The Pap test
Pap test results
Questions to ask your doctor, nurse or nurse practitioner
Prevention
The Ontario Cervical Screening Program cannot provide help with individual medical questions.
The Pap Test
What is the Pap test?
A Pap test is one of many tests your doctor, nurse or nurse practitioner will do when you have a regular health check-up. The Pap test looks at the cells of your cervix. It can show unhealthy changes in these cells. Unhealthy cells can sometimes lead to cancer. It does not screen for ovarian cancer.
Why do I need a Pap test?
Cases of and deaths from cervical cancer have gone down by over 60% in the last 30 years, mostly due to screening using regular Pap tests. Yet, every week, about 10 Ontario women will get cancer of the cervix and three women will die from it. Many women who have cancer of the cervix have never had a Pap test. Having regular Pap tests and early treatment, if necessary, can prevent most cancers of the cervix.
How often should I have a Pap test?
The current Ontario Screening Guidelines recommend that women have a Pap test:
- Every year once you start having sex (this includes any sexual activity)
- If your tests are normal for three years in a row, then you will need a Pap test every two to three years -- ask your doctor or nurse about how often you should have a Pap test
It is important to continue having a Pap test after menopause (when your monthly periods stop). Ask your doctor or nurse if you still need a Pap test if you have had a hysterectomy (operation to remove part of or the whole uterus). Women who have sex with women and women who no longer have sex also need regular Pap tests.
Women over 70 can stop having Pap tests if they have had at least three normal tests in the past 10 years.
The risk of cancer of the cervix increases as you get older. Ask your doctor, nurse or nurse practitioner if YOU still need a Pap test.
What if I think I don't need a Pap test?
"I've never had a Pap test and never had a problem; I feel great!" Remember… changes in the cervix can occur without you knowing it. Only having regular Pap tests will help you to prevent problems before they happen.
"I'm afraid the test will hurt and I'll find it embarrassing."
You will become more comfortable with having Pap tests as you make it a regular part of your medical check-ups. Discuss the Pap test with your doctor or nurse to help you relax. You may also find it helpful to talk with someone you know who has had a Pap test. If you feel you can't ask your doctor or nurse for a Pap test, talk with a public health nurse about how to ask your doctor or nurse for the test.
What can I expect when having a Pap test?
This test only takes a few minutes. You may feel nervous or uncomfortable about having a Pap test. Choose a doctor or nurse you feel comfortable with. You can bring a friend or family member to stay with you while the test is being done.
You may have some mild spotting of blood (not your period) after this test. This is normal. You should check with your doctor or nurse if it seems a bit more than expected or if you are worried.
An internal exam should be done following your Pap test. The doctor or nurse will check your vagina, uterus, and ovaries with their gloved fingers.
When is the best time for a Pap test?
- When you do not have your period (monthly bleeding)
- When you have not had sex for 1 day (24 hours) before the test
- When you have not put anything such as foams or medicines in your vagina for two days (48 hours)
Where do I go for a Pap test?
A Pap test is done at your doctor’s office or at a community clinic. Check with your health provider or local public health unit for additional information..
Pap Test Results
How are Pap test results reported?
After your sample is taken, it is sent to a laboratory to be examined by trained professionals. It may take several weeks for the results of your Pap test to be sent back to your doctor or nurse's office.
Pap test results may be:
- normal (or negative)
- abnormal
- cancer of the cervix
Your doctor or nurse will call you only if there is a problem. Sometimes you may need to ask your doctor or nurse about your results. Most times, your Pap test results will be normal.
Often, unhealthy cells change back to healthy on their own. If you do have unhealthy cell changes, it is important that you talk to your doctor or nurse about what your results mean and what treatments are available.
What happens next?
If your test results are normal, you will need to have another test within 1 to 2 years. Ask your doctor or nurse when it is time for your next Pap test.
If your test results are abnormal, you may need to see your doctor or nurse for another Pap test in 6 to 12 months. You may also be referred to a specialist for treatment.
What if my tests results are abnormal?
If you find your Pap test is abnormal, you may be worried and wonder what it means. For most women, an abnormal Pap test result does not mean you have cancer. It may just mean that there are changes in the cells of your cervix. It may mean that you have a simple problem or infection that is easy to treat. These cells can be treated before they turn into cancer.
Early cell changes on the cervix are called abnormal cells, not cancer. For most women, the abnormal cells change back to normal on their own. For some women, the abnormal cells do not change back and may become cancer cells if they are not found and treated. These are called pre-cancerous cell changes.
Cancer of the cervix may take a long time to develop, and there are usually no warning signs and symptoms. Fortunately, the regular Pap test can find most abnormal cells on the cervix before they turn into cancer.
Follow up on your Pap test!
You took the first step when you had your Pap test. Following up on an abnormal Pap result is your next most important step! There are many treatments for abnormal cells on the cervix and cancer of the cervix. The important thing to remember is to talk with your doctor or nurse. Together, you can make a plan that is best for you.
Remember
- An abnormal Pap test result does not always mean you have cancer!
- Most pre-cancerous cell changes can be treated
- There are effective treatments for cancer of the cervix
Understanding your Pap test results.
It may take several weeks for your results to come back. Most often, your doctor or nurse will call you with your results only if they are not normal. Your doctor or nurse may use medical language. Feel free to ask questions if you don't understand your results. Your result will be in one of these groups:
Normal or negative
Everything is fine. The cells of your cervix are all the same in shape and size. You should continue to have regular Pap tests.
Cell changes
Some of the cells of your cervix have changed or are abnormal. These changes fall into four groups. Your doctor or nurse might use the medical short form for these groups:
- ASCUS: Mild cell changes
- LSIL: Moderate cell changes
- HSIL: Serious cell changes
- AGUS: Glandular cells in the cervix that are not normal
Cancer
Severe cell changes on your cervix that need specialized treatment. It is very important that you work with your doctor to treat your cancer. There are many good methods to successfully treat cancer of the cervix and the surrounding tissue.
You have treatment options
Your treatment plan will depend on the cell changes you have and your needs. Sometimes, your doctor or nurse will ask you to have another Pap test in 6 to12 months to see if your cells will change back to normal on their own. You may worry about waiting but remember that three out of four abnormal Pap test results return to normal by the next test. You may need Pap tests more often for a short period of time. Your doctor may suggest an HPV test.
It usually takes up to 10 years for abnormal cells to turn into cancer.
For more serious cell changes, you will be referred to a specialist who will look more carefully at your cervix with a colposcope. It is a special set of binoculars that helps your doctor see your cervix more clearly.
Your doctor may also take a biopsy (small piece of tissue from your cervix) for a closer look under a microscope in a lab. It is the only way to know for sure if the abnormal cells are cancer.
Cancer of the cervix can be treated with surgery, radiation, chemotherapy and other treatments.
Questions to ask your doctor, nurse or nurse practitioner:
If your test is Normal or Negative:
- When should I come back for my next Pap test?
If your test shows Abnormal cells:
- Do I have an infection and how will it be treated?
- How will the abnormal cells be treated?
- How will this affect my everyday life?
- After I have been treated, when should I have my next Pap test?
If your test shows cancer of the cervix:
- How will it be treated?
- Will the treatment affect my daily life?
- Will treatment affect my sex life or my ability to get pregnant?
- How far along is the cancer?
- How can I be sure that it hasn't spread to other parts of my body?
- After I have been treated, when should I have my next Pap test?
Prevention
What else can I do to prevent cancer of the cervix?
Protect yourself from Human Papillomavirus.
Take care:
- Eat well ( follow Canada’s Food Guide ), exercise regularly, manage stress and get enough rest to stay healthy and keep your immune system strong.
- Use condoms. They may not fully protect you from HPV, but they are effective protection against other sexually transmitted infections. HPV may be found on skin that is not covered by the condom.
Be aware:
- Smoking tobacco and breathing second-hand smoke can make mild cell changes on your cervix, progress to cancer.
- Each time you have a new sexual partner, your risk of getting HPV rises.
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