The Importance of a Pap Test

   The Papanicolaou test (also called Pap smear, Pap test, cervical smear, or smear test) is a screening test used in gynecology to detect premalignant and malignant (cancerous) processes in the ectocervix. Significant changes can be treated, thus preventing cervical cancer. The cervix is the lower part of the uterus (womb) that opens at the top of the vagina.

How the Test is Performed

The Pap smear is done as part of a gynecological exam. You will lie on a table and place your feet in stirrups to position your pelvis for examination. The health care provider will insert an instrument (speculum) into your vagina and open it slightly to see inside the vaginal canal.
The health care provider will take a sample of cells from the outside and just inside the opening of the cervix (cervical canal) by gently scraping the outside of the cervix with a wooden or plastic spatula, then inserting a small brush that looks like a pipe cleaner into the canal.
The cells are placed on a glass slide, or put in a bottle containing a preservative, and then sent to the lab for examination.
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How to Prepare for the Test

Tell your health care provider if you:

• Are taking any medications or birth control pills
• Have had an abnormal Pap smear
• Might be pregnant

Within 24 hours of the test, avoid:

• Douching
• Having intercourse
• Taking a tub bath
• Using tampons

Avoid scheduling your Pap smear while you have your period (are menstruating), because blood and cells from the uterus may affect the accuracy of the Pap smear. Empty your bladder just before the test.

How the Test Will Feel

You may have some discomfort, similar to menstrual cramps, and a feeling of pressure during the procedure. You may bleed a little bit after the test.

Why the Test is Performed

The Pap smear can detect cancerous or precancerous conditions of the cervix. Most invasive cancers of the cervix can be detected early if women have Pap tests and pelvic examinations.
Screening should start within 3 years after first having vaginal intercourse or by age 21. After the first test:

• Woman should have a Pap smear every 2 years to check for cervical cancer.
• If you are over age 30 or your Pap smears have been negative for 3 times in a row, your doctor may tell you that you only need a Pap smear every 3 years.
• If you or your sexual partner have other new partners, then you should have a Pap smear every 2 years.
• After age 65-70, most women can stop having Pap smears as long as they have had three negative tests within the past 10 years.
• If you have a new sexual partner after age 65, you should begin having Pap smear screening again.

Women who have had a total hysterectomy (uterus and cervix removed) and have not had any previous history of cervical dysplasia (abnormal cells), cervical cancer, or any other kind of pelvic cancer, may not need to have Pap smears.

Normal Results

A normal value is negative, meaning there are no abnormal cells present.
Note: Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

What Abnormal Results Mean

The current system divides the abnormal results into these main areas:

• ASCUS or AGUS (atypical cells of uncertain significance): These changes may be due to infection with HPV but may also mean there are precancerous changes present.
• LSIL (low-grade dysplasia) or HSIL (high-grade dysplasia): This means precancer changes are likely to be present; the risk of cancer is greater if the result is HSIL.
• Carcinoma in situ (CIS): This usually means the abnormal changes are likely to progress to cancer.
• Atypical squamous cells (ASC–H): This means abnormal changes have been found and may be HSIL.
• Atypical glandular cells (AGC): Cell changes are seen that suggest precancer of the upper part of the cervical canal or inside the uterus.

When a Pap smear shows abnormalities, further testing or follow-up is needed. The next step depends on the results of the Pap smear, your previous history of Pap smears, and risk factors you may have for cervical cancer.
This may include:

• Colposcopy-directed biopsy
• An HPV test to check for the presence of the HPV virus types most likely to cause cancer

For minor cell changes, doctors usually recommend having a repeat Pap smear in 3-6 months.

Risks

There are no risks involved.

Considerations

The Pap smear test is not 100% accurate. Cervical cancer may be missed in a small number of cases. Fortunately, cervical cancer develops very slowly in most women and follow-up Pap smears should identify worrisome changes in time for treatment.
The following drugs may affect Pap smears:

• Colchicine
• Compounds in cigarettes
• Estrogen
• Podophyllin
• Progestins
• Silver nitrate

Sources:
http://www.medicinenet.com/pap_smear/article.htm 
http://abcnews.go.com/Health/video/pap-smear-12772099
http://www.cbsnews.com/video/watch/?id=5721042n
Are Pap smears still necessary if I'm 62 years old and have had a hysterectomy?http://www.mayoclinic.com/health/pap-smear/AN00013

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Recommended Adult Immunization Schedule - 2011

 

1. Influenza vaccination
Annual vaccination against influenza is recommended for all persons aged 6 months and older, including all adults. Healthy, nonpregnant adults aged less than 50 years without high-risk medical conditions can receive either intranasally administered live, attenuated influenza vaccine (FluMist), or inactivated vaccine. Other persons should receive the inactivated vaccine. Adults aged 65 years and older can receive the standard influenza vaccine or the high-dose (Fluzone) influenza vaccine. Additional information about influenza vaccination is available at http://www.cdc.gov/vaccines/vpd-vac/flu/default.htm.
2. Tetanus, diphtheria, and acellular pertussis (Td/Tdap) vaccination
Administer a one-time dose of Tdap to adults aged less than 65 years who have not received Tdap previously or for whom vaccine status is unknown to replace one of the 10-year Td boosters, and as soon as feasible to all 1) postpartum women, 2) close contacts of infants younger than age 12 months (e.g., grandparents and child-care providers), and 3) healthcare personnel with direct patient contact. Adults aged 65 years and older who have not previously received Tdap and who have close contact with an infant aged less than 12 months also should be vaccinated. Other adults aged 65 years and older may receive Tdap. Tdap can be administered regardless of interval since the most recent tetanus or diphtheria-containing vaccine.
Adults with uncertain or incomplete history of completing a 3-dose primary vaccination series with Td-containing vaccines should begin or complete a primary vaccination series. For unvaccinated adults, administer the first 2 doses at least 4 weeks apart and the third dose 6–12 months after the second. If incompletely vaccinated (i.e., less than 3 doses), administer remaining doses. Substitute a one-time dose of Tdap for one of the doses of Td, either in the primary series or for the routine booster, whichever comes first.
If a woman is pregnant and received the most recent Td vaccination 10 or more years previously, administer Td during the second or third trimester. If the woman received the most recent Td vaccination less than 10 years previously, administer Tdap during the immediate postpartum period. At the clinician’s discretion, Td may be deferred during pregnancy and Tdap substituted in the immediate postpartum period, or Tdap may be administered instead of Td to a pregnant woman after an informed discussion with the woman.
The ACIP statement for recommendations for administering Td as prophylaxis in wound management is available at http://www.cdc.gov/vaccines/pubs/acip-list.htm.
3. Varicella vaccinationAll adults without evidence of immunity to varicella should receive 2 doses of single-antigen varicella vaccine if not previously vaccinated or a second dose if they have received only 1 dose, unless they have a medical contraindication. Special consideration should be given to those who 1) have close contact with persons at high risk for severe disease (e.g., healthcare personnel and family contacts of persons with immunocompromising conditions) or 2) are at high risk for exposure or transmission (e.g., teachers; child-care employees; residents and staff members of institutional settings, including correctional institutions; college students; military personnel; adolescents and adults living in households with children; nonpregnant women of childbearing age; and international travelers).
Evidence of immunity to varicella in adults includes any of the following: 1) documentation of 2 doses of varicella vaccine at least 4 weeks apart; 2) U.S.-born before 1980 (although for healthcare personnel and pregnant women, birth before 1980 should not be considered evidence of immunity); 3) history of varicella based on diagnosis or verification of varicella by a healthcare provider (for a patient reporting a history of or having an atypical case, a mild case, or both, healthcare providers should seek either an epidemiologic link with a typical varicella case or to a laboratory-confirmed case or evidence of laboratory confirmation, if it was performed at the time of acute disease); 4) history of herpes zoster based on diagnosis or
verification of herpes zoster by a healthcare provider; or 5) laboratory evidence of immunity or laboratory confirmation of disease.
Pregnant women should be assessed for evidence of varicella immunity. Women who do not have evidence of immunity should receive the first dose of varicella vaccine upon completion or termination of pregnancy and before discharge from the healthcare facility. The second dose should be administered 4–8 weeks after the first dose.
4. Human papillomavirus (HPV) vaccination
HPV vaccination with either quadrivalent (HPV4) vaccine or bivalent vaccine (HPV2) is recommended for females at age 11 or 12 years and catch-up vaccination for females aged 13 through 26 years.
Ideally, vaccine should be administered before potential exposure to HPV through sexual activity; however, females who are sexually active should still be vaccinated consistent with age-based recommendations. Sexually active females who have not been infected with any of the four HPV vaccine types (types 6, 11, 16, and 18, all of which HPV4 prevents) or any of the two HPV vaccine types (types 16 and 18, both of which HPV2 prevents) receive the full benefit of the vaccination. Vaccination is less beneficial for females who have already been infected with one or more of the HPV vaccine types. HPV4 or HPV2 can be administered to persons with a history of genital warts, abnormal Papanicolaou test, or positive HPV DNA test, because these conditions are not evidence of previous infection with all vaccine HPV types.
HPV4 may be administered to males aged 9 through 26 years to reduce their likelihood of genital warts. HPV4 would be most effective when administered before exposure to HPV
through sexual contact.
A complete series for either HPV4 or HPV2 consists of 3 doses. The second dose should be administered 1–2 months after the first dose; the third dose should be administered 6 months after the first dose.
Although HPV vaccination is not specifically recommended for persons with the medical indications described in Figure 2, “Vaccines that might be indicated for adults based on medical and other indications,” it may be administered to these persons because the HPV vaccine is not a live-virus vaccine. However, the immune response and vaccine


Source:
http://www.cdc.gov/vaccines/recs/schedules/adult-schedule.htm

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