PAP Smear

James Metz, MD
Abramson Cancer Center of the University of Pennsylvania
Last Modified: November 1, 2001

There has been a dramatic decrease in the death rate from cervical cancer since the introduction of thePAP smear by Dr. Papiniculou in the 1940s. It rapidly became the most effective screening test forcancer ever introduced. The PAP smear can detect both precancerous changes and cancer of thecervix. By detecting lesions that are precancerous, specific treatments can be implemented toprevent a woman from ever developing cervical cancer. It is estimated there were 4,900 deathsdue to cervical cancer in 1998.

PAP smears are performed along with a pelvic exam by a physician or other specially trainedhealth care professionals. A speculum is inserted into the vagina so that the cervix can bevisualized. For those patients who have had a hysterectomy with removal of the cervix, the vaginalcuff is visually inspected. For those patients with an intact cervix, a sample of cells is taken fromthe outer portion of the cervix using a wooden or plastic spatula. A small brush is then used to takea second sample from the inner part of the cervix. Both of these samples are immediately placedon glass slides and preserved with a special spray. For those patients without a cervix, a sampleis taken from the vaginal cuff. Following the PAP smear, a pelvic exam is performed.

The American Cancer Society recommends that all women begin yearly PAP smears and pelvicexaminations at the age of 18 or when they become sexually active, whichever comes first. It isrecommended women continue with pelvic exams annually. PAP smears should be done annuallyfor at least three consecutive negative PAP smears in a row. The test may be done less often at thediscretion of the health care provider after 3 annual normal PAP smears.

For those patients who have been treated for a cervical or endometrial cancer, more frequent PAP smears are recommended. Typically, pelvic exams and PAP smears are performed every 3-6months in the first few years after completion of treatment with surgery or radiation therapy. Thehighest chance for recurrence of cancer is in the first 3 years, so judicious follow-up isrecommended.