The SOGC provides the following public education pamphlets designed for patients, clinics and health-care facilities. This material has been reviewed and endorsed by the SOGC’s subject matter experts.
What is a Pap test?
This is a simple test that can help prevent cervical cancer. It is sometimes called a Pap smear. The Pap test detects cell changes on your cervix that, if left untreated for several years, could eventually turn into cervical cancer.
When changes in cervical cells are found early, they can often be treated effectively before they become dangerous -- regular Pap testing can reduce cervical cancer deaths by 70 per cent.
Your health-care provider will ask you to lie down on the examination table. He or she will insert a speculum into your vagina -- this tool may feel cold and slightly uncomfortable, but will not hurt. It will allow your health-care provider to see your cervix. Using a slender tool that sometimes has a small brush or cotton swab on the end, some cells will be taken from your cervix and sent to a laboratory for analysis. A Pap test takes only a few minutes. It may take the laboratory a few weeks to analyze the cells. Often, your health-care provider will contact you only if the results are abnormal.
How can I get a Pap test?
You can get a Pap test from your health-care professional, such as a family physician, midwife, nurse practitioner or gynaecologist.
How often should I have a Pap test?
In the past, national guidelines have recommended that you begin having Pap tests within three years of becoming sexually active or by age 21. You should have a Pap test once per year until you have had two normal test results in a row, and then you only need one every three years. You should continue having tests until you are at least 70 years old.
Each province and territory in Canada has its own protocols governing how often you should have a Pap test. Check the guidelines for your province or territory here.
Even if you have been vaccinated against the human papillomavirus (HPV), which is the root cause of many cervical cancer cases, it is still important to get regular Pap tests.
What is the difference between normal and abnormal results?
Sometimes Pap tests are unsatisfactory for example, because there weren't enough cells in the sample taken from your cervix. In this case, you will be informed that your Pap test needs to be repeated so that it can be accurately analyzed. If your test was satisfactory, you will have either a normal Pap test result or an abnormal Pap test result.
If you have a normal Pap test result, this means that no abnormal cells were found and you should continue having routine Pap tests. Every year, almost 400,000 Canadian women have an abnormal Pap test result. This means that there may be abnormal cells on your cervix and you will need further testing to learn more about those cells.
There are several potential causes for abnormal results. The cells on your cervix could be inflamed because of an infection (such as a yeast infection or a sexually transmitted infection). If you have mild abnormalities that suggest these causes, you will likely need to have another Pap test in six months, when a possible infection has had time to clear. Most abnormal cells on the cervix that are detected by a Pap test will clear without any treatment.
The abnormal cells could also be a very early sign of pre-cancer, or cancer itself. However, it is very unlikely that you have cancer: Pap tests are done to detect precancerous changes that can be treated before cancer starts and it can take some years for cancer to develop after an abnormal Pap test. If you have abnormal cells that could be related to cancer, you will be referred to a colposcopy clinic for further evaluation and treatment.
To examine the cervix better after an abnormal Pap test, you may need a colposcopy. Your health-care provider, usually a gynaecologist or colposcopist (lower genital tract specialist), will use a special solution on your cervix which causes abnormal cells to turn white. He or she will then use a colposcope to look at your cervix. This is a special instrument that shines a light on your cervix and magnifies it, like looking through binoculars.
Your health-care provider may take a tissue sample from your cervix for further testing in a laboratory. A colposcopy doesn't feel much different from a Pap test, although some women feel some cramping and bleed a little bit afterward. Your health-care provider will recommend treatment to remove the abnormal cells, depending on the results of the colposcopy and laboratory tests.
How are abnormal cells treated?
If testing shows that you have some changes on your cervix that could lead to cancer, your doctor may recommend cryosurgery, laser surgery or a LEEP procedure to remove the affected cells. Cryosurgery freezes cells off, laser surgery burns or vaporizes the cells off, and LEEP (Loop Electrosurgical Excision Procedure) removes the cells using a wire loop.
Rarely, women may have to have treatment more than once, because the treatments don't always reach all of the affected cells the first time. You may need more frequent Pap tests after treatment to see if it has worked and to keep an eye out for any more changes of your cervix.
More information on Pap testing