Talk:Pap test: Difference between revisions

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== ASCUS ==

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You have a lot of comments, so let me try to respond one by one:

• * I do not feel strongly about the graph, so I’ll remove it.

• * As mentioned in my other edits, there is a wealth of data that supports the use of HPV testing for routine screening of women 30+. See my full comments on page [insert link].

• * I have made clear in the revised edits below that in reference to the HPV test, sensitivity refers to CIN 3 and cancer (since I agree that sometimes CIN 2 is treated with “watch and wait.”) Note, though, that to be consistent, the sensitivity/specificity ranges cited for conventional and liquid-based cytology should have similar detail. Since most studies for cytology cite results for CIN 2+, I have updated the copy to include this parameter, as well as to include the most recent data. Likewise, for HPV testing, we can retain the lower end of the sensitivity/specificity ranges, but since the preponderance of recent data is now at the upper end, I have reflected that in my edits.

In addition: I have to disagree on one significant point. I consider sensitivity to be of equal importance to specificity. I – and my patients – would prefer to be told that they might be at risk, and then find out later they are fine, than to be surprised later with a diagnosis of invasive cancer. Most of the experts who speak at conferences on this topic agree. (Sensitivity is particularly important in low-resource countries, where frequent medical visits by women are not practical and a broader definition of “at-risk” is needed.)

• * I agree that annual screening is not the norm ex-U.S. and have reflected that in my revised edits. However, although you are right that there are other methods for following up on ASC-US Paps, and I acknowledge that in my revised edits, all of the experts at the various conferences I attend – as well as the literature -- regard triage with HPV testing to be the gold standard.

• * Finally, we can retain the reference to the April publication you mention, but then I would move it to the end of the conventional Pap section.

Thus, see my revised edited copy below:

However, it is not a perfect test. "A nurse performing 200 tests each year would prevent a death once in 38 years. During this time she or he would care for over 152 women with abnormal results, over 79 women would be referred for investigation, over 53 would have abnormal biopsy results, and over 17 would have persisting abnormalities for more than two years. At least one woman during the 38 years would die from cervical cancer despite being screened."[2] In addition, 2005 study published in the Journal of the National Cancer Institute found that 32% of invasive cervical cancers were due to Pap detection failure. Testing for HPV along with the Pap for women over 30, as well as the HPV vaccine, may offer better prospects in the long term.

***

•••

By adding the more sensitive HPV test, the specificity (correlation with actual disease) may decline. However, the drop in specificity is not significant.7

•••

***

Randomized, controlled trials have shown that the HPV test is significantly more sensitive in identifying women with cervical disease (CIN 2, 3 or cancer) than cytologyError! Bookmark not defined.,Error! Bookmark not defined.. It is FDA-approved for use along with the Pap for routine screening of women 30 and over, or as a follow-up evaluation of women of all ages with inconclusive cytology results.

Randomized, controlled trials have shown that the HPV test is significantly more sensitive in identifying women with cervical disease (CIN 2, 3 or cancer) than cytologyError! Bookmark not defined.,Error! Bookmark not defined.. It is FDA-approved for use along with the Pap for routine screening of women 30 and over, or as a follow-up evaluation of women of all ages with inconclusive cytology results.

***

Abnormal cell changes (called dysplasia or cervical/endocervical intraepithelial neoplasia) are almost exclusively caused by sexually transmitted human papillomaviruses (HPV).Error! Bookmark not defined. The Pap is designed to detect the existence of cervical cancer or potentially pre-cancerous lesions by sampling cells from the outer opening of the cervix (Latin for "neck") of the uterus and the endocervix.

•••

Abnormal cell changes (called dysplasia or cervical/endocervical intraepithelial neoplasia) are almost exclusively caused by sexually transmitted human papillomaviruses (HPV).Error! Bookmark not defined. The Pap is designed to detect the existence of cervical cancer or potentially pre-cancerous lesions by sampling cells from the outer opening of the cervix (Latin for "neck") of the uterus and the endocervix.

•••

***

In the United States, medical guidelines generally recommend that females begin getting an annual Pap smear three years after they first become sexually active or at the age of 21, whichever comes first. Practices differ in other countries, with routine Pap testing often recommended every three to five years. If a Pap result is inconclusive or appears abnormal, further evaluation is needed with repeat cytology or – as many experts now recommend -- an HPV DNA test (which looks for the presence of the virus that is the primary cause of cervical cancer). Whatever method is used for follow-up evaluation – repeat cytology or HPV DNA testing – a colposcopy exam is normally performed if results are abnormal.

The HPV DNA test also is approved in the United States for routine screening of women over 30, when they are most at risk of developing cervical cancer, along with a Pap. If both the Pap and HPV test results are normal, U.S. guidelines recommend re-testing once every three years. Research conducted in Europe and elsewhere, however, suggests that re-testing could be delayed even further – to five or six years – since the HPV DNA test is so sensitive in identifying women at risk.

•••

***

A report in the International Journal of Cancer found that about one-third of cervical cancers occurred in women whose last Pap smears had appeared normal. In the United States, physicians who fail to diagnose cervical cancer from a Pap smear have been convicted of negligent homicide. In 1988 and 1989, Karen Smith had received Pap smears which were argued to have "unequivocally" shown that she had cancer; however, the lab had not made the diagnosis. She died on March 8, 1995. Later, a physician and a laboratory technician were convicted of negligent homicide. These events have led to even more rigorous quality assurance programs, and to emphasizing that this is a screening, not a diagnostic test, associated with a small irreducible error rate. This concern about missing pre-cancerous cells and cancer has also been one of the driving forces behind increased adoption of HPV DNA testing in addition to cytology for older women.

A study published in April 2007 suggested the act of performing a Pap smear produces an inflammatory cytokine response, which may initiate immunologic clearance of HPV, therefore reducing the risk of cervical cancer. Women who had even a single Pap smear in their history had a lower incidence of cancer. "A statistically significant decline in the HPV positivity rate correlated with the lifetime number of Pap smears received. [Moved up from the HPV testing section.]

•••

***

Studies of the accuracy of conventional cytology report:

• * sensitivity (for detecting CIN 2, or moderate dysplasia, or greater): from 50% , to 72%.[4]

• * specificity (for CIN 2 or greater): from 71% to 97%.7

Studies of the accuracy of liquid-based cytology report:

• * sensitivity (for detecting CIN 2, or moderate dysplasia, or greater): from 61%[6] to 85%. , ,

• * specificity (for CIN 2 or greater): from 64%20 to 97%.21

Studies of the accuracy of HPV testing report:

− * sensitivity (for detecting CIN 3, or pre-cancerous dysplasia, or higher): as low as 88%, [4] but most studies have found higher rates, ranging from 93% to 100%. , , , ,

− * specificity (for detecting CIN 3 or higher): 73% to 93% [4] ,

[[Special:Contributions/71.224.215.219|71.224.215.219]] ([[User talk:71.224.215.219|talk]]) 20:08, 28 April 2008 (UTC)

'''EDIT WARNING''' Various problematic markup revised and reflist-talk dropped below. — [[user:MaxEnt|MaxEnt]] 21:18, 18 May 2020 (UTC)

{{Reflist-talk}}

== Karen Smith ==

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They can also put some numbing cream in your vagina beforehand.

<small><span class="autosigned">— Preceding [[Wikipedia:Signatures|unsigned]] comment added by [[User:86.161.16.236|86.161.16.236]] ([[User talk:86.161.16.236|talk]] • [[Special:Contributions/86.161.16.236|contribs]]) </span></small><!-- Template:Unsigned -->

: There is no such thing as a "virginal speculum" (or 'virginal spectrum' for that matter) There are different sizes and shapes of specula which can be chosen depending on anatomical differences, but there is not one designated specifically for women who have never had intercourse. Pain and discomfort are to different things. A pelvic examination will often be uncomfortable, but should not be frankly painful. If the exam is painful, then it could indicate that the person has a pathology that needs evaluation. "Numbing cream" should not be needed for an examination. Part of the examination is determining if there are areas that are painful. It is important to note that to allow them to be evaluated, and any numbing of the area would hinder this. If you experience pain or discomfort, discuss this with your healthcare provider. [[User:D.c.camero|D.c.camero]] ([[User talk:D.c.camero|talk]]) 16:41, 11 June 2018 (UTC)

== Vaginal examination ==

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[[User:Cyberfreeworld|Cyberfreeworld]] ([[User talk:Cyberfreeworld|talk]]) 18:51, 23 March 2013 (UTC) Would like to see a section that shows more about the actual practice of this test. After research when did FDA (for example) approve this. When did medical providers actually begin using this test. Were there any objections or attempts to prohibit use of Pap tests (smear). Was there any controversy about its effectiveness in the early days? This should be under History.

== Mum's the word? ==

<blockquote>

The Papani'''colaou''' test is a method of cervical screening used to detect potentially precancerous and cancerous processes ... The test was independently invented in the 1920s by Dr. Georgios Papani'''kolaou''' and Dr. Aurel Babeș and '''named after''' Papani'''kolaou'''.

</blockquote>

Named after: You had ''one'' job. Care to explain yourself, or mum's the word?

A possible solution is to create a redirect from [[Georgios Papanicolaou]] (no such page as of today) to Georgios Papanikolaou and then standardize on the 'c' spelling within this article. &mdash; [[user:MaxEnt|MaxEnt]] 21:06, 18 May 2020 (UTC)

:On a moment's further thought, if I were moved to rectify this small inconsistency, I'd probably link "Georgios Papanicolaou" in the first instance (either through the proposed redirect, or by textual override to the existing link title) and then gloss this first instance with "(also spelled Papanikolaou)". And then standardize on the 'c' spelling for the rest of the voyage. &mdash; [[user:MaxEnt|MaxEnt]] 21:11, 18 May 2020 (UTC)

==Wiki Education assignment: UCSF SOM Inquiry In Action-- Wikipedia Editing 2022==

{{dashboard.wikiedu.org assignment | course = Wikipedia:Wiki_Ed/UCSF_School_of_Medicine/UCSF_SOM_Inquiry_In_Action--_Wikipedia_Editing_2022_(Fall) | assignments = [[User:Christophermlee|Christophermlee]], [[User:Seyvonneip|Seyvonneip]], [[User:Sophiakalei|Sophiakalei]] | reviewers = [[User:Yslee22|Yslee22]], [[User:Zetinoy|Zetinoy]], [[User:Ymesfin|Ymesfin]] | start_date = 2022-08-08 | end_date = 2022-09-20 }}

The addition of sensitivity and specificity of pap smears was well written and easy to understand. I thought the gender-affirming care section was written with an objective lens and contained several clinical pearls! I appreciated the elaboration of the light microscopy technique but the following sentence doesn't add much to the section: "Screening with light microscopy is first done on low (10x) power and then switched to higher (40x) power upon viewing suspicious findings." Great job! [[User:Zetinoy|Zetinoy]] ([[User talk:Zetinoy|talk]]) 07:06, 17 September 2022 (UTC)

<span class="wikied-assignment" style="font-size:85%;">— Assignment last updated by [[User:Zetinoy|Zetinoy]] ([[User talk:Zetinoy|talk]]) 06:37, 17 September 2022 (UTC)</span>

== Peer Review ==

The article covers a broad range of topics falling under the umbrella of Pap smear. The photos of smear samples with descriptions below are helpful. The addition of gender-affirming care section is inclusive of people who may not identify as cis-gender women. The incorporation of statistics to corroborate effectiveness bolsters the informative nature of the article. The procedure section seem a bit jargon-heavy, so maybe reducing the amount of technical terms (or at least following up the use of technical terms with a brief explanation in few words) may be helpful. Lastly, it is uncertain how much value/benefit the "Experimental Techniques" section adds to the article, but overall a great update and revision of the previous article. [[User:Yslee22|Yslee22]] ([[User talk:Yslee22|talk]]) 17:37, 16 September 2022 (UTC)

== Wiki Education assignment: UCSF SOM Inquiry In Action-- Wikipedia Editing 2022 ==

The introduction to the page offers great insights and an overview of the subject matter without being too overbearing to the reader. Your team did a great job of balancing just how much information to provide in the introduction to keep readers fully informed. In doing so, it also creates a nice segue into the more detail-heavy sections later in the article. All the major details are also substantiated by articles, and so the References sections is very extensive, offering lots of outside sources for readers to reference. [[User:Ymesfin|Ymesfin]] ([[User talk:Ymesfin|talk]]) 01:26, 17 September 2022 (UTC)