Pap Smears and Management of Abnormal Smears

A pap smear (cervical cytology) is a test performed on cells from a woman’s cervix every two years.

Please note: As of 1 December 2017, in Australia pap smears are being phased out in favour of the HPV test which is required every five years instead of two. It is performed in the same way as pap smear but tests for the human papillomavirus (HPV) instead.

What does a pap smear test for?

Detection of abnormal cells provide an early warning of potentially pre-cancerous cells, which facilitates further testing, and hopefully prevention of cervical cancer.

Why get a pap smear?

A pap smear is a screening test for early detection of abnormal cells on the cervix. It is therefore generally a test performed on well women, without symptoms.

Symptoms of cervical cancer are relatively non-specific and overlap significantly with less serious gynaecological conditions, therefore a pap smear is the most reliable way to detect cervical cancer or pre-cancerous cells.

Symptoms such as vaginal bleeding after intercourse, irregular ‘spotting’, weight loss, vaginal discharge and pelvic pain are usually not associated with cervical cancer, but the deceptive nature of this disease means that regular pap smears are an essential part of any well-woman program.

How is a pap smear performed?

A pap smear is a simple test which can be performed by your GP or their practice nurse.

It involves a vaginal speculum examination, and gentle scraping of the cervix with a small wooden spatula, to remove the most superficial cells of the cervix.

These cells are then transferred to a glass slide and a fixative spray is applied to prepare the specimen for examination under a microscope. Some women experience discomfort during the procedure; this is usually mild and only lasts for a few seconds.

The specimen on the glass slide is sent to a pathology laboratory, where highly trained staff look at the cells under a microscope to detect subtle changes.

The results of the test may take several weeks to become available and are sent to your general practitioner.

Pap smear results explained

The results of a pap smear are usually categorised as one of the following:

• Normal
• Unsatisfactory sample
• Low-grade SIL – mild changes
• High-grade SIL – moderate or marked changes

Description and classification of abnormalities are frequently being updated in an attempt to achieve international standardisation and scientific accuracy, therefore different terminology may appear on your pap smear result.

The result may be accompanied by a recommendation, for example to repeat the test in 12 months. This recommendation may take into account previous abnormal smear results for the individual woman concerned.

Abnormal Pap Smear

It is natural to feel anxious or worried if you have just found out that your HPV test is positive (abnormal pap smear).

HPV is present in nearly all (99.7%) cervical cancer cases. However, not all HPV infections lead to cervical cancer.

Most women don't know they have HPV until they receive positive HPV test result. For most women the virus clears naturally in one to two years. However, in some cases HPV may take longer to clear from the body, increasing the risk of developing cervical cancer.

If HPV is found, additional tests will automatically be done on the same sample of cells in the laboratory. Your doctor will let you know what will happen next. Depending on the results of all of the tests, you might have a repeat cervical screening test in 12 months, to see if the HPV infection has cleared, or might have a follow-up procedure called a colposcopy.

It's important to remember that HPV infections usually clear on their own. Also keep in mind that most abnormal cells are not cervical cancer, and can usually be treated quickly and painlessly.

What if I’ve had an abnormal Pap test result before?

If a past Pap test picked up an abnormality, you will continue to have personalised care from your specialist or doctor. This might include regular appointments and tests for a period of time.

It is recommended that women of any age who have symptoms (including pain or abnormal vaginal bleeding or discharge) should see their GP immediately and be referred to a gynaecologist.