Summary of reasons for<unk> ing patient's characteristic indication rationale under age 21, regardless of sexual history no<unk>  more harms than benefits age 20–25 until age 50–60<unk>  every 3–5 years if results normal broad recommendation over age 65; history of normal<unk> s no further<unk> ing recommendation of USPSTF, ACOG, ACS and ASCP; had total hysterectomy for non-cancer disease – cervix removed no further<unk> ing harms of screening after hysterectomy outweigh the benefits had partial hysterectomy – cervix remains continue<unk> ing as normal has received HPV vaccine continue<unk> ing as normal vaccine does not cover all cancer-causing types of HPV history of endometrial cancer, with history of hysterectomy discontinue routine<unk> ing<unk>  no longer effective and likely to give false positive Screening guidelines vary from country to country. In general, screening starts about the age of 20 or 25 and continues until about the age of 50 or 60. Screening is typically recommended every three to five years, as long as results are normal. American Congress of Obstetricians and Gynecologists (ACOG) and others recommend starting screening at age 21. Many other countries wait until age 25 or later to start screening. For instance, some parts of Great Britain start screening at age 25. ACOG's general recommendation is that people with female reproductive organs age 30–65 have an annual well-woman examination, that they not get annual<unk> s, and that they do get<unk> s at three to five year intervals. HPV is passed through skin to skin contact; sex does not have to occur, although it is a common way for it to spread. It takes an average of a year, but can take up to four years, for a person's immune system to control the initial infection. Screening during this period may show this immune reaction and repair as mild abnormalities, which are usually not associated with cervical cancer, but could cause the patient stress and result in further<unk> s and possible treatment. Cervical cancer usually takes time to develop, so delaying the start of screening a few years poses little risk of missing a potentially precancerous lesion. For instance, screening people under age 25 does not decrease cancer rates under age 30. HPV can be transmitted in sex between females, so those who have only had sex with other females should be screened, although they are at somewhat lower risk for cervical cancer. Guidelines on frequency of screening vary—typically every three to five years for those who have not had previous abnormal smears. Some older recommendations suggested screening as frequently as every one to two years, however there is little evidence to support such frequent screening; annual screening has little benefit but leads to greatly increased cost and many unnecessary procedures and treatments. It has been acknowledged since before 1980 that most people can be screened less often. In some guidelines, frequency depends on age; for instance in Great Britain, screening is recommended every three years for women under 50, and every five years for those over. Screening should stop at about age 65 unless there is a history of abnormal<unk>  result or disease. There is probably no benefit in screening people aged 60 or over whose previous<unk> s have been negative. If a woman's last three<unk>  results were normal, she can discontinue<unk> ing at age 65, according to the USPSTF, ACOG, ACS, and ASCP; England's NHS says 64. There is no need to continue screening after a complete hysterectomy for benign disease.<unk>  smear screening is still recommended for those who have been vaccinated against HPV since the vaccines do not cover all HPV types that can cause cervical cancer. Also, the vaccine does not protect against HPV exposure before vaccination. Those with a history of endometrial cancer should discontinue routine<unk> s after hysterectomy. Further<unk> s are unlikely to detect recurrence of cancer but do bring the risk of giving false positive results, which would lead to unnecessary further<unk> ing. More frequent<unk>  smears may be needed to follow up after an abnormal<unk>  smear, after treatment for abnormal<unk>  or biopsy results, or after treatment of cancer ( cervical, colon, etc ). Effectiveness The<unk> , when combined with a regular program of screening and appropriate follow-up, can reduce cervical cancer deaths by up to 80%. Failure of prevention of cancer by the<unk>  can occur for many reasons, including not getting regular screening, lack of appropriate follow-up of abnormal results, and sampling and interpretation errors. In the US, over half of all invasive cancers occur in females who have never had a<unk>  smear; an additional 10 to 20% of cancers occur in those who have not had a<unk>  smear in the preceding five years. About one-quarter of US cervical cancers were in people who had an abnormal<unk>  smear but did not get appropriate follow-up (patient did not return for care, or clinician did not perform recommended<unk> s or treatment). Adenocarcinoma of the cervix has not been shown to be prevented by<unk> s. In the UK, which has a<unk>  smear screening program, adenocarcinoma accounts for about 15% of all cervical cancers. 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. Results In screening a general or low-risk population, most<unk>  results are normal. In the United States, about 2–3 million abnormal<unk>  smear results are found each year. Most abnormal results are mildly abnormal (ASC-US (typically 2–5% of<unk>  results) or low-grade squamous intraepithelial lesion (LSIL) (about 2% of results)), indicating HPV infection. Although most low-grade cervical dysplasias spontaneously regress without ever leading to cervical cancer, dysplasia can serve as an indication that increased vigilance is needed. In a typical scenario, about 0.5% of<unk>  results are high-grade SIL (HSIL), and less than 0.5% of results indicate cancer; 0.2 to 0.8% of results indicate Atypical Glandular Cells of Undetermined Significance (AGC-NOS). As liquid-based preparations (LBPs) become a common medium for<unk> ing, atypical result rates have increased. The median rate for all preparations with low-grade squamous intraepithelial lesions using LBPs was 2.9% compared with a 2003 median rate of 2.1%. Rates for high-grade squamous intraepithelial lesions (median, 0.5%) and atypical squamous cells have changed little. Abnormal results are reported according to the Bethesda system. They include: * Squamous cell abnormalities (SIL) * Atypical squamous cells of undetermined significance (ASC-US) * Atypical squamous cells – cannot exclude HSIL (ASC-H) * Low-grade squamous intraepithelial lesion (LGSIL or LSIL) * High-grade squamous intraepithelial lesion (HGSIL or HSIL) * Squamous cell carcinoma * Glandular epithelial cell abnormalities * Atypical glandular cells not otherwise specified (AGC or AGC-NOS) Endocervical and endometrial abnormalities can also be detected, as can a number of infectious processes, including yeast, herpes simplex virus and trichomoniasis. However it is not very sensitive at detecting these infections, so absence of detection on a<unk>  does not mean absence of the infection. Image:Normal<unk>  (Cervical) Smear.Micrograph of a normal<unk>  smear Image:Low-grade sil and endocx.Micrograph of a<unk>  showing a low-grade intraepithelial lesion (LSIL) and benign endocervical mucosa.<unk>  stain. Image:Trichomonas<unk> .Micrograph of a<unk>  showing trichomoniasis. Trichomonas organism seen in the upper right.<unk>  stain. Image:Herpes simplex virus<unk> .Micrograph of a<unk>  showing changes of herpes simplex virus.<unk>  stain. Image:Adenocarcinoma on<unk>  1.Endocervical adenocarcinoma on a<unk> . Image:Candida<unk>  1.Candida organisms on a<unk> . Image:Herpes_simplex_virus_pap_test.Viral cytopathic effect consistent with herpes simplex virus on a<unk> . Image:Pap<unk>  normal.Normal squamous epithelial cells in premenopausal women Image:Pap<unk>  atropy.Atrophic squamous cells in postmenopausal women Image:Pap<unk>  endocervical cells.Normal endocervical cells should be present into the slide, as a proof of a good quality sampling Image:Pap<unk>  citolysis.The cytoplasms of squamous epithelial cells melted out; many Döderlein bacilli can be seen. Image:Pap<unk>  trichomonas.Infestation by Trichomonas vaginalis Image:Pap<unk>  abnormal.An obviously atypical cell can be seen Pregnancy<unk> s can usually be performed during pregnancy up to at least 24 weeks of gestational age.<unk> s during pregnancy have not been associated with increased risk of miscarriage. An inflammatory component is commonly seen on<unk>  smears from pregnant women and does not appear to be a risk for subsequent preterm birth. After childbirth, it is recommended to wait 12 weeks before taking a<unk>  because inflammation of the cervix caused by the birth interferes with<unk>  interpretation.
Pap test
Pregnancy test
Cervical screening
Anal Pap smear
Breast self-examination
Male genital examination
Colposcopy
Trichology