What this test measures
A wooden / plastic spatula and / or endocervical brush collects cells from the cervical transformation zone (squamocolumnar junction). Cells are smeared on a glass slide, fixed, stained with Papanicolaou stain, and examined microscopically. Bethesda 2014 reporting system classifies findings: NILM (normal), ASC-US, ASC-H, LSIL, HSIL, AGC, AIS, squamous cell carcinoma, adenocarcinoma. Used for cervical cancer screening since the 1940s; saved millions of lives globally.
Why it matters
Cervical cancer is the second most common cancer in Indian women (~75,000 deaths/year). India has ~1/5 of global cervical cancer deaths due to limited screening coverage. WHO's 90-70-90 elimination strategy calls for HPV vaccination (90% girls), screening (70% women 35 + 45 years), and treatment (90% precancer + invasive). Pap smear was the workhorse historically but is increasingly replaced by HPV DNA testing as primary screen (more sensitive). Pap remains valuable in resource-limited settings, as a co-test with HPV, and for triage of HPV-positive women.
How to prepare
Avoid sexual intercourse, vaginal medications, douching, and tampons for 48 hours before the test. Schedule outside menstrual period (ideally mid-cycle). Inform if you are pregnant or postmenopausal — sampling technique may differ.
Markers & reference ranges
Reference ranges below are typical adult values. Your lab's reported range may differ slightly based on the assay platform and patient demographics — always read your report against the range printed on it.
| Marker | Normal range | If low | If high |
|---|---|---|---|
| Pap Smear Result (Bethesda category)[1] | NILM (Negative for Intraepithelial Lesion or Malignancy) | NILM — normal; repeat in 3 years (conventional Pap alone) or 5 years (co-test with HPV). | ASC-US (Atypical Squamous Cells of Undetermined Significance) — repeat in 6-12 months or reflex HPV. LSIL (Low-grade SIL) — colposcopy and biopsy. ASC-H — colposcopy. HSIL (High-grade SIL) — colposcopy + biopsy + excision. AGC (Atypical Glandular Cells) — colposcopy + endocervical curettage + endometrial sampling. Squamous cell carcinoma / adenocarcinoma — urgent oncology referral. |
Bethesda 2014 categories and management
| Result | Next step |
|---|---|
| NILM (normal) | Re-screen in 3 years |
| ASC-US | Reflex HPV or repeat Pap in 6-12 months |
| LSIL | Colposcopy |
| ASC-H | Colposcopy (urgent) |
| HSIL | Colposcopy + biopsy + LEEP / excision |
| AGC | Colposcopy + endocervical curettage + endometrial biopsy |
| SCC / Adenocarcinoma | Urgent gynaecologic oncology referral |
Frequently asked questions
How often should I get a Pap smear?
Every 3 years for women 21-65 (conventional Pap alone) or every 5 years if co-tested with HPV. After hysterectomy for benign reasons, screening can be stopped.
Should I get HPV testing instead?
WHO now recommends HPV testing as primary screen (more sensitive than Pap, especially for adenocarcinoma). LBC (liquid-based cytology) is the cytology technology of choice when Pap is needed. Many guidelines combine HPV + Pap (co-testing).
Why avoid intercourse before the test?
Recent sexual activity, vaginal medications, or douching can interfere with cell collection and produce poor-quality smears.
What if my result says "atypical"?
ASC-US (atypical squamous cells of undetermined significance) usually doesn't mean cancer — it indicates mildly abnormal cells. Reflex HPV testing or repeat Pap in 6-12 months guides further action.
Is Pap smear painful?
Mildly uncomfortable — the speculum and brush cause brief pressure. Usually well-tolerated; takes 2-5 minutes.
Can the test miss cancer?
Conventional Pap has ~50-70% sensitivity for high-grade lesions per single test. Sensitivity rises with repeated screening. LBC and HPV testing improve sensitivity.
Related Histopathology / Cytology tests
Tests commonly ordered alongside PAP-Pap smear, or that help interpret an unexpected result.
Sources & references
- WHO — Cervical Cancer Screening · accessed 2026-05-30T00:00:00.000Z
- Bethesda System 2014 · accessed 2026-05-30T00:00:00.000Z
- FOGSI — Cervical Screening · accessed 2026-05-30T00:00:00.000Z
- ICO/IARC — India Cervical Cancer · accessed 2026-05-30T00:00:00.000Z
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