Pap Test (Pap Smear)
A Pap test is sometimes called a Pap smear. It can be an option for cervical cancer screening for women and other individuals with a cervix. It can also be used to check cervical cells in some other situations.
What is a Pap test?
A Pap test is a test done on cells collected from the cervix (lower part of the uterus). In a lab, the cells are smeared on a glass slide and looked at closely under a microscope to see if there are changes in them that might be cancer or a precancer.
When might a Pap test be done?
A Pap test can be used as an option for cervical cancer screening, either:
- Along with an HPV test (known as a co-test), typically every 5 years
- By itself if an HPV test isn’t available, typically every 3 years
An HPV test alone (known as a primary HPV test) is the preferred way to screen for cervical cancer, but co-testing or a Pap test alone are acceptable options. To learn more, see the American Cancer Society Guideline for Cervical Cancer Screening.
A Pap test might also be done:
- As a follow-up test for an abnormal (positive) HPV test result
- If you have symptoms that are suspicious for cervical cancer
How should I prepare for a Pap test?
If you’re getting a Pap test, you can do several things to help make it as accurate as possible. This might include:
- Trying not to schedule an appointment for a time during your menstrual period. The best time is at least 5 days after your period stops.
- Not using tampons, birth-control foams or jellies, other vaginal creams, moisturizers, or lubricants, or vaginal medicines for up to 7 days before the Pap test.
- Not using a douche for 2 to 3 days before the Pap test.
- Not having vaginal sex for 2 days before the Pap test.
It's important to ask your health care team how to prepare for your Pap test.
What to expect when getting a Pap test
For this test, you’ll lie on an exam table with your feet in stirrups. Your health care provider will gently insert a speculum inside your vagina. The speculum is a metal or plastic duckbill-shaped instrument that keeps your vagina open so your cervix can be seen clearly.
Next, using a small spatula or brush, the provider will collect a sample of cells and mucus by lightly scraping the exocervix (see illustration in What Is Cervical Cancer?). A small brush or a cotton-tipped swab is then inserted into the opening of your cervix to take a sample from the endocervix.
If your cervix has been removed because you had a trachelectomy or hysterectomy as a part of treatment for a cervical cancer or precancer, cells from the upper part of your vagina, known as the vaginal cuff, will be sampled.
The samples are then sent to a lab to be checked for any abnormal changes.
Are there risks to getting a Pap test?
Although the Pap test is very good at finding cervical cancer and precancer, it’s not perfect. Some limits of the Pap test include:
- Sometimes a test might suggest that there is a precancer or cancer when there isn’t one. This is known as a false positive result. This might result in further tests and procedures.
- Some cell changes found with a Pap test might never become cervical cancer, but they might still result in further tests and treatments.
- While it’s not common, sometimes a test might miss a precancer or cancer. This is known as a false negative result.
Because this test isn’t perfect, it’s important to follow the recommended screening schedule in the American Cancer Society Guideline for Cervical Cancer Screening.
What's the difference between a pelvic exam and a Pap test?
Many people confuse pelvic exams with Pap tests.
The pelvic exam is part of a woman’s routine health care. During a pelvic exam, the health care provider looks at and feels the reproductive organs, including the uterus and the ovaries, and may do tests for sexually transmitted infections. Part of a pelvic exam includes gently inserting a speculum into the vagina so the health care provider can see the vaginal walls and the cervix. Pelvic exams may help find other types of cancers and reproductive problems.
A Pap test (and/or HPV test) can be done during the speculum part of a pelvic exam, but sometimes a pelvic exam is done alone. A Pap test is used to find early cervical cancer or precancers.
Understanding your Pap test results
The most widely used system for describing Pap test results is the Bethesda System (TBS). There are 3 main categories, some of which have sub-categories:
- Negative for intraepithelial lesion or malignancy (NILM)
- Epithelial cell abnormalities
- Other malignant neoplasms
You may need further testing if your Pap test shows any of the abnormalities below. To learn more, see Tests for Cervical Cancer.
This category means that no signs of cancer, precancer, or other significant abnormalities were found.
There may be findings that are unrelated to cervical cancer, such as signs of infection with yeast, herpes, or Trichomonas vaginalis (a type of sexually transmitted infection), for example. Specimens from some women may also show “reactive cellular changes”, which is how cervical cells look when infection or other inflammation is present.
This means that the cells lining the cervix or vagina show changes that might be cancer or precancer. This category is divided into several groups for squamous cells and glandular cells.
Squamous cell abnormalities
Atypical squamous cells (ASC)
This category includes two types of abnormalities:
- Atypical squamous cells of uncertain significance (ASC-US) describes cells that look abnormal, but it is not possible to tell if this is caused by infection, irritation, or precancer. Most of the time, cells labeled ASC-US are not precancers, but more testing, like an HPV test, is needed to be sure.
- Atypical squamous cells where high-grade squamous intraepithelial lesion (HSIL) can’t be excluded (ASC-H) is used to describe cells that look abnormal and are possibly a precancer that needs more testing and may need treatment.
Squamous intraepithelial lesions (SILs)
There are two categories of SILs:
- In low-grade SIL (LSIL) the cells look mildly abnormal. This might also be called mild dysplasia or cervical intraepithelial neoplasia grade 1 (CIN1).
- In high-grade SIL (HSIL) the cells look severely abnormal and are less likely than the cells in LSIL to go away without treatment. They are also more likely to develop into cancer if they are not treated. This might also be called moderate to severe dysplasia or cervical intraepithelial neoplasia grade 2 or 3 (CIN2 or CIN3).
Further tests are needed if SIL is seen on a Pap test result. If treatment is needed, it can cure most SILs and prevent invasive cancer from forming.
Squamous cell carcinoma
This result means that a woman likely has an invasive squamous cell cancer. Further testing will be done to be sure of the diagnosis before starting any treatment.
Glandular cell abnormalities
Atypical glandular cells (AGC)
This term is used when the glandular cells don’t look completely normal under the microscope but it isn't clear whether the changes are due to a harmless condition, like inflammation or infection, or something more serious like precancer or cancer. In this case, more testing is needed to find out for sure.
Adenocarcinoma
This result means that a woman likely has an invasive glandular cell cancer. Cancers of the glandular cells are called adenocarcinomas. In some cases, the doctor examining the cells might be able to tell whether the adenocarcinoma started in the endocervix, in the uterus (endometrium), or elsewhere in the body.
Further testing will likely be done to be sure of the diagnosis before starting any treatment.
This category is for other types of cancer that rarely affect the cervix, such as melanoma, sarcoma, and lymphoma.
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- References
Developed by the American Cancer Society medical and editorial content team with medical review and contribution by the American Society of Clinical Oncology (ASCO).
Eifel P, Klopp AH, Berek JS, and Konstantinopoulos A. Chapter 74: Cancer of the Cervix, Vagina, and Vulva. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 11th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2019.
Jhungran A, Russell AH, Seiden MV, Duska LR, Goodman A, Lee S, et al. Chapter 84: Cancers of the Cervix, Vulva, and Vagina. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, Pa: Elsevier; 2020.
National Cancer Institute. Physician Data Query (PDQ). Cervical Cancer Treatment – Health Professional Version. 2019. https://www.cancer.gov/types/cervical/hp/cervical-treatment-pdq. Updated February 6, 2019. Accessed on October 30, 2019.
National Cancer Institute. Understanding Cervical Changes: Next Steps After an Abnormal Screening Test. 2019. https://www.cancer.gov/types/cervical/understanding-cervical-changes#ui-id-2. Updated October 8, 2019. Accessed on November 1, 2019.
Perkins, R.B., Wolf, A.M.D., Church, T.R., et al. Self‐collected vaginal specimens for human papillomavirus testing and guidance on screening exit: An update to the American Cancer Society cervical cancer screening guideline. CA Cancer J Clin. 2025. Available at https://doi.org/10.3322/caac.70041
Last Revised: December 4, 2025
American Cancer Society medical information is copyrighted material. For reprint requests, please see our Content Usage Policy.
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