical abnormalities after an
abnormal pap smear. The procedure requires a abnormal pap smear. The procedure requires a
trained colposcopist and can be expensive to trained colposcopist and can be expensive to
perform. However, Pap smears are very perform. However, Pap smears are very
sensitive and some negative biopsy results may sensitive and some negative biopsy results may
represent undersampling of the lesion in the represent undersampling of the lesion in the
biopsy, so negative biopsy with positive biopsy, so negative biopsy with positive
cytology requires careful follow up.cytology requires careful follow up.
Experimental visualization techniques use Experimental visualization techniques use
broad-band light (e.g., direct visualization, broad-band light (e.g., direct visualization,
speculoscopy, cervicography, visual inspection speculoscopy, cervicography, visual inspection
with acetic acid or with Lugol's, and colposcopy) with acetic acid or with Lugol's, and colposcopy)
and electronic detection methods (e.g., and electronic detection methods (e.g.,
Polarprobe and in-vivo Spectroscopy). These Polarprobe and in-vivo Spectroscopy). These
techniques are less expensive and can be techniques are less expensive and can be
performed with significantly less training. They performed with significantly less training. They
do not perform as well as Pap smear screening do not perform as well as Pap smear screening
and colposcopy. At this point, these techniques and colposcopy. At this point, these techniques
have not been validated by large-scale trials have not been validated by large-scale trials
and are not in general use.and are not in general use.
In the developed world result of cervical biopsy In the developed world result of cervical biopsy
guided by colposcopy is the "gold standard" for guided by colposcopy is the "gold standard" for
diagnosing cervical abnormalities after an diagnosing cervical abnormalities after an
abnormal pap smear. The procedure requires a abnormal pap smear. The procedure requires a
trained colposcopist and can be expensive to trained colposcopist and can be expensive to
perform. However, Pap smears are very perform. However, Pap smears are very
sensitive and some negative biopsy results may sensitive and some negative biopsy results may
represent undersampling of the lesion in the represent undersampling of the lesion in the
biopsy, so negative biopsy with positive biopsy, so negative biopsy with positive
cytology requires careful follow up.cytology requires careful follow up.
Experimental visualization techniques use Experimental visualization techniques use
broad-band light (e.g., direct visualization, broad-band light (e.g., direct visualization,
speculoscopy, cervicography, visual inspection speculoscopy, cervicography, visual inspection
with acetic acid or with Lugol's, and colposcopy) with acetic acid or with Lugol's, and colposcopy)
and electronic detection methods (e.g., and electronic detection methods (e.g.,
Polarprobe and in-vivo Spectroscopy). These Polarprobe and in-vivo Spectroscopy). These
techniques are less expensive and can be techniques are less expensive and can be
performed with significantly less training. They performed with significantly less training. They
do not perform as well as Pap smear screening do not perform as well as Pap smear screening
and colposcopy. At this point, these techniques and colposcopy. At this point, these techniques
have not been validated by large-scale trials have not been validated by large-scale trials
and are not in general use.and are not in general use.
Thank YouThank You
For more information visit
http://docturs.com/dd/pg/groups/2392/cervical-smear-test-pap-test/
For more information visit
http://docturs.com/dd/pg/groups/2392/cervical-smear-test-pap-test/
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