Pap Test

British Columbia Specific Information

A Pap test, also known as a Papanicolaou test or pap smear, is a test used to determine if there are abnormal cells in the cervix. If abnormal cells are found, steps can be taken to try to prevent them from developing into cervical cancer. Cervical cancer is a disease in which the cells of the cervix become abnormal and start to grow uncontrollably, forming tumors. In Canada, a Pap test is the most effective and recommended screening test for cervical cancer. In B.C., it is recommended women aged 25-69 be screened every 3 years. To learn more about the cervical cancer screening program in B.C., including guidelines on who should be tested, visit BC Cancer Agency - Cervix Screening.

Approximately 70 per cent of all cervical cancer is caused by the human papillomavirus (HPV) types 16 and 18. The HPV vaccines, Cervarix^® (HPV2) and Gardasil^® (HPV4), protect against infection from certain types of human papillomaviruses (HPV). Health Canada approves the HPV vaccine Gardasil^® (HPV4) for use in women and men. Health Canada also approves the HPV vaccine Cervarix^® (HPV2) for use in women; however it is not currently approved for use in men.

Some groups are eligible to receive the vaccine for free. Those not eligible to receive the vaccine for free may purchase it from a pharmacy or doctor’s office. For information about the vaccine, including who is eligible to receive it for free, see HealthLinkBC File #101b Human Papillomavirus (HPV) Vaccine.

For more information about HPV see HealthLinkBC File #101a Human Papillomavirus (HPV) Infection and Genital Warts. For information on other HPV vaccine programs in B.C., visit ImmunizeBC - HPV (Human Papillomavirus).

Test Overview

A Pap test is done to look for changes in the cells of the cervix . During a Pap test, a small sample of cells from the surface of the cervix is collected by your doctor. The sample is then spread on a slide (Pap smear) or mixed in a liquid fixative (liquid-based cytology) and sent to a lab for examination under a microscope. The cells are examined for abnormalities that may point to abnormal cell changes, such as dysplasia or cervical cancer.

The recommended Pap test schedule is based on your age and on things that increase your risk. Talk to your doctor about how often to have this test.

Cervical cancer is often caused by a high-risk type of the human papillomavirus (HPV). Talk to your doctor about getting the HPV shots to prevent infection with the types of HPV that are most likely to cause cervical cancer.

Why It Is Done

A Pap test is done to look for changes in the cells of the cervix. Finding these changes and treating them when needed will greatly lower your chance of getting cervical cancer.

How To Prepare

Try to schedule the test when you're not having your period, since blood can interfere with the results of the test. If your bleeding is light, you may still be able to have a Pap test.
Do not use douches, tampons, vaginal medicines, sprays, or powders for at least 24 hours before your test.
Some doctors recommend that you avoid sex for 24 hours before a Pap test.
If you've had problems with pelvic examinations in the past or have experienced rape or sexual abuse, talk to your doctor about your concerns or fears before the examination.

How It Is Done

Before the test

You may want to empty your bladder before the examination.

You will need to take off your clothes below the waist and drape a paper or cloth covering around your waist.

You will then lie on your back on an examination table with your feet raised and supported by footrests. This allows the doctor to examine your external genital area, vagina, and cervix. You may want to wear socks to keep your feet warm while they are in the footrests.

During the test

The doctor will insert a speculum into your vagina. The speculum gently spreads apart the vaginal walls. This allows the inside of the vagina and the cervix to be examined.

Your doctor will collect several samples of cells from your cervix using a cotton swab, a brush (cytobrush or cervix brush), or a small spatula. Cells are collected from the visible part of the cervix as well as from its opening (endocervical canal). In women who don't have a cervix, cells from the vagina are collected if a Pap test is needed. The cells are smeared on a slide or mixed in a liquid fixative and sent to a lab to be looked at under a microscope.

How It Feels

You will feel more comfortable during your Pap test if you are relaxed. Breathing deeply and having a light conversation with your doctor may help you relax. Holding your breath or tensing your muscles will increase your discomfort.

You may feel some discomfort when the speculum is inserted. This is more likely if your vagina is irritated, tender, or narrow. You may also feel pulling or pressure when the sample of cervical cells is being collected.

Risks

There is very little chance of a problem from having a Pap test. You may have a small amount of vaginal bleeding after this test. And you may want to use a pad or panty liner to protect your clothes from any spotting.

Results

A normal result means that the test did not find any abnormal cells in the sample.
An abnormal result can mean many things. Most of these are not cancer. The results of your test may be abnormal because:
- You have an infection of the vagina or cervix, such as a yeast infection.
- You have an IUD (intrauterine device for birth control).
- You have low estrogen levels after menopause that are causing the cells to change.
- You have cell changes that may be a sign of precancer or cancer. The results are ranked based on how serious the changes might be.

There are many other reasons why you might not get a normal result. If the results were abnormal, you may need to get another test within a few weeks or months. If the results show changes that could be a sign of cancer, you may need a test called a colposcopy, which provides a more complete view of the cervix.

Sometimes the lab cannot use the sample because it does not contain enough cells or was not preserved well. If so, you may need to have the test again. This is not common, but it does happen from time to time.