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PAP
TESTS
Understanding
your results
The Manitoba Cervical Cancer Screening Program
is a program of Manitoba Health,
managed by CancerCare Manitoba
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What is a Pap test?
A Pap test is a test that may find changes in the
cervix.
During a Pap test, cells are taken from a woman’s
cervix, placed on a slide and sent to a lab for
assessment. In most cases, the cells are normal.
In some instances, cells will be abnormal.
These abnormal cells, called cervical dysplasia, are
not usually cancer. In most cases, they will never
become cancer. Sometimes these cells can over
time grow and become cancerous. A Pap test can
detect cervical dysplasia and alert your health
provider before this happens.
If the laboratory detects abnormal cells, your health
provider will be notified. You should be contacted
if the results are abnormal. At the time of your
Pap test, it is important to ask about how and
when you will be contacted.
Regular Pap tests with follow-up of abnormal changes
can prevent most cancer of the cervix. Most women
who get cancer of the cervix have not had a Pap test
or have not had one in over 5 years.
How often should I have a Pap test?
Most women need a pap test once a year for three
years. If those results are okay, then you need a
pap test only once every two years. Talk to your
doctor or nurse about what is best for you.
Where can I get a pap test?
To have a Pap test you need to go to a doctor,
nurse, clinic or nursing station. Check with your
health care provider to learn if you need to make
an appointment.
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What is the cervix and where is it
located?
The uterus (womb) is made up of two parts.
The upper part is the place where a baby grows.
The cervix is the lower
part of the uterus, joining
the womb to the vagina.
Abnormal cells (cervical
dysplasia) may develop
at this opening to the
womb.
FALLOPIAN TUBE
UTERUS
OVARY
CERVICAL CANAL
VAGINA
CERVIX
If my Pap test is abnormal, does it
mean I have cancer?
No it doesn’t
In most cases, cancer is not the reason for an
abnormal Pap test. The most common reason is
an infection of your vagina or cervix. Most of the
time, abnormal cells detected by a pap test will
disappear on their own without any treatment.
In some cases, however, these abnormal cells may
need to be treated. Most women who have
abnormal Pap test results and who have followup tests and/or treatment will never get cancer of
the cervix.
Keep all appointments after an abnormal Pap test.
Most cervical cancers could be prevented if women
had regular Pap tests with follow-up of abnormal
changes.
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Are Pap tests Accurate?
The pap test is still the most effective screening
test available for finding abnormal cells that may
lead to cervical cancer.
But it is not perfect!
A single pap test cannot be considered 100%
reliable for a number of reasons, including:
1. Abnormal cells may have been washed
away by douching, lubricants or sexual
activity before the test.
2. Cells may have been missed at the time
the test was taken
3. Abnormal cells on the slide were not
seen at the lab.
4. Normal cells were viewed as abnormal.
Most cervical cancers grow slowly. By having a
Pap test every two years, the chance of missing
abnormal cells will be reduced and the
opportunity for finding and successfully treating
abnormal cells is good.
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What does my Pap test results
really mean?
Although most Pap test come back as normal, about
one in ten tests comes back as abnormal. The
following is a description of the terms that are used
to explain a Pap test.
Terms used to describe the overall quality of the
sample of cells taken from your cervix:
Words You
Might See
What It Means
Satisfactory
for Evaluation
The lab was able to
examine the cells
on your Pap Test
Presence of
Transformation
Zone Cells
The presence of
transformation zone
cells simply describes
the area of the cervix
that the cells were
taken from.
Transformation zone
cells are not always
seen but a diagnosis
can still be made.
Unsatisfactory
for Evaluation
Sometimes there is a
problem looking at
the cells from your Pap
test. This may be
because not enough
cells were taken, there
was blood mixed in
with the cells, or for
many other reasons.
What You
Should Do
Have another Pap
test taken after
3 months.
This repeat test
is because of a
problem looking at
the cells and not
because of any
abnormal findings
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Terms used to describe the type of cells seen
on the slide:
Words You Might See
What It Means
Negative for Intraepithelial
Lesion or Malignancy
No abnormal cells were seen.
Organisms and/or
Inflammation
Organisms Reactive Repair
You probably have an infection or some
type of irritation to your cervix. Talk with
your doctor if you see the words:
trichnomonas, actinomyces, chlamydia or
herpes virus effects.
Endometrial cells
Endometrial cells could be of no significance
but could indicate the need for further
testing.
ASC-US
(Atypical scquamous cellsundetermined significance)
Cells on the cervix cannot be clearly
identified as abnormal or normal.
LSIL
(low-grade scquamous
intraepithelial lesions)
The laboratory has detected mild dysplasia
on your cervix.
HSIL
(high-grade scquamous
intraepithelial lesion)
Moderate to severe dysplasia was seen.
This result is more serious than LSIL, but it
is important to remember that in most
cases this is still dysplasia and not cancer.
ASC-H
(atypical scquamous cells –
cannot rule out HSIL)
Abnormal cells were seen and they may
be HSIL.
Scquamous carcinoma
You may have cancer.
AGC
(Atypical Glandular Cells)
There may be an abnormality of the
glandular cells of the cervix, uterus or ovary.
Return to your doctor or nurse anytime you have
abnormal bleeding, discharge or pain.
Do not wait for your next Pap test.
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What You Should Do
Have three tests with this diagnosis, one year apart, then you may
have Pap tests every two years.
e
with
It is important to remember that the Pap test is not used to find
sexually transmitted infections (STI). If you think you have a STI, tell
your doctor or nurse so you can talk about other tests.
or
nce
Talk to your doctor or nurse, as more tests may be required.
A repeat Pap test will be needed. If a result of ASC-US occurs again,
you will need a more sensitive test called a colposcopy.
sia
n.
t it
You will likely need a repeat Pap test in six months. If the LSIL persists,
you will need a colposcopy.
Your health provider will arrange for you to have a colposcopy.
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y
Your health provider will arrange for you to have a colposcopy.
Your health provider will arrange for you to have a colposcopy
and biopsy.
Your health provider will arrange for you to have a colposcopy.
ary.
This is important to do even if you had a recent Pap
test that was negative for intraepithelial lesion or
malignancy.
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What are rejected slides?
The lab will refuse slides if they are not labeled
properly, or are broken. If the slide is refused, the
lab will destroy it and there will be no report
available. You should have a repeat Pap test after
3 months. This repeat test is because of a problem
with the slide, missing or mismatched information
between the slide and the requisition not because
of any abnormal findings.
What if I need a repeat Pap test?
If you need a repeat Pap test, you should wait at
least 3 months in order to allow cells on the cervix
to grow back and be available for sampling.
You should schedule your repeat Pap test after:
•
Any vaginal or cervical infection, yeast
infection or STD has been treated (wait 2
weeks after your last dose of medicine).
•
Your period has stopped completely.
Also:
1. Do not use tampons, douches, creams
and/or foams for 48 hours before your
Pap test.
2. Do not have sexual intercourse for 24
hours before the test.
3. Tell your health provider if you have any
other health concerns or allergies.
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Abnormal cervical cells.
What next?
What is colposcopy?
A colposcopy refers to an examination of the
cervix and vagina using a low-powered
magnifying instrument known as a colposcope.
It is done to assess any abnormalities on your
cervix and to determine if any treatment is
necessary. A gynecologist who is specially
trained as a colposcopist does this examination.
You should:
- try to book the appointment for when you
are not menstruating
- tell the nurse or doctor if you are allergic
to iodine or shellfish before the exam
If you are pregnant, it is safe to have a
colpsocopy exam.
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You will lie down on an examination table
and place your feet in stirrups (foot holders
like those used in a pelvic exam) just as you
did for your Pap test. The specialist will gently
insert a speculum into your vagina in order
to separate the vaginal walls so your cervix
can be seen easily. The colposcope is then
placed close to the opening of your vagina.
The doctor will be able to see your cervix better
because of the use of the magnifying lens. In
some offices, a small monitor beside your
examination table will allow you to see your
own cervix, should you desire.
The doctor will stain the cervix with a staining
solution. The solution changes colour when
it touches unhealthy cells, so the doctor can
tell the difference between healthy cells
and abnormal ones. If there are
abnormal cells, a biopsy may be
performed at this time. The
entire colpsocopy procedure
takes between 15-20 minutes
and usually is not painful.
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Healthy cervix
through the
colposcope
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What are the treatments for
abnormal cells?
The treatments for abnormal cells are laser surgery,
LEEP or LLETZ, and cone biopsy. If you are having
any of these treatments you should before the test
tell the doctor or nurse:
-if you think your are pregnant
-if you are allergic to iodine or shellfish
What is laser surgery?
Laser surgery uses an intense, narrow beam of light
(called a laser beam) to remove abnormal cells.
Since a laser beam can be focused precisely on a
tiny area, it is frequently used as treatment for
cervical dysplasia.
The treatment takes about 10 minutes. You are
positioned similar to having a Pap test and a
speculum is placed into your vagina. Vinegar and
iodine solutions are put on the cervix. Local
freezing is then used. The laser beam is pointed
at the area of your cervix that needs treatment.
One common side effect of laser surgery may be
a watery discharge that will last up to two weeks.
Bring a pad for after the treatment.
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What is a LEEP?
LEEP is short for loop
electro surgical excision
procedure. It is usually
performed by the same
physician who performed
the colposcopy. It is
usually performed in the
office of the colposcopist.
The treatment takes about
10 minutes. You are
positioned similar to
having a Pap test and a
speculum is placed into
your vagina. Vinegar and
iodine solutions are put
on the cervix. After
freezing the area with local
anesthetic (freezing) an
electrical wire loop is
inserted into the vagina
and all the abnormal
tissue is removed. You
may feel a brief warm sensation.
You can expect a brown/black discharge for
about two weeks. Bring a pad for after the
treatment.
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What is a cone
biopsy?
A cone biopsy refers to
the removal of a coneshaped piece of tissue.
The tissue removed
provides a more
extensive sample for
diagnosis than a simple
biopsy. A cone biopsy
is usually done as a day
surgery procedure. If
cancer cells have been
detected, it will also
determine whether or not
these cells have spread to
other tissues.
Sometimes, the cone
biopsy is also the
treatment if the physician
has actually removed all
of the abnormal cells that
were present.
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How do I get my results?
You can obtain your results about any test
done for cervical cancer screening from:
• Your health care provider or
•
You can call the Manitoba Cervical
Cancer Screening Registry at
204-788-8626 or
toll free 1-866-616-8805 to have a
copy of your results mailed to you
free of charge.
Please refer to the Brochure:
“Registry - Facts and Information”.
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Related information available from:
Manitoba Cervical Cancer
Screening Program
5-25 Sherbrook St
Winnipeg, MB R3C 2B1
Toll free: 1-866-616-8805
204-788-8626
Bookmark
What every woman should know
about Pap tests
Brochures
Registry – Fact and Information
HPV – What everyone should know
about genital HPV
Video
Pap tests –
what every woman needs to know
Colposcopy –
what every woman needs to know
*Note - videos are available at all
public libraries in Manitoba*
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