Editing Pap test (section)

===Effectiveness===
The Pap test, when combined with a regular program of screening and appropriate follow-up, can reduce cervical cancer deaths by up to 80%.<ref name=Arbyn10>{{cite journal |vauthors=Arbyn M, Anttila A, Jordan J, Ronco G, Schenck U, Segnan N, Wiener H, Herbert A, von Karsa L | title = European Guidelines for Quality Assurance in Cervical Cancer Screening. Second Edition—Summary Document | journal = Annals of Oncology | volume = 21 | issue = 3 | pages = 448–458 | year = 2010 | pmid = 20176693 | pmc = 2826099 | doi = 10.1093/annonc/mdp471 }}</ref>

Failure of prevention of cancer by the Pap test can occur for many reasons, including not getting regular screening, lack of appropriate follow-up of abnormal results, and sampling and interpretation errors.<ref name=DeMay>{{cite book| author = DeMay, M. | year = 2007 | title = Practical principles of cytopathology. Revised edition. | isbn = 978-0-89189-549-7| publisher = American Society for Clinical Pathology Press| location = Chicago, IL}}</ref> In the US, over half of all invasive cancers occur in females who have never had a Pap smear; an additional 10 to 20% of cancers occur in those who have not had a Pap smear in the preceding five years.{{citation needed|date=August 2024}} About one-quarter of US cervical cancers were in people who had an abnormal Pap smear but did not get appropriate follow-up (patient did not return for care, or clinician did not perform recommended tests or treatment).{{citation needed|date=May 2021}}

[[Adenocarcinoma]] of the cervix has not been shown to be prevented by Pap smears.<ref name=DeMay /> In the UK, which has a Pap smear screening program, adenocarcinoma accounts for about 15% of all cervical cancers.<ref>{{cite web | title=Cancer Research UK website | url=http://info.cancerresearchuk.org/cancerstats/types/cervix/incidence/ | access-date=2009-01-03 | url-status=dead | archive-url=https://web.archive.org/web/20090116222837/http://info.cancerresearchuk.org/cancerstats/types/cervix/incidence/ | archive-date=2009-01-16 }}</ref>

Estimates of the effectiveness of the United Kingdom's call and recall system vary widely, but it may prevent about 700 deaths per year in the UK.<ref name="pmid12714468">{{cite journal |vauthors=Raffle AE, Alden B, Quinn M, Babb PJ, Brett MT | title = Outcomes of screening to prevent cancer: analysis of cumulative incidence of cervical abnormality and modelling of cases and deaths prevented | journal = BMJ | volume = 326 | issue = 7395 | page = 901 | year = 2003 | pmid = 12714468 | pmc = 153831 | doi = 10.1136/bmj.326.7395.901 }}</ref>

Multiple studies have performed sensitivity and specificity analyses on Pap smears. Sensitivity analysis captures the ability of Pap smears to correctly identify women with cervical cancer. Various studies have revealed the sensitivity of Pap smears to be between 47.19 - 55.5%.<ref name=":0">{{Cite journal |date=December 2007 |title=Specificity, sensitivity and cost |url=https://www.nature.com/articles/nrc2287 |journal=Nature Reviews Cancer |language=en |volume=7 |issue=12 |pages=893 |doi=10.1038/nrc2287 |s2cid=43571578 |issn=1474-1768|url-access=subscription }}</ref><ref name=":1">{{Cite journal |last1=Najib |first1=Fatemeh sadat |last2=Hashemi |first2=Masooumeh |last3=Shiravani |first3=Zahra |last4=Poordast |first4=Tahereh |last5=Sharifi |first5=Sanam |last6=Askary |first6=Elham |date=September 2020 |title=Diagnostic Accuracy of Cervical Pap Smear and Colposcopy in Detecting Premalignant and Malignant Lesions of Cervix |journal=Indian Journal of Surgical Oncology |volume=11 |issue=3 |pages=453–458 |doi=10.1007/s13193-020-01118-2 |issn=0975-7651 |pmc=7501362 |pmid=33013127}}</ref><ref name=":2">{{Cite journal |last1=Nkwabong |first1=Elie |last2=Laure Bessi Badjan |first2=Ingrid |last3=Sando |first3=Zacharie |date=January 2019 |title=Pap smear accuracy for the diagnosis of cervical precancerous lesions |journal=Tropical Doctor |language=en |volume=49 |issue=1 |pages=34–39 |doi=10.1177/0049475518798532 |pmid=30222058 |s2cid=52280945 |issn=0049-4755|doi-access=free }}</ref> Specificity analysis captures the ability of Pap smears to correctly identify women without cervical cancer. Various studies have revealed the specificity of Pap smears to be between 64.79 - 96.8%.<ref name=":0" /><ref name=":1" /><ref name=":2" /> While Pap smears may not be entirely accurate, they remain one of the most effective cervical cancer prevention tools. Pap smears may be supplemented with HPV DNA testing.{{citation needed|date=October 2022}}