For Healthcare Professionals
Does this patient need a pap today?
Updated with ACOG PB 168, October 2016
Pap & colpo results interpretation
For Patients
Patient Section

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How old is the patient?

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Do any of these Special Circumstances apply to the patient?

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Recommendation

ACOG recommends the following for women with HIV:

Initiation and Continuation of Screening
Cytology only screening should begin within 1 year of onsent of sexual activity or if already sexually active, within the first year after HIV diagnosis, but no later than 21 years old.

Screening should continue throughout a woman's lifetime and should not stop at age 65


Screening Frequency
Younger than 30: If initial screening is normal, then repeat screening should be in 12 months. If there are 3 consecutive annual cytology screenings, then follow-up screening with cytology only should be every 3 years

30 or older: Screening with cytology alone or co-testing. After onc negative co-testing, next screening can be in 3 years; or after 3 consecutive annual cytology screenings are negative, then follow-up screening should be every 3 years


Abnormal Results
- NILM/HPV positive should be followed as in the general population

- Any cytology result of LSIL requires a colposcopy

- ASCUS cytology in women 21 and older: should be followed with reflex HPV testing. If HPV testing is not able to be completed then cytology should be repeated in 6-12 months, and any result of ASCUS or greater should be followed with colposcopy.

- ASCUS cytology in women younger than 21: repeat cytology in 6-12 months without reflex HPV testing.

- ASCUS with HPV negative (reflex or co-testing) can return to regular screening
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Recommendation

Routine, age-appropriate screening should continue for at least 20 years after, even if screening will continue past age 65.

If the treatment was completed in the past 2 years, be sure that correct initial post-treatment surveillance was completed.

Click continue below to figure out if you patient needs a pap smear today based on her age and last testing.

Please note that the age-based recommendation for future screening you receive may not be inline with the above. With this patient’s history, you should follow the above recommendation for length of future screening.

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Does the patient have a history of either of these:

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Recommendation

Screening no longer indicated
If hysterectomy was for ovarian or endometrial cancer, consultation with a Gyn Oncologist is prudent.
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Recommendation

Annual cervical cytology screening is reasonable.
ThePapApp team also suggests further consultation with either a Gynecologist or Gyn Oncologist as appropriate.
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Recommendation

Screening no longer indicated
If hysterectomy was for ovarian or endometrial cancer, cervical cancer screening is no longer recommended, but consultation with a Gyn Oncologist is prudent.
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Recommendation

This patient does not need a pap smear today.
This patient does not need a pap smear until she is 21 years old.
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Are results from last pap smear available?

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What was the last screening method used?

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Has there been adequate prior screening for this patient?

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Recommendation

This patient needs a pap smear today. This should be with cytology only.
Cytology only testing is recommended for this patient every 3 years until the age of 30. Annual testing should not be completed.
Note: HPV testing alone, without cytology, is not currently recommended as an appropriate screening method.
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Recommendation

Use you best clinical judgement to determine if pap smear is needed.
If there is a concern that her last pap smear was more than 3 years ago, or the last pap smear was abnormal it may be prudent to obtain a pap smear today.

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Years since last pap smear?

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Years since last co-testing?

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Recommendation

This patient needs a pap smear today. This should be with co-testing.
Co-testing every 5 years until adequate prior screening is completed is preferred for this patient.

Cytology screening alone can be done every 3 years as an acceptable alternative. Annual testing should not be completed.
Note: HPV testing alone, without cytology, is not currently recommended as an appropriate screening method by ACOG.
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Recommendation

This patient needs a pap smear today. This should be with co-testing.
Co-testing every 5 years until at least the age of 65 is preferred for this patient.

Cytology screening alone can be done every 3 years as an acceptable alternative. Annual testing should not be completed.

Note: HPV testing alone, without cytology, is not currently recommended as an appropriate screening method by ACOG.
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Recommendation

This patient needs a pap smear today. This should be with cytology ± reflex HPV.
Cytology with or without reflex HPV testing is recommended for this patient every 3 years until the age of 30.

Ages 21-24: Cytology only is prefered, reflex HPV testing is acceptable
Ages 25-29: Reflex HPV testing is prefered, cytology only is acceptable
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Recommendation

This patient needs a pap smear today. This should be done with co-testing.
Co-testing every 5 years until at least the age of 65 is preferred for this patient.

Cytology screening alone can be done every 3 years as an acceptable alternative.

Annual testing should not be completed.
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What was the most recent cytology result?

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Recommendation

This patient needs a pap smear today. This should be done with co-testing.
Co-testing every 5 years until at least the age of 65 is preferred for this patient.

Cytology screening alone can be done every 3 years as an acceptable alternative.

Annual testing should not be completed.
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Recommendation

This patient needs a pap smear today. This should be done with co-testing.
Co-testing every 5 years until adequate prior screening is completed is preferred for this patient.

Cytology screening alone can be done every 3 years as an acceptable alternative.

Annual testing should not be completed.
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What was the most recent cytology result?

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Recommendation

This patient does not need a pap smear today.
The next pap smear should be performed 3 years after most recent pap smear. Annual testing should not be completed.
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If reflex HPV testing was preformed, what was the result?

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HPV Status?

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HPV Status?

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Recommendation

Options for ASC-US cytology follow-up:
Ages 21-24: Repeat cytology in 12 months is preferred; (reflex HPV testing is acceptable)
Ages 25-29: Reflex HPV testing is preferred; (repeat cytology in 12 months is acceptable)

See the ASCCP guidelines for more information
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Recommendation

This patient may need a colposcopy. Next pap smear should be based on results of that colposcopy.
    Common Indications for colposcopy:
  • Any cytology of HSIL, ASC-H, AGC, regardless of HPV status
  • ASC-US or LSIL* with positive HPV testing
  • Positive HPV type 16 or 18 (regardless of cytology result)

*Note: LSIL in women age 21-24 should be followed by repeat cytology in 12 months. LSIL with negative HPV testing in women older than 30 should be followed by repeat co-testing in 12 months. LSIL in a woman older than 30 without HPV testing should be followed by a colposcopy. See ASCCP guidelines for more information
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Recommendation

This patient does not need a pap smear today.
The next pap smear should be performed with co-testing 5 years after most recent pap smear, unless the patient will be over 65 at that time and adequate prior screening has been attained.
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Recommendation

    Options for a cytology-negative/HPV-positive result:
  1. Immediate HPV genotype-specific testing for HPV type 16 (either with or without testing for type 18).
    If either genotype is found, then proceed directly to colposcopy. Women without HPV type 16 or 18 should follow the recommendation below.
  2. Repeat co-testing one year after most recent screeing.
    If results are the same (cytology-negative/HPV-positive), or cytology is LSIL or greater, then proceed directly to colposcopy.
ThePapApp team recommends that you confirm that the HPV genotyping test used by your lab is FDA approved.
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Recommendation

Screening can be discontinued.
Regardless of any new sexual partners.
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Recommendation

Screening should continue for at least 20 years after initial post-treatment surveillance, even if screening will continue past age 65.

Screening should be performed every 3 years with cytology only regardless of patient age

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Recommendation

ACOG has the following recommendation for immunocompromised women from non-HIV causes.
"No studies or major society recommendations exist to guide cervical cancer screening in women who are immunocompromised because of non-HIV causes. Annual cytology traditionally has been performed in these women, but it is reasonable to extrapolate the recommendations for women with HIV infection to this group."

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Years since last pap smear?

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Recommendation

This patient needs a pap smear today. This should be with cytology only.
Cytology only testing is recommended for this patient every 3 years until 20 years after initial post-treatment surveillance.
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Did the pathologist note any Atypical Endometrial Cells?

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Recommendation

Initial work-up for all subcategories of AGC except atypical endometrial cells:
Colposcopy (with endocervical sampling) and HPV testing for all patients. For those patients over 35 years old or at risk for endometrial cancer an endometrial biopsy is also indicated.

See the ASCCP guidelines for more information
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Recommendation

Initial work-up for Atypical Endometrial Cells:
Endometrial and endocervical biopsy. If no endometrial pathology is found you should then proceed to colposcopy.

See the ASCCP guidelines for more information
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What type of result would you like to interpret?

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What is the cytology result?

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What is the HPV status?

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Recommendation

Either option is acceptable follow-up:
1. Immediate HPV genotype-specific testing for HPV type 16 (either with or without testing for type 18). If either 16 or 18 is found, then the patient needs a colposcopy. If both 16 and 18 are not found, co-testing should be repeated in 1 year.

2. Repeat co-testing in one year If cytology is ≥ ASC or HPV is positive, then patient needs colposcopy. If cytology is NILM and HPV is negative co-testing should be repeated in 3 years.

ThePapApp team recommends that you confirm that the HPV genotyping test used by your lab is FDA approved.
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Recommendation

Routine screening; no follow-up is needed.
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Recommendation

If the patient is 29 or younger then no follow-up is needed.

If the patient is 30 or older, routine HPV testing is recommended, even with normal cytology results. If possible this testing should be ordered.
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What is the HPV status?

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Recommendation

This patient needs a colposcopy
Endocervical sampling is preferred in non-pregnant women with no lesions and in those with inadequate colposcopy. It is acceptable for others.
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Recommendation

1. Reflex HPV testing is the preferred follow-up option.
If positive then patient needs colposcopy. If negative co-testing should be repeated in 3 years.

2. Repeating cytology in 1 year is an acceptable option.
If cytology is ≥ ASC then patient needs colposcopy. If cytology is NILM than routine screening should be continued.
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Recommendation

Initial work up for AGC
For all types of AGC, except for atypical endometrial cells:
Colposcopy (with endocervical sampling). For those patients over 35 years old or at risk for endometrial cancer an endometrial biopsy is also indicated.

For atypical endometrial cells
Endometrial and endocervical sampling. If no pathology is found then proceed to colposcopy.
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How old is the patient?

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What is the histology result?

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What was the preceeding cytology/HPV status?

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Recommendation

Follow-up with co-testing in 12 months. No treatment is needed.
If HPV positive or cytology ≥ ASC then repeat colposcopy is needed. If both cytology and HPV are negative then age appropriate screening should resume in 3 years. (If this screening is HPV positive or cytology ≥ ASC then repeat colposcopy is also needed. If both negative then patient can return to routine screening).

If CIN1 persists for at least 2 years, treatment or follow-up are both acceptable options.
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Recommendation

All are acceptable follow-up options:
1. Observe with co-testing at 12 and 24 months.

For HSIL a diagnostic excisional procedure is needed.
For HPV positive or any cytological abnormality (other than HSIL) colposcopy is needed
If both HPV and cytology are negative, at both visits then patient can return to routine age-appropriate screening.

2. Review all findings
A change in diagnosis should be managed according to the ASCCP guidelines.

3. Perform a diagnostic excisional procedure
Not an option for pregnant patients.
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What is the histology result?

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What was the preceeding cytology?

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Recommendation

Repeat cytology in 12 months.
If ≥ ASC-H or HSIL then a repeat colposcopy is needed . If less than ASC-H or HSIL then repeat cytology in 12 months. (If this subsequent cytology is ≥ ASC then a repeat colposcopy is needed. If negative then patient can return to routine screening).
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Recommendation

Observe with colposcopy and cytology every 6 months for up to 2 years.
Possible results of observation:

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Recommendation

All are acceptable follow-up options:
1. Review all findings
A change in diagnosis should be managed according to the ASCCP guidelines.

2. Perform a diagnostic excisional procedure

3. Observe with cytology and colposcopy, performed at 6 and 12 months
If both are negative, return to routine screening. If either is HSIL, perform a diagnostic excisional procedure. All other results manage accordingly.
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Recommendation

A diagnostic excisional procedure should be performed (except in a pregnant patient).

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Was the colposcopy, adequate or inadequate? Is this recurrent disease?

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Recommendation

Either an excision or ablation of the T-zone should be performed (except in a pregnant patient).

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Recommendation

Co-testing should be performed at 12 and 24 months.
If both are negative the co-testing should be repeated in 3 years (if this testing is also negative, the patient can return to routine screening for at least 20 years, regardless of age).
If any testing is abnormal a repeat colposcopy is needed.
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Recommendation

A biopsy is needed.
If no CIN 2,3 is found than continue to observe with cytology and colposcopy.
if CIN 2,3 is found manage per ASCCP guidelines.
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What type of result would you like to interpret?

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What is the cytology result?

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Recommendation

Options for a pregnant patient with LSIL:
1. Colposcopy is the preferred follow-up option.
If no CIN 2, 3 is found, follow-up postpartum. If CIN 2, 3 is found then manage per the ASCCP guidelines.

2. Deferring colposcopy until at least 6 weeks postpartum is an acceptable follow-up option.
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What is the histology result?

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Recommendation

Postpartum follow-up per ASCCP guidelines.
Click below to determine the correct postpartum follow-up based on the colposcopy result and preceding cytology.

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Recommendation

Recommendations for a pregnant patient with an AGC pap smear:
After reviewing the pap smear, colposcopy and cervical biopsy can be considered, Endocervical curettage and/or endometrial biopsy should not be performed during pregnancy.

Referral may be warranted if more evaluation is considered.
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Recommendation

Screening for cervical cancer is not recommended for women under the age of 21.
According to ACOG Practice Bulletin #140: if a woman younger than 21 years is inadvertently screened and has an abnormal test result, the result should not be ignored and should be managed based on the guidelines for 21-24-year old women.
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What is the HPV status?

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Recommendation

Either of the following options is acceptable:
1. Colposcopy

2. Repeat cytology in 2-4 months
Results of this repeated cytology should be followper the ASCCP guidelines, taking into account HPV testing. If sample is unsatisfactory again colposcopy is recommended.
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Recommendation

Repeat cytology in 2-4 months.
Results of this repeated cytology should be followper the ASCCP guidelines, taking into account HPV testing. If sample is unsatisfactory again colposcopy is recommended.
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How old is the patient?

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What is the HPV status?

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Recommendation

HPV testing is the preferred next step.
Repeating cytology in 3 years is an acceptable alternative.
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How old is the patient?

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Recommendation

1. Repeat cytology testing in 12 months is the preferred follow-up option.
-If next cytology is ASC-H, AGC, or HSIL then colposcopy is needed.
-If result is NILM, ASC-US, or LSIL then cytology should be repeated again in 12 months.
-If this result is ≥ ASC then colposcopy is needed.
-If there are two consecutive negative results the patient can return to routine screening.

2. Reflex HPV testing is an acceptable follow-up option.
If positive the patient needs the follow-up outlined above. If negative patient can return to routine screening.
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How old is the patient?

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Recommendation

Repeat cytology testing in 12 months.
If next cytology is ASC-H, AGC, or HSIL then colposcopy is needed. If result is NILM, ASC-US, or LSIL then cytology should be repeated again in 12 months. If this result is ≥ ASC then colposcopy is needed. If there are two consecutive negative results the patient can return to routine screening.
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What is the HPV status?

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Recommendation

1. Repeat co-testing in 12 months is the preferred follow-up option.
If next cytology is ≥ ASC or HPV positive then colposcopy is needed.
If result is both cytology and HPV negative then co-testing should be repeated in 3 years.

2. Immediate colposcopy is an acceptable follow-up option.
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Recommendation

This patient needs a colposcopy.
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How old is the patient?

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Recommendation

This patient needs a colposcopy.
For women age 21-24 and in a pregnant woman of any age, immediate loop electrosurgical excision is unacceptable.
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Recommendation

This patient needs a colposcopy.
Coloposcopy should be with endocervical assessment.

For women 25 or older, unless they are pregnant, immediate loop electrosurgical excision is also acceptable.
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Recommendation

Repeat cytology in 3 years.
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What would you like to learn about?

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A pap smear is done by a healthcare provider during a pelvic exam. After placing a speculum into the vagina, he or she will use a small plastic brush or spatula to gently wipe some cells off the surface of the cervix. The cervix is the lowest part of the uterus; it is the part that can be seen or felt through the vagina. Some women find this type of exam to be relatively uncomfortable, but it should not be painful. The sample of cells will be sent to a lab for further evaluation and testing.

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Cervical cells are sent to a laboratory for evaluation by a doctor who specializes in looking at cells under a microscope. This is called “cytology testing.” The doctor will examine the sample to look for any abnormal or unhealthy appearing cells. These cells could indicate cancer of the cervix, or a problem that may lead to cancer in the future unless it is identified and treated.

For all women 30 and older, and some women 29 and younger, this sample will also be tested for a virus called the Human Papilloma Virus (HPV). Studies have shown that HPV is one of the causes of cervical cancer or abnormal cervical cells. The test will determine if you have certain high-risk types of HPV. While there are many types of HPV, there are only a few types that can lead to cervical cancer (the test looks only for the high risk types). Other types can cause genital warts or, rarely, other types of cancer. Most people that have HPV have no symptoms at all.

For more info about HPV click: www.cdc.gov/std/HPV/STDFact-HPV.htm
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Pap smears are designed to detect cervical cancer or abnormal cells that could indicate a problem that may lead to cancer in the future unless it is identified and treated. Two tests are done on the pap smear sample. The first test is called cytology and looks at the appearance of cervical cells under a microscope to identify abnormal or unhealthy cells. The second test identifies certain types of the human papilloma virus (HPV) that can be associated with cervical cancer. These two tests help you and your healthcare provider decide when you need to get your next round of testing, if other testing is needed, and what your risk of developing cervical cancer is. Depending on age, not all women get both tests done.

Many studies have show that women who get regular pap smears, according to the guidelines, are less likely to develop cervical cancer, or it is found much sooner when treating the cancer is easier.
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There are many online resources to learn more about pap smears and cervical cancer screening. ThePapApp team recommends the following:

Cervical cancer information from the CDC

Cervical cancer screening and pap smear information sheet from the US Preventive Services Task Force
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How old are you?

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The new pap smear guidelines (2012) recommend that most women under the age of 21 do not need a pap smear and that a woman’s first pap smear should be when she is 21 years old and not before. Being sexual active does not change this recommendation.

There are certain circumstances that can change this recommendation. These include, but are not limited to, such things as: a history of abnormal pap smears or other testing, a history of cancer of the cervix, ovaries or uterus, treatment for pre-cancer of the cervix, removal of the uterus (hysterectomy), organ transplants, infection with HIV/AIDS and exposure to diethylstilbestrol (DES).
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Most women between the ages of 21 and 29 need a pap smear every three years. The new pap smear guidelines (2012) recommend that a woman’s first pap smear should be when she is 21 years old and not before. Being sexual active does not change this recommendation.

For women age 21 to 29, only “cytology testing,” which looks for abnormal or unhealthy cells under a microscope, should be used. Testing for the Human Papilloma Virus (HPV) is only needed if abnormal cells are seen.

There are certain circumstances that can change this recommendation. These include, but are not limited to, such things as: a history of abnormal pap smears or other testing, a history of cancer of the cervix, ovaries or uterus, treatment for pre-cancer of the cervix, removal of the uterus (hysterectomy), organ transplants, infection with HIV/AIDS and exposure to diethylstilbestrol (DES).
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The new pap smear guidelines (2012) recommend that most women between the ages of 30 and 65 get a pap smear only every five years. The reason for this change from every 3 years, or in some cases every year, is that each pap smear sample is now tested two ways (this is called “co-testing”).

Cytology testing looks for any abnormal or unhealthy cells, and testing for the Human Papilloma Virus (HPV) can detect certain types of this virus that are associated with cervical cancer. If both of these tests are normal then testing can be spaced out to every five years, as long as there has been an appropriate pap smear history. This is considered the best testing strategy for most women in this age group.

An alternative testing plan is to get pap smears every three years and only do cytology testing to look for abnormal cells. In this case, testing for the Human Papilloma Virus (HPV) is only done if abnormal cells are seen. While this is an acceptable alternative, the “co-testing” strategy above is considered better and thus the recommended option.

There are certain circumstances that can change this recommendation. These include, but are not limited to, such things as: a history of abnormal pap smears or other testing, a history of cancer of the cervix, ovaries or uterus, treatment for pre-cancer of the cervix, removal of the uterus (hysterectomy), organ transplants, infection with HIV/AIDS and exposure to diethylstilbestrol (DES).
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The best pap smear screening strategy for women who are older than 65 can be more confusing than for younger women. Many women may be able to stop getting pap smears altogether if their last few pap smears were normal, and if they were done within in the past five to ten years.

For women older than 65 who have had some abnormal pap smears recently, have not had a pap smear in the past 5 years, or do not have records of their recent pap smears then the recommendations for women aged 30 to 65 should be followed.

You should talk with your healthcare provider about your personal pap smear history to figure out what is the best plan for you.

There are certain circumstances that can change this recommendation. These include, but are not limited to, such things as: a history of abnormal pap smears or other testing, a history of cancer of the cervix, ovaries or uterus, treatment for pre-cancer of the cervix, removal of the uterus (hysterectomy), organ transplants, infection with HIV/AIDS and exposure to diethylstilbestrol (DES).
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Cervical cancer is the 13th most common cancer of women in the United States – approximately 12,000 women in the United States were diagnosed with cervical cancer in 2010. However, throughout the entire world, cervical cancer is the 3rd most common cancer. There are so many fewer cases of cervical cancer in the United States because of screening tests like pap smears.

The Human Papilloma Virus (HPV) is the most common sexually transmitted infection in the United States according to the Center for Disease Control and Prevention (CDC). There are over 40 types of HPV, but only a few types can cause cancer. Some HPV types also cause genital warts. The CDC reports that by the age of 50, 4 out of every 5 women will have been infected with some type of HPV at one point in their lives. According to the World Health Organization 13% of women in the United States are estimated to have an HPV infection of their cervix at a given time. HPV is also very common among men, who often have no symptoms.
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    There are several ways which women can reduce their risk of developing cervical cancer:
  1. Get regular pap smears according to the most recent guidelines, or as often as your doctor recommends.
  2. If you are between the age of 11 and 26, you can get a vaccine against some types of Human Papilloma Virus (HPV). There are two types of HPV vaccine (Cervarix and Gardasil). Both Cervarix and Gardasil protect against HPV types that cause cancer. Gardasil also protects against some HPV types that cause genital warts. Both Cervarix and Gardasil require 3 injections to complete the full vaccine series - it is important to get all three injections.
  3. Don’t smoke (it increases your risk of developing cervical cancer, and many other types of cancer – not just lung cancer!)
  4. Use condoms during sex.
  5. Limit your number of sexual partners
For more informatoin on prevention, click here.
ThePapApp team reminds you that all patients must consult with a physician, doctor, or other healthcare provider before using any information from this tool
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About The App

ThePapApp: Version 2.1

ThePapApp is designed to help healthcare professionals answer two of the most common women's health questions: "does this patient need a pap smear today?" and "what do I do with this abnormal test result?" ThePapApp's screening tool will allow you to use your patient's demographic information and cervical cancer screening history to figure out if she needs a pap smear. The results interpretation tool will help you determine the next step after a screening or diagnostic test is performed. These references were used to develop ThePapApp, which was last updated October 17, 2016.

ThePapApp is a production of the Department of Obstetrics and Gynecology at the University of Massachusetts Medical School (© 2018).

ThePapApp was created and developed by Daniel Terk M.D. He is a graduate of the UMass Medical School and completed residency training in Obstetrics & Gynecology at the University of Rochester Medical Center / Strong Memorial Hospital. He currently works for UMass Memorial Medical Group in Leominster, Massachusetts. You can contact him at Dan@ThePapApp.org.

Professional guidance, academic support, and clinical supervision were provided by:

  • Tiffany A. Moore-Simas MD, MPH, MEd; Vice chair of Ob/Gyn
  • Joanna Cain MD; Professor of Ob/Gyn and Vice Chair for Faculty Development
  • Stuart Finkel of IstariNight Computing designed and developed ThePapApp.

    Abbreviations

    References

    Disclaimer

    TERMS AND CONDITIONS OF USE

    PLEASE READ THE FOLLOWING TERMS AND CONDITIONS ("Terms") CAREFULLY BEFORE CONTINUING. These Terms govern the relationship between the University of Massachusetts ("University"), a public institution of higher education of the Commonwealth of Massachusetts and you ("you" or "User"). The University is granting you the right to use the ThePapApp software tool ("Tool") only upon the condition that you accept all of the terms and conditions contained in these Terms. By clicking on the "Accept" button, or otherwise accessing or using the Tool, you accept all of the terms and conditions of these Terms and agree to be bound by its terms. If you do not accept the terms of these Terms, you are not permitted to use the Tool. Please click the "Cancel" button and do not access or use the Tool.

    1. Informational Purpose Only. The information provided by this Tool is for informational purposes only. No information offered by this Tool shall be construed as or understood to be medical advice or care. Clinical Users, including, but not limited to, Physicians, Doctors or Health Care providers, must individualize decision making to the specific patient or situation. Each patient's history and risk factors should be reviewed individually. The Tool should not be seen as an alternative to any part of the standard of care. Patient Users must consult with a physician, doctor or other healthcare provider before using any information from this Tool. In connection with this statement, please take particular care to read the Disclaimer of Warranty and Liability.
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    3. Disclaimer of Warranty and Liability. The Tool is made available on an "AS IS" basis. UNIVERSITY MAKES NO REPRESENTATIONS OR WARRANTIES CONCERNING THE TOOL AND EXPRESSLY DISCLAIMS ALL WARRANTIES, INCLUDING WITHOUT LIMITATION ANY EXPRESS OR IMPLIED WARRANTY OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, AND NON-INFRINGEMENT OF THIRD-PARTY INTELLECTUAL PROPERTY RIGHTS. You agree that the Tool is not a unique or irreplaceable means to conduct the relevant portion of your business, and consequently you have no right to specific performance under any circumstances. University has no obligation to assist in your use of the Tool or to provide services or maintenance of any type with respect to the Tool. The entire risk as to the quality and performance of the Tool is borne by you. You acknowledge that the Tool may contain errors or bugs. You must determine whether the Tool sufficiently meets your requirements. This disclaimer of warranty is an essential part of these Terms.
    4. No Consequential Damages; Indemnification. In no event is University liable to you for any damages resulting from lost profits or loss of data or for any special, incidental, punitive, indirect or consequential damages however caused and whether or not University has been made aware of the possibility of those damages. To the extent permitted by applicable law, you agree to indemnify, defend, and hold harmless University and its directors, officers, representatives, employees, and agents against all losses, expenses (including without limitation any legal expenses), claims, demands, suits, or other actions arising from your use of the Software.
    5. Miscellaneous. If any provision of these Terms is held to be unenforceable for any reason, that provision shall be modified only to the extent necessary to make it enforceable. You may not assign these Terms. These Terms is governed by and construed in accordance with the laws of the Commonwealth of Massachusetts irrespective of any conflicts of law principles. You agree that any legal action arising out of or in connection with these Terms shall be brought in the Massachusetts Superior Court in Suffolk County. The applicability of the United Nations Convention on Contracts for the International Sale of Goods is expressly excluded. These Terms constitutes the entire agreement between the University and you with respect to its subject matter and supersedes all prior agreements or understandings between the parties relating to its subject matter. These Terms may only be modified by a written agreement that is signed by duly authorized representatives of both parties and specifically references these Terms.
    Last updated on May 2, 2018

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    Contact Us

    Thanks for your interest in ThePapApp. You can contact ThePapApp team by emailing us at info@ThePapApp.org

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    We worked hard on creating ThePapApp and we would love to hear what you think about it. Email us at feedback@ThePapApp.org with your questions, comments or suggestions. We look forward to hearing from you.

    Adequate Prior Screening

      Adequate Prior Screening consists of either of the following:
    1. Three consecutive negative cytology results within the past 10 years, with the most recent testing within 5 years
    2. Two consecutive negative co-testing results within the past 10 years, with the most recent testing within 5 years

    Co-Testing

    Co-Testing:
    Cytology with routine high-risk HPV testing, (meaning HPV testing is done automatically with all samples).

    Initial post-treatment

      Initial post-treatment surveillance should consist of either of the following:
    1. Two consecutive negative cytology results, taken at 6 and 12 months after treatment
    2. Two consecutive negative high-risk HPV results, taken at 6 and 12 months after treatment