Papanicolaou test
Variant: Pap test
(păp‵-ă-nē'kă-low‵ 
)
[George Nicholas Papanicolaou, Gr.-born U.S. scientist, 1883–1962]
ABBR: Pap test
A cytological study used to detect cancer in cells that an organ has shed. The Pap test has been used most often in the diagnosis and prevention of cervical cancers, but it also is valuable in the detection of pleural or peritoneal malignancies and in the evaluation of cellular changes caused by radiation, infection, or atrophy.SYN: Pap smear.
Cellular material is collected and smeared on a glass slide. DNA hybrid testing for HPV can be done on the liquid-based specimen. When suspicious cells are identified, further testing may be performed on the same sample. Testing for human papilloma virus (HPV) is often performed if results show abnormal changes of uncertain significance. HPV is the primary risk factor for cervical cancer. Currently the two available technologies are Thin Prep Pap Test and Sure Path.
SEE: illus.
Since the introduction of the Pap test, death from cervical cancer in the U.S. has declined by 70%. Although interpretation of the test is subject to human error, a variety of developments have improved test accuracy, including use of computer-generated procedures for detection and examination of abnormal cells and mand ated reexamination of sample batches to test quality control. A woman may augment the accuracy and value of the Pap test by following these guidelines: Asking her health care provider about the quality of the laboratory evaluating the results; having an annual Pap test beginning by age 21 or when the woman becomes sexually active; scheduling the test during a time when she does not expect to be bleeding; abstaining from sexual intercourse and putting nothing in her vagina; providing a detailed medical history, including use of birth control pills or other exogenous hormones and results of past Pap tests; and requesting a second opinion on the Pap test if she is at risk for cancer of the reproductive tract.
As with any test, it is possible that human errors may influence results. It is important that the quality of performance of the technicians and physicians be periodically reviewed by persons not employed by the laboratory or hospital.Screening Recommendations: The American Cancer Society (ACS) and the American College of Obstetricians and Gynecologists (ACOG) both recommend that screening for cervical cancer begin about 3 years after a woman begins having vaginal intercourse, but no later than age 21. Annual Pap testing should continue until age 30. After age 30, the ACS says women can reduce test frequency to every 2 to 3 years if their health care provider uses the newer liquid-based Pap tests, which include human papillomavirus (HPV) typing. In young, sexually active women, certain types of HPV cause precancerous changes that can lead to cervical cancer. Women who have had a hysterectomy for benign conditions and who do not have a cervix no longer need to undergo screening.
Screening can stop at age 65 or 70 for those women who have never had positive findings on previous examinations, as long as they have no new risk factors for cervical cancer.
Certain women are at high risk for cervical cancer and may need more frequent testing than the general population. These include women with HPV, chlamydial, or HIV infection and those who are immunosuppressed as a result of other illnesses. Additional risk factors for cervical cancer include early age at first intercourse, a history of sexually transmitted illnesses, cigarette smoking or substance abuse, a previous history of cervical dysplasia, a history of multiple sexual partners, or having a sexual partner who has other partners with cervical cancer.
Patient Care: Because Pap testing has been effective in detecting the early stages of cervical cancer, health care professionals should advocate this procedure for their female patients and participate in health promotion efforts to increase the number of women who have the test done regularly.