PAP Test (Part One)

What is the PAP Test and how is it performed?

The PAP Test is a microscopic examination of cells taken from the cervix (neck of the womb) and/or vagina to observe their changes (precancerous, cancerous). It is also known as the Papanicolaou test or cervical/vaginal cytology. The PAP Test was first used as an examination method by Georgios Papanicolaou.

The PAP test can also be performed to detect vaginal or uterine infections. Infections and abnormal cells may be present without causing noticeable symptoms. Some of them may require treatment, while others may need further testing, or to be monitored over time.

Some strains of HPV (human papillomavirus), a very common sexually transmitted viral infection, may be associated with an increased risk of cervical cancer. The HPV DNA test may be advised simultaneously or following a pap test, especially for women over the age of 30.

Procedure:

• The patient's name (or corresponding number in the register) is marked on the glass slide
• The gynecologist takes a sample of cells from the cervix (surface layer) with a plastic or wooden spatula and spreads it on the slide.
• The material is quickly fixed by dipping the slide in a fixative liquid with 95% ethyl alcohol or by using a fixative spray (95% alcohol or 100% methanol).
• The slide is sent to the laboratory to be stained by the histopathology technician.
• The histopathologist examines the slide under a microscope.

Reasons for false negative tests:

• poor quality of material,
• its unsuitability,
• errors in interpretation by the examiner

When is it advised to perform the PAP Test?

The appropriate frequency for the PAP Test depends on age and sexual activity. The American College of Obstetricians and Gynecologists (ACOG) reviewed its 2009 guidelines to recommend that screening with Pap test should begin no earlier than age 21 and then should be performed every two years until the age of 29.

A PAP Test may not be required more than once every three years at the age of 30 and thereafter, with three consecutive normal tests and no presence of any other anomaly. ACOG also recommended that women over 30 have the option for an HPV DNA test along with the Pap test. If both are negative, testing should not be repeated more often than every three years.

If a woman has or has had a history of the following conditions, then the Pap test may be performed more frequently. Some of these conditions include:

- HIV
- The woman's mother used DES (diethylstilbestrol) when pregnant with her.
- Previous treatment for cancer or a situation called cervical intraepithelial neoplasia: 2 or 3 (CIN 2, CIN 3).

In other situations, a PAP Test is advised when a woman has multiple sexual partners, is pregnant, has abnormal vaginal bleeding, pain or itching.