Q&A Topic: The Pap Test

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Elisa E. Burns, MD, FACOG

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Q. What does the Pap test do and what occurs?

A. The Pap test (or Pap smear) screens for pre-cancerous cellular abnormalities in a woman’s cervix. If abnormalities are found, you can be monitored or treated so you don’t develop cervical cancer. As a screen, the Pap smear identifies those women who need further evaluation. Cells are scraped from your cervix and examined for pre-cancerous changes in tissue. Depending on your age, history, and prior Pap test results, the cells might also be tested for high-risk types of the human papillomavirus (HPV), the most common cause of cervical cancer. Ninety-nine percent of cervical cancer cases are caused by the human papillomavirus, which is generally sexually transmitted.

Q. What are the next steps if my Pap results are abnormal?

A. If your cervical cells appear abnormal and/or you are positive for high-risk HPV, you may undergo a colposcopy, an examination of the cervix under magnification, to find areas most likely to have abnormal cells. If these are present, a biopsy is used to make a definitive diagnosis.  Not every woman with a positive biopsy result may need treatment. Among women between 20 to 30 years, cervical cell abnormalities often go away by themselves. More and more, we follow rather than treat women in this age range. We can do that because cervical cancer develops slowly. When an older woman receives a positive biopsy report, we are more likely to treat because the abnormalities don’t always go away on their own. We usually treat by surgically removing the abnormal area.

Q. How effective is the Pap test?

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. Routine Pap screening tests have decreased the rate of cervical cancer in the U.S. by 80 percent. Women who get screened for cervical cancer have an extremely low rate of this cancer.

Q. At what age should I start and stop having Pap tests?

A. Women are currently advised to start getting Pap tests at 21. In women under 21, there is a very low incidence of the type of high-grade abnormalities that will progress to cervical cancer. We delay the test to avoid overtreatment as these abnormalities will mostly go away on their own.  Screening after age 65 is not needed if a woman has had a recent history of normal Pap results.A specific protection for young women and young men is the Gardasil vaccine against HPV which induces immunity against some of the high-risk types of the HPV. The vaccine is best given between the ages of 11 and 13, but can be given up to age 27. It is recommended that women start having the HPV test along with their Pap test at age 30.

Q. How often should I receive a Pap test and do I need to ask for it? A. Its frequency depends on your age, history, prior results, and when you were last tested. If your Pap test and HPV test are negative, you are advised to repeat both tests in three years. Gynecologists perform Pap tests as a standard procedure.

Learn More About Dr. Burns
Director, Quality & Outcomes
Institute for Robotic & Minimally Invasive Surgery
Northern Westchester Hospital

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Northern Westchester Hospital is a proud member of Northwell Health.

Read Past Topics from Dr. Burns:
Robot-Assisted Gynecologic Surgery
Pelvic Organ Prolapse


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