Pap test

This page was reviewed under our medical and editorial policy by

Ruchi Garg, MD, Chair, Gynecologic Oncology, City of Hope Atlanta, Chicago and Phoenix

This page was reviewed on November 17, 2021.

A Pap test, also known as a Pap smear, is a screening tool performed by a medical provider to look for abnormal changes to cells in the cervix, which connects the uterus and the vagina. Left untreated, abnormal cells may develop into cervical cancer and spread to other organs.

The sexually transmitted human papillomavirus (HPV) is the leading cause of cervical cancer. HPV can also cause vaginal, vulvar, penile, anal and oral cancers in both men and women. The pap test and the HPV test are the two screening methods for cervical cancer.

For decades, cervical cancer was the leading cause of cancer deaths in women. Since the American Cancer Society's (ACS) endorsement of the Pap test in the 1960s, the cervical cancer death rate in the United States has dropped by about 70 percent. Not only can the test find cervical cancer in its early stages, it can also detect changes in the cervix before cancer develops, which helps explain the decline in diagnoses. The ACS estimates that 13,820 new cases of cervical cancer will be diagnosed in the United States in 2024.

The average age of a cervical cancer diagnosis is 50.

What happens during a Pap test?

Pap tests are performed in the doctor’s office as part of a gynecological exam. An instrument called a speculum, which may be metal or plastic, is gently placed inside the vagina to expand it so the gynecologist can examine the vagina and cervix. Using a slender brush and spatula, a sample of cervical cells is collected and sent to the lab to check for the presence of abnormal cells. Sometimes, even if the cervix has been removed, samples may need to be taken from the vagina. The procedure takes only a few minutes and is painless for most women, though some women may find it uncomfortable. There may be a sensation of pressure when the speculum is inserted in the vagina. The test is often performed along with an HPV test, something known as co-testing, as both procedures examine cells from the cervix.

Pap test results typically come back within a few days. Abnormal cells don’t necessarily mean a woman has cancer. It may be an indication of:

  • Cervical dysplasia, meaning there are abnormal cells that aren’t cancerous (These abnormal cells may go away on their own, or they may develop into cancer if not caught and treated early.)
  • HPV or another infection
  • Inflammation, which may occur if the woman had sexual intercourse or used a diaphragm shortly before the Pap test

If your doctor is concerned about the test results, further testing will be recommended.

How often should a Pap smear be repeated?

Screening guidelines are issued by the U.S. Preventive Services Task Force (USPSTF), a group of independent experts who make screening recommendations for preventive services based on peer-reviewed evidence.

For women who are not at high risk for cervical cancer, the USPTF recommends that:

  • Women between the ages of 21 and 29 have a Pap test alone every three years.
  • Women between the ages of 30 and 65 have a Pap test and an HPV test every five years (known as co-testing), or a Pap test alone every three years.

The USPSTF does not recommend a screening test for:

  • Women older than 65 who have had regular screenings throughout their lifetime and who are not considered high risk for cervical cancer
  • Women younger than 21
  • Women who have had a hysterectomy that included removing the cervix and who do not have a history of a high-grade precancerous lesion or cervical cancer

What should I know about cervical cancer screening?

Regular screenings have been shown to save lives. The screening guidelines do not apply to women who have a history of high-grade precancerous cervical lesions or cervical cancer, in utero exposure to diethylstilbestrol (DES), or a compromised immune system.

What are the risk factors for cervical cancer?

Risk factors for cervical cancer include:

  • Family history that includes a biological mother who took the hormone drug Diethylstilbestrol (DES) to prevent miscarriage
  • Family history of cervical cancer
  • Certain strains of HPV
  • Sexual intercourse before the age of 18
  • Multiple sexual partners
  • A partner who has an HPV infection or who has had many sexual partners
  • History of smoking
  • A weakened immune system
  • Long-term use of birth control pills
  • Medical history that includes having had three or more full-term pregnancies
  • A full-term pregnancy before the age of 20
  • A diet low in fruits and vegetables

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