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| |    The Pap Test by Marjorie Greenfield, M.D. reviewed by Laura Jana, M.D., F.A.A.P. A Pap test is a method used to determine if there are any abnormal cells on the surface or the lining of the cervix. The test is done during a pelvic examination by using a special small brush or flat stick to take a small sample of cells from these areas, to later be evaluated under a microscope. The Pap test helps to screen for cervical cancer and precancer; occasionally it provides evidence of other reproductive-tract cancers or infections. The benefit of the Pap test is that it often can bring to attention changes in cervical cells several years before these changes represent cancer. Because of this, the Pap test is extremely useful in preventing cervical cancer. Why get regular Pap tests? Pap tests sometimes fail to detect premalignant (or precancerous) lesions that are present. However, as it generally takes many years for such lesions to progress toward cancer, what may be missed one year will, it's hoped, be identified the next year. That's why yearly Pap tests are so valuable. If you are at very low risk for cervical cancer, you might be able to get Pap tests only once every three years--after two consecutive tests come back normal. Your practitioner can advise you whether this would be appropriate in your individual situation. What does an abnormal Pap mean? Abnormal Pap tests identify several types of cervical changes: atypical cells, low-grade lesions, high-grade lesions, and cancer. Sometimes the term mild dysplasia is used instead of low-grade lesion, and moderate or severe dysplasia is included in what is called high-grade. "Atypia" is the mildest type of pap abnormality and may represent cellular changes caused by infection, inflammation, or dysplasia. Dysplasia simply means abnormal (dys-) growth (-plasia) and signifies changes in the cervical cell structure (individual cell) and architecture (how the cells are put together). Dysplasia, particularly the high-grade type, sometimes progresses to cancer over a period of years if it goes untreated. Since the Pap test sample only includes cells that have been removed from the cervix, its results may underestimate the severity of dysplasia. This happens when the most severe lesion is not shedding cells at the time of the test or if the most abnormal cells escape notice when the technologist screens the slide. If a Pap test identifies an abnormality, it's necessary to further evaluate the cervix. This is usually accomplished by colposcopy. What causes dysplasia? Dysplasia is caused by a viral infection of the cervix. It most often develops in women who have been exposed to human papilloma virus (HPV). Some people with HPV have warts in the genital area, but the majority of these viral infections are asymptomatic. Condoms can help prevent transmission of the virus. What can I do to lower my risk of cervical cancer? There are several known ways to reduce your chances of developing dysplasia and cervical cancer. For one, don't take up the habit of smoking, and if you're already a smoker, quit now. Limit your number of lifetime sexual partners and practice safe sex. With Pap tests for regular screening, colposcopy and biopsies for follow-up of abnormal Pap tests, and treatment of significant dysplasia, most cervical cancer is preventable.
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