June 13, 2006

• What is a Pap examination?
• What can I learn from my Pap examination?
• Who should have a Pap examination?
• When is the best time to get a Pap examination?
• How often should I have a Pap examination?
• What does my doctor need to know about me?
• Are some women more at risk for cervical cancer than others?
• What are my responsibilities toward cancer detection?
• How reliable and accurate are Pap examinations?
• What makes a laboratory accredited?
• Can I question my doctor about the quality of the laboratory that will examine my Pap test?

No cancer screening test in medical history is as effective for early detection of cancer as the Pap examination. Since the Pap examination was introduced after World War II, death rates from uterine cervical cancer have decreased 70 percent in the U.S. Unfortunately, thousands of women still fail to have regular Pap examinations.

What is a Pap examination?
The Pap examination (sometimes called the Pap test or Pap smear) is named for George Papanicolaou, MD, a physician who pioneered this method of cancer detection in the 1930s.

A Pap examination is usually performed at the time of a pelvic examination, which can help detect signs of cancer in female organs other than the cervix. A Pap examination is a simple procedure in which your physician painlessly obtains cells from the surface of your cervix, often using a special brush to sample the area where most cancers begin to develop. The cells are placed on a glass slide, which is sent to a laboratory. At the laboratory, the cells are stained and then examined under a microscope by specially trained cytotechnologists. If an abnormality is found, a pathologist, a physician who specializes in laboratory medicine, studies the cells and makes the final interpretation.

The results of your Pap examination are reported to your doctor within several weeks. Many doctors notify patients of their examination results in writing or by telephone. Others ask patients to call the office for their results. No matter what your doctor’s preference, it’s important that you find out the results of your Pap examination.

What can I learn from my Pap examination?
The Pap examination is a screening test for cervical cancer. Its primary purpose is to detect early cervical cancer and pre-cancerous conditions. An abnormal Pap test often means pre-cancer, a change that can lead to cervical cancer if left untreated. If cancerous or pre-cancerous cells are found, the next step is a more thorough examination of your cervix, during which your physician will obtain tissue biopsies for a pathologist to study. Sometimes, an abnormal Pap test means there are uncertain cell changes that could be pre-cancerous or could be entirely benign, needing no further investigation. Your physician may recommend repeat Pap tests or tissue biopsies to explain these uncertain changes.

A Pap examination also may detect infections such as bacteria, yeast, or viruses. One kind of sexually transmitted virus is important to detect because of its link to cervical cancer. This virus is human papillomavirus (HPV), sometimes called “condyloma”, or genital warts.

Who should have a Pap examination?
The College of American Pathologists encourages annual pelvic exams and regular cervical cancer screening for all women beginning within three years after they have become sexually active or by age 21.

When is the best time to get a Pap examination?
If you are having menstrual periods, the best time for a Pap examination is during the two weeks following the end of menstrual flow. If you’ve reached menopause, you can schedule your Pap examination anytime.

To ensure that the cells your physician obtains during the exam are adequate for evaluation, you should abstain from sexual activity and avoid using vaginal douches or lubricants for 48 hours before the examination.

How often should I have a Pap examination?
The College of American Pathologists recommends that you have regular Pap and pelvic examinations. Cervical cancer takes time to develop into a deadly disease. With early detection by a Pap examination, cervical precancer or cancer can be treated with a high probability of cure. The pelvic exam is added insurance; it can help detect signs of cancer in female organs other than the cervix.

Lengthened intervals of cervical cancer screening may be appropriate for some women depending upon specific clinical circumstances, including age, high-risk human papillomavirus (HR-HPV) status, and other risk factors for cervical cancer.

What does my doctor need to know about me?
Your physician and the pathologist who reviews your Pap examination need answers to the following questions:

* Have you ever had an abnormal Pap exam in the past?
* Are you or have you been sexually active? Have you been exposed to any sexually transmitted diseases?
* Have you had vaginal infections or abnormal vaginal discharge?
* When was your last menstrual period?
* Have you had any spotting or abnormal bleeding?
* Are you taking medications such as antibiotics, birth control pills, hormone pills or creams, or medication for heart disease?
* Have you had surgery, chemotherapy, or radiation treatment?
* Are you pregnant?

Are some women more at risk for cervical cancer than others?
Any woman can develop cancer of the cervix, but you are at a higher risk if:

* You have had multiple sex partners or a male partner who has had multiple female partners. If your partner has had sex with other women, you are at high risk even if you have had only one partner.
* You have had genital warts.
* You had sexual relations before the age of 18.
* You previously had an abnormal Pap examination.

Although not having a Pap examination doesn’t cause cancer, you are at a greater risk if you have never had a Pap examination, or had your last one three or more years ago.

What are my responsibilities toward cancer detection?
If detected early, cervical cancer can be treated with a high rate of cure. Even better, most cases of cervical cancer can be prevented by detection and treatment of pre-cancerous lesions. Do your part and make an annual Pap and pelvic examination part of your total health care program. It could save your life.

How reliable and accurate are Pap examinations?
No other screening procedure in medical history is as effective for detecting cancer. As effective as the Pap examination is, however, it is not perfect. A single Pap examination cannot be considered 100 percent reliable for several reasons:

* the cell-sample obtained might not include abnormal cells.
* abnormal cells might have been washed away by douching, lubricants, or sexual activity.
* abnormal cells may have escaped detection.

There have been recent advances in both Pap smear preparation processes and screening. Computerized screening and thin-layer preparations are now available in many laboratories. These advances offer laboratories access to technologies that may improve the quality and accuracy of Pap smear screening.

Your best assurance that cervical cancer will be detected early is to schedule a Pap examination at regularly scheduled intervals and to make sure that the sample is studied at an accredited laboratory.

Here at PacRim Pathology we use: ThinPrep® Imaging System.

What makes a laboratory accredited?
Find out if the laboratory evaluating your Pap examination is accredited by the College of American Pathologists or another recognized accrediting body. Accreditation guarantees that the laboratory has been inspected by outside professionals and that the personnel use quality control and quality assurance procedures daily. In an accredited laboratory, you can be sure that pathologists and cytotechnologists who analyze your Pap test have the proper training and experience. To find out if the laboratory that evaluates your Pap examination is accredited, or for more information about women's health issues, visit www.cap.org.

Can I question my doctor about the quality of the laboratory that will examine my Pap test?
Certainly! You can and should make sure qualified personnel in an accredited laboratory will evaluate your Pap examination. Some questions you might ask include:

* What is the name of the laboratory and where is it located?
* Is the laboratory accredited? Is it ever inspected?
* Do you (the physician) have good communication with the pathologist at the laboratory where my Pap examination will be evaluated?
* Can I see a copy of my Pap examination report? Will you explain the results to me?
* Will the laboratory inform you if my cell sample is not adequate for study so another sample can be taken?

If the laboratory that your doctor uses is not accredited, you can request that your Pap examination be sent to an accredited laboratory. The mission of the College of American Pathologists, the principal organization of board-certified pathologists, is to represent the interests of the public, patients, and pathologists by fostering excellence in the practice of pathology worldwide.

Please note: The College of American Pathologists does not offer medical advice. This information is provided as a public service to help you better understand medical conditions. Consult your person physician to seek medical advice.

This information was drafted for the College of American Pathologists by it’s Public Affairs Committee with College experts in cytopathology.

Posted June 13, 2006