Skip to Main Content

We have a new app!

Take the Access library with you wherever you go—easy access to books, videos, images, podcasts, personalized features, and more.

Download the Access App here: iOS and Android

  • • Starting at age 21 or no more than 3 years after becoming sexually active, women should have a Papanicolaou (Pap) smear on a yearly basis until they have had three consecutive normal tests, after which the screening interval can be increased to every 3 years.
  • • All women whose test samples show cellular abnormalities, persistent atypical squamous cells, or atypical squamous cells of unclear significance that test positive for high-oncogenic-risk human papillomavirus (HPV) require referral for colposcopy and biopsy.

Cervical cancer is the second most common cancer in women worldwide. An estimated 466,000 new cases of cervical cancer are diagnosed each year, resulting in 231,000 deaths. The majority of these cases occur in countries that have limited or no effective screening programs. In the United States and other developed countries, rates of cervical cancer have markedly diminished over the past 30 years as a result of Pap smear screening. Despite this, more than 10,000 cases of cervical cancer are diagnosed in the United States each year, leading to almost 4000 deaths. Countries that initiate Pap screening experience decreases in cancer rates compared with countries that do not. For example, in the mid-1960s, Finland, Sweden, and Iceland all initiated Pap smear screening whereas Norway did not. In the subsequent 20 years, the incidence of cervical cancer did not change in Norway but dropped 50% in the other countries.

Despite widespread screening in the United States, about 50% of all women with cervical cancer have not had a Pap smear in the preceding 3 years and another 10% have not been screened in the past 5 years. Over 50 million Pap smears are obtained each year in the United States, and 7% (3.5 million) of these are abnormal. A woman who never has a Pap smear has a 3.5% risk for developing cervical cancer; this is reduced to 0.8% with Pap smear screening. Infection with high-oncogenic-risk HPV is found in most, if not all, cervical cancers. Detection of high-oncogenic-risk HPV types from cervical samples is now a part of routine clinical management to identify women with abnormal Pap smears who need further treatment

In 1928 George Papanicolaou initiated the sampling of vaginal cells, speculating that these cells would predict which women would develop cervical cancer. His initial findings were not appreciated by the general medical community, but he persevered and, together with Dr Herbert Traut, published a monograph in 1943 that eventually resulted in Pap smears becoming the standard of care in cervical cancer screening. The procedure they outlined was modified in 1947 by Ayre, who collected cervical cells directly using a wooden spatula.

Although the Pap smear (also called the Pap test) has reduced the incidence of cervical cancer by almost 75%, it is difficult to collect and read a Pap smear in a uniform manner. This lack of uniformity led to widespread confusion about what constituted an abnormal test result. The development of common ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.