Cervical cancer is one of the most common cancers worldwide and the Pap smear test is one of the best diagnostic tools available for detecting early abnormalities in the cells of the cervix. Not all Pap smear abnormalities are cancer.

The frequency of Pap smear tests is a commonly contested issue. Some doctors believe that every woman over the age of 18 years, who is sexually active, should be routinely tested annually. Many specialists on the subject believe that after three consecutive annual tests, only tri-annual testing is necessary. Some believe that women over the age of 65 years do not need to continue to be screened, especially if she has never had an abnormal result. Women who have risk factors that are associated with prevalence for cancer should have Pap tests regularly.

Historically, traditional pap smears have had a sensitivity of only 50%, so new devices have been recently developed to reduce the number of false-negative results. Research is continuing to further improve both the accuracy and the specificity of the tests.

An individual approach needs to be taken with pap tests, as there are several extenuating circumstances which can explain the results. The most important aspect is looking at Pap smear results in relation to the patient’s medical history, particularly their gynecological history. Of particular relevance is the early age of first intercourse or pregnancy, HIV, HPV, smoking, having had multiple sexual partners and a history of genital neoplasia.

Physical examination is still a useful tool in the diagnosis of cervical cancer, because the cervix will appear normal, or not, to the naked eye. If the doctor sees any abnormalities, then further investigation can be carried out. If there are abnormalities present, such as discharge, these could affect the Pap smear test, so should be carefully removed before the test sample is taken.

If Pap smear abnormalities are detected in a routine test, there are options available to the doctor.

• A repeat pap test may be ordered to check the results of the first one.
• A series of regular tests may be carried out.
• Examination of the patient again may find that there was inflammation present at the times of the Pap smear. This may be caused by candida, herpes, Chlamydia, trichomonas vaginalis or gardnerella vaginalis. After the infection has been treated, another Pap test will be needed with a follow-up done three to six months after that.
• If abnormal cells are discovered during a Pap test, but they are not conclusive for the presence of cancer cells, other factors will be considered, such as the presence of risk factors in the patient. This will determine the course of action to be taken. Possible repeat tests will be carried out at four to six month intervals, for two years, until three consecutive negative results are obtained.
• Some abnormal cells, typically low grade squamous intraepithelial lesions, often revert to normal on their own, without any medical intervention. A patient with no risk factors will have follow-up Pap tests every four to six months until three consecutive negative results are obtained, or other diagnostic procedures, like biopsy, may be considered.
• If more aggressive cell abnormalities are found, further diagnostic tests will be ordered to enable doctors to properly identify the cells. Appropriate treatment can then be commenced.