Q: My Pap test was abnormal — what should I do?
A: Don't panic. There are many things that can produce an abnormal result. To improve the reliability of the test, schedule your appointment two weeks after your menstrual period and refrain from having intercourse, or using vaginal contraceptives or douches for at least 48 hours before the test.
Q: I've already gone through menopause. Should I continue to have Pap tests?
A: Current guidelines suggest that if you are age 65-70 or older and your last three Pap tests were normal, you can stop having Pap tests; however, annual pelvic exams are still recommended.
Q: My health care professional has recommended a hysterectomy for invasive cervical cancer. How do I know if this is the right thing to do?
A: There are a number of diagnostic steps your health care professional should take before surgery, including a colposcopy and biopsy. Treatment regimens are always your choice and should be discussed thoroughly with your health care professional. Additionally, you should seek a second opinion from a gynecological oncologist before undergoing any surgical procedure. A gynecological oncologist is an obstetrician-gynecologist who has had special training in the care of women with cancers of the cervix, ovary, uterus and vulva.
Q: Is it true that there are new tests to replace the Pap smear?
A: There are several new technologies, but most are designed to improve the reliability of the Pap test, which is still the most widely used screening test to detect changes in cervical cells. Pap tests, like other early detection tests, are not 100 percent accurate. Still, when performed properly, the Pap smear detects a significant majority of cervical cancers — usually in the early stages when the likelihood of a cure is the greatest.
Q: How often should I have a Pap test?
A: The American Cancer Society recommends that screening begin three years after the beginning of vaginal intercourse, but no later than 21 years of age. If your health care professional uses regular Pap tests, you should continue annual screenings to age 30. If a liquid-based Pap test is used, screening can be performed every two years, provided results are normal. Once a woman turns 30 and has had three consecutive "normal" Pap tests, she can be screened every two to three years.
Women over 30 may also want to consider an HPV screening test that uses DNA-based technology to detect HPV in addition to the Pap test. The DNA-HPV screening may be performed at the same time as the Pap test.
However, women who are at an increased risk for developing cervical cancer (those with new or multiple sexual partners) should be screened more frequently. Women who have abnormal Pap test results should discuss subsequent tests and follow-up with their health care professionals.
Women who are 65-70 years or older and have had three previously normal Pap test results and no abnormal results in the past 10 years may stop screening for cervical cancer altogether.
Women who have had a total hysterectomy (removal of the uterus and cervix) may also stop screening unless the hysterectomy was performed because of cervical cancer or pre-cancer-related reasons, or you have a history of abnormal Pap smears. If the hysterectomy was performed to treat cervical cancer, more frequent Pap screenings may be recommended.
Q: I've avoided going to the health care professional for years and never even had a Pap test. What can I expect when I have the test?
A: A Pap test is a simple procedure: After a speculum (the standard device used to examine the cervix) is placed in your vagina, cells are skimmed from the surface of the cervix then smeared onto a glass slide. A sample is taken from the T-zone with a tiny wooden or plastic spatula, or a tiny brush. The cervix is the narrow neck of the uterus that opens into the vagina. For women who have had total hysterectomies, in which the cervix is removed, cells are taken from the walls of the vagina. The slide is delivered to a laboratory where a cytotechnologist (a lab professional who reviews your Pap test slides) and, when necessary, a pathologist (a health care professional who examines bodily tissue samples) examine the sample for any abnormalities. Each smear contains roughly 50,000 to 300,000 cells.
Q: I have cervical cancer and my health care professional has not recommended chemotherapy. I thought it was used for all cancers?
A: Depending on the stage of your cancer, sometimes radiation alone will be recommended as a treatment. However, clinical trials show that the combination of radiation therapy and chemotherapy with cisplatin is more effective than radiation alone for women with stage IB2 cervical cancer. This prompted the National Cancer Institute to recommend that chemotherapy be considered in all patients receiving radiation therapy for cervical cancer larger than four centimeters. If you're unsure of whether chemotherapy is an option for you, talk to your health care professional.
Q: My Pap test was reported as a false negative. What does that mean?
A: When a Pap test fails to detect an existing abnormality, the result is referred to as a false negative. Even under the best of conditions, there is always a small, but irreducible false negative rate. Several factors can contribute to a Pap test reporting a false negative:
- When irregular cells are located high in the cervical canal they are difficult to access under normal Pap test procedures
- Menstrual blood can mask abnormal cells; these cells would not be visible to the cytotechnologist
- An inadequate sample — when not enough cells were collected during the Pap test
- Human error, where the person reviewing the slide misinterpreted abnormal cells as normal
Q: I haven't had a Pap smear in several years because I don't have health insurance and can't afford it. Are there any options for me?
A: The National Breast and Cervical Cancer Early Detection Program provides breast and cervical cancer screening services to underserved women throughout the country, including 13 American Indian/Alaska Native organizations. Services are either free or provided on a sliding scale based on your income. For information about access in your area, call 1-888-842-6355 (select option 7) or log onto www.cdc.gov/cancer/nbccedp.
Additionally, Medicare provides 100 percent coverage for a Pap smear and 80 percent coverage of the pelvic examination once every 24 months. If you are at high risk for cervical or vaginal cancer, or if you are of childbearing age and have had an abnormal Pap smear in the preceding 36 months, Medicare covers these tests every 12 months.
Last medical review: 6/06
Last date updated: 1/07
Copyright 2007 National Women's Health Resource Center Inc. (NWHRC)