Laboratory Tests Pap smear
The Papanicolaou (Pap) smear, in which cervical cells are collected and smeared on a slide for microscopic examination, is a widely used screen for precancerous or cancerous changes in cervical cells. There is general agreement that Pap screening should be done annually, along with a pelvic exam, starting at age 18 or when a woman becomes sexually active, whichever occurs first. However, the frequency with which you should have the test is a decision that should be made with your doctor based on your personal and medical history. Recent innovations in Pap testing include a new collection method called the ThinPrep, which involves placing the samples collected into a special liquid preservative instead of directly onto slides, and computerized slide analysis systems, such as the AutoPap – both aimed at improving the accuracy of detection of abnormal cervical cells.
HPV test HPV testing and typing is available. The American College of Obstetricians and Gynecologists (ACOG) released guidelines in August 2003 recommending that women 30 years or older be offered an HPV DNA test in addition to their Pap smear and pelvic exam as an additional screening tool for cervical cancer. (It was not recommended for screening those under 30 because there is an increased prevalence of HPV in this age group but it rarely causes cancer). The HPV DNA test detects the presence of the most common high-risk HPV types, although it does not determine the specific type. According to ACOG, if both the HPV DNA test and Pap smear are negative and the woman does not have an underlying health condition, such as HIV or immunosuppression, then the patient can wait for three years before having another Pap smear and HPV DNA test (but should continue to have their annual pelvic exam).
The HPV DNA test and Pap smear may be ordered on a more frequent basis to monitor positive HPV tests, abnormal Pap smear changes, and those patients who have underlying medical conditions, such as HIV or immunosuppression.
It is not usually necessary to determine the specific type or strain of HPV present, but if it is required, other DNA testing methods may be used. Determining the presence and specific strain of HPV in women who have abnormal Pap smears may offer doctors additional information about their patients’ risk of developing cervical cancer. However, more research is needed to understand the relationship between HPV and cervical cancer. Although there is a demonstrated link between some strains of HPV and an increased risk of cervical cancer, most women who are infected with HPV do not develop cervical cancer, and many women who do have cervical cancer do not have HPV. It is thought that there may be other factors involved, and HPV testing may eventually prove most useful as an adjunct test to the Pap smear.
Other tests
- Colposcopy - a follow-up test that involves putting a vinegar-like solution on the cervix and then using a magnifying instrument to look closely at the cervix, checking for abnormal areas. A Schiller test, may also be done, in which iodine is placed on the cervix, causing normal cells to turn brown and abnormal cells to show up as white or yellow.
- Biopsy - if abnormal areas are found on the cervix, small pieces of tissue will be removed for examination by a pathologist. A biopsy and microscopic evaluation is the only way to tell for sure whether abnormal cells are cancerous, precancerous, or reactive for some other reason.
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