Editing Pap test (section)

{{short description|Cervical screening test to detect potential cancers}}
{{redirect|Pap smear|the American musician|Pat Smear}}
{{more citations needed|date=July 2023}}
{{Infobox interventions
 | Name        = Papanicolaou test
 | Image       = High-grade squamous intraepithelial lesion.jpg
 | Caption     = High-grade squamous intraepithelial lesion
 | ICD10       =
 | ICD9        = {{ICD9|795.00}}
 | MeshID      = D014626
 | MedlinePlus = 003911
 | OtherCodes  =
}}
The '''Papanicolaou test''' (abbreviated as '''Pap test''', also known as '''Pap smear''' (AE),<ref>{{Cite web|url=https://medlineplus.gov/lab-tests/pap-smear/|title=Pap Smear: MedlinePlus Lab Test Information|website=medlineplus.gov|language=en|access-date=2018-11-07}}</ref> '''cervical smear''' (BE), '''cervical screening''' (BE),<ref>{{cite web |url=https://www.nhs.uk/conditions/cervical-screening/ |access-date=2018-09-04 |publisher=NHS |title=Cervical Screening|date=2017-10-20 }}</ref> or '''smear test''' (BE)) is a method of [[cervical screening]] used to detect potentially [[Precancerous condition|precancerous]] and [[cancer]]ous processes in the [[cervix]] (opening of the [[uterus]] or womb) or, more rarely, [[Human anus|anus]] (in both men and women).<ref>{{cite journal |last1=Lindsey |first1=Kimberley |last2=DeCristofaro |first2=Claire |last3=James |first3=Janet |title=Anal Pap smears: Should we be doing them? |journal=Journal of the American Academy of Nurse Practitioners |date=August 2009 |volume=21 |issue=8 |pages=437–443 |doi=10.1111/j.1745-7599.2009.00433.x|pmid=19689440 }}</ref> Abnormal findings are often followed up by more sensitive diagnostic procedures and, if warranted, interventions that aim to prevent progression to [[cervical cancer]]. The test was independently invented in the 1920s by the [[Greeks|Greek]] physician [[Georgios Papanikolaou]] and named after him. A simplified version of the test was introduced by the [[Canadians|Canadian]] obstetrician [[Anna Marion Hilliard]] in 1957.

A Pap smear is performed by opening the [[vagina]] with a [[speculum (medical)|speculum]] and collecting [[cell (biology)|cells]] at the outer opening of the cervix at the [[transformation zone]] (where the outer squamous cervical cells meet the inner glandular endocervical cells), using an [[Ayre spatula]] or a [[cytobrush]]. The collected cells are examined under a [[microscope]] to look for abnormalities. The test aims to detect potentially precancerous changes (called [[cervical intraepithelial neoplasia]] (CIN) or cervical dysplasia; the [[squamous intraepithelial lesion]] system (SIL) is also used to describe abnormalities) caused by [[human papillomavirus]], a sexually transmitted [[DNA virus]]. The test remains an effective, widely used method for early detection of precancer and cervical cancer. While the test may also detect infections and abnormalities in the [[Canal of the cervix|endocervix]] and [[endometrium]], it is not designed to do so.

Guidelines on when to begin Pap smear screening are varied, but usually begin in [[adult]]hood. Guidelines on frequency vary from every three to five years.<ref name="US2012">{{cite journal |last1=Moyer |first1=VA |last2=U.S. Preventive Services Task |first2=Force |date=Jun 19, 2012 |title=Screening for cervical cancer: U.S. Preventive Services Task Force recommendation statement. |journal=Annals of Internal Medicine |volume=156 |issue=12 |pages=880–91, W312 |doi=10.7326/0003-4819-156-12-201206190-00424 |pmid=22711081 |s2cid=36965456}}</ref><ref name=Saslow2012/><ref name="ACS">American Cancer Society. (2010). [http://www.cancer.org/Cancer/CervicalCancer/DetailedGuide/cervical-cancer-prevention Detailed Guide: Cervical Cancer. Can cervical cancer be prevented?] Retrieved August 8, 2011.</ref> If results are abnormal, and depending on the nature of the abnormality, the test may need to be repeated in six to twelve months.<ref name="ACOG">{{cite web | author = The American College of Obstetricians and Gynecologists | year = 2009 | url = http://www.acog.org/publications/patient_education/bp085.cfm | title = ACOG Education Pamphlet AP085&nbsp;– The Pap Test | location = Washington, DC. | access-date = June 5, 2010 | url-status = dead | archive-url = https://web.archive.org/web/20100615081510/http://www.acog.org/publications/patient_education/bp085.cfm | archive-date = June 15, 2010 }}</ref> If the abnormality requires closer scrutiny, the patient may be referred for detailed inspection of the cervix by [[colposcopy]], which magnifies the view of the cervix, vagina and vulva surfaces. The person may also be referred for [[HPV test|HPV DNA testing]], which can serve as an adjunct to Pap testing. In some countries, viral DNA is checked for first, before checking for abnormal cells.<ref>{{Cite web |date=2016-07-05 |title=Cervical cancer screening in England to use 'more accurate' viral DNA test |url=https://news.cancerresearchuk.org/2016/07/06/cervical-cancer-screening-in-england-to-use-more-accurate-viral-dna-test/ |access-date=2023-08-10 |website=Cancer Research UK - Cancer News |language=en-GB}}</ref> Additional biomarkers that may be applied as ancillary tests with the Pap test are evolving.<ref>{{Cite journal|last1=Shidham|first1=VinodB|last2=Mehrotra|first2=Ravi|last3=Varsegi|first3=George|last4=D′Amore|first4=Krista L|last5=Hunt|first5=Bryan|last6=Narayan|first6=Raj|date=2011-01-01|title=p16 INK4a immunocytochemistry on cell blocks as an adjunct to cervical cytology: Potential reflex testing on specially prepared cell blocks from residual liquid-based cytology specimens|journal=CytoJournal|language=en|volume=8|issue=1|pages=1|doi=10.4103/1742-6413.76379|pmc=045765|pmid=21369522 |doi-access=free }}</ref>