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{{Reliable sources for medical articles}}
== ASCUS ==
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Good god people, shouldn't SOME recognition be made of how freakin' INVASIVE and uncomfortable this examination is for the patient!?? How about a mention of maybe some medical research into a HPV detection method that does NOT require such invasive practices??? SOMETHING!! --[[User:Promus Kaa|Promus Kaa]] 05:13, 19 October 2007 (UTC)
:If you can find a well-referenced piece about this sort of thing in a [[WP:RS|reliable source]], then I would say by all means put it in. Not simply personal-experience type pages, though. [[User:86.132.138.84|86.132.138.84]] 18:06, 15 November 2007 (UTC)
::I think a pap smear is a small price to pay and quite effective if you compare death due to [[cervical cancer]] in the developed and developing world ({{PMID
::: I would agree that something should be included about patient discomfort and also if that acts as a deterrent to screening. <span style="font-size: smaller;" class="autosigned">— Preceding [[Wikipedia:Signatures|unsigned]] comment added by [[Special:Contributions/114.198.97.208|114.198.97.208]] ([[User talk:114.198.97.208|talk]]) 07:47, 27 February 2013 (UTC)</span><!-- Template:Unsigned IP --> <!--Autosigned by SineBot-->
:::: Not to be flippant, the number one risk factor for death from cervical cancer is inadequate cervical cancer screening. In fact, the majority of women who die from cervical cancer have never had a pap smear. [[User:D.c.camero|D.c.camero]] ([[User talk:D.c.camero|talk]]) 00:06, 1 June 2018 (UTC)
== Aurel Babes ==
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* put into a liquid and then, via automation, put onto a [[microscope slide]] --as opposed to
* smeared onto a microscope slide directly and then fixed.
See: {{PMID
== Annual screening is not "generally recommended" ==
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You have a lot of comments, so let me try to respond one by one:
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.)
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! 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). 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:
Studies of the accuracy of liquid-based cytology report:
Studies of the accuracy of HPV testing report:
[[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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:I have moved the sections on types of screening and HPV tests to [[cervical screening]] as it contains information on other types of cervical screening test than the Pap test. [[User:Jah998|Jah998]] ([[User talk:Jah998|talk]]) 14:37, 28 March 2011 (UTC)
::I oppose the split. In particular splitting liquid based (LB) Paps onto a separate page doesn't make sense. LB versus conventional Paps are just different procedures for preparing the slide. The collection is the same, the reading is done in the same way, it is just a matter of different handling of the samples in between. (Which also has different results for effectiveness as a screening test.) Eventually there might be enough material to warrant separate coverage of LB, but currently LB is hardly explained at all.
::The coverage of cervicography and HPV testing could probably better be handled by splitting out separate articles on those topics, keeping a summary in the main article. But there should be just one main article, and it should remain Pap test. [[User:Zodon|Zodon]] ([[User talk:Zodon|talk]]) 09:11, 12 August 2011 (UTC)
:::I disagree. 'Pap test' is a very US-focused term. For example, in the UK, it's called a 'smear test', or just 'cervical screening'. I think it makes more sense to have an overall page on 'cervical screening' that discusses all the different methodologies, then links through to other pages where necessary. Thoughts? [[User:HenryScow|HenryScow]] ([[User talk:HenryScow|talk]]) 12:08, 19 October 2011 (UTC)
::::The name of the article is not important, per [[WP:Name]]. Other common names for the test should be redirects to whichever name the article resides under. (So if it is called a smear test or whatever - those should just be redirects to Pap smear.)
::::As far as the methods listed - liquid based cytology is still a Pap smear (it is just a different collection method, but it is still prepared into a slide just as with the conventional Pap). There is not enough material here to warrant a separate article on liquid based. Putting it in a separate article gives the false impression that it is a different test.
::::The material about "Testing in resource-poor areas" and "Other options" is just research into possible ways of using HPV testing. At best it would be under research (doesn't warrant much coverage until it becomes real).
::::Likewise "Visual inspection to detect pre-cancer or cancer" is something that has been tried, and so far hasn't panned out. (There have been numerous tests, such as cervicography, etc. which have been tried.)
::::HPV testing is so far approved as an adjunct to Pap smear screening (e.g. for triage of abnormal results). There are trials (some noted above) considering the possibility of using it for primary screening. It could make sense at some point to create an article about HPV testing. But so far all of the other methods are essentially variants of Pap smear, HPV testing or Colposcopy. Creating an article about cervical screening just means an extra article to maintain. [[User:Zodon|Zodon]] ([[User talk:Zodon|talk]]) 05:24, 15 March 2012 (UTC)
== "Most women contract HPV soon after becoming sexually active" ==
Pretty sure most women don't contract HPV at all (at least, not yet). Sounds like something you'd hear Senator John Kyl say at a pro-abstinence-only-education-bill signing party (as a non-factual statement).
[[Special:Contributions/184.18.13.121|184.18.13.121]] ([[User talk:184.18.13.121|talk]]) 15:46, 15 April 2011 (UTC)
:I'm pretty sure the meaning of the statement was more accurately, "Most women who contract HPV, do so soon after becoming sexually attractive (in their 20's)." But I removed it because it was poorly written. ~[[user:ttony21|<span style="color:#008080; font-family:'Comic Sans MS'">'''Ttony21''']]<sup>([[User talk:Ttony21|talk]], [[Special:Contributions/Ttony21|contribs]])</sup></span> 02:26, 11 August 2011 (UTC)
::Most women do contract HPV (HPV is the most widely spread STI, e.g. more than 80% of US women, with similar levels in other parts of the world, as evidenced by cervical cancer incidence). (See [[Human_papillomaviruses#Epidemiology]])
::So the sentence means exactly what it said. Most women do contract HPV, and most of them do so soon after becoming sexually active.
::So I restored the sentence. I thought it had the benefit of being brief, but if you think it is too concise for clarity we can try to improve it. [[User:Zodon|Zodon]] ([[User talk:Zodon|talk]]) 08:57, 12 August 2011 (UTC)
:::The specific claim that (1) "most women contract it" and (2) "most who do contract it do so soon after becoming sexually active" implies (3) "most women contract it soon after becoming sexually active", is fallacious; for example, say 80% contract it, and 60% of those contract it soon after becoming sexually active -- then (1) and (2) are both satisfied, but (3) is not -- that would only be 60% of 80% = 48% of the total population. However, it is obviously ''possible'' to satisfy all three, but the data -- even in [[Human_papillomaviruses#Epidemiology|in the article linked to justify the claim]] -- doesn't seem to back it up. There ''is'' data that supports (1) (so my initial gut feeling that most women don't contract it was flat out wrong), but I don't see any that supports (2)...from the article: ''"Estimates of HPV prevalence vary from 14% to more than 90%"'' -- and most of them seem to be on the lower end. It seems the only way to get over 50% is is to look at the proportion who get it ''at least once in their lifetime''.
:::In any case, since I'm not a doctor or an epidemiologist, I'm not going to remove the sentence...but in hopes of attracting someone more credible and knowledgeable than me to take a look at it, I am going to make the claim explicit -- the sentence will be changed to "More than three quarters of all women will contract HPV at some point in their lives, and more than half of all women will contract it soon after becoming sexually active." That way, no one can look at it and think "Oh, they must mean 'most women who DO contract it contract it shortly after becoming sexually active'", which is how I interpreted it as well...the only reason I said anything was because I thought it was a humorous / unfortunate choice of words. [[Special:Contributions/184.18.13.121|184.18.13.121]] ([[User talk:184.18.13.121|talk]]) 20:12, 10 September 2011 (UTC)
::::The assertion that most women contract HPV shortly after after starting having sex is not based on reasoning from 1) and 2). The discussion above was pointing out that 1) and 2) and 3) are all verifiable, not reasoning from 1 and 2 to derive 3.
::::I reverted the change to the wording of the section because it was not supported by the reference given, and it made the paragraph less clear by introducing material that was not directly relevant. The point is that those who recently started sex are at low risk of cancer, but highly likely to show changes due to initial HPV infection, so they should not be screened. In this context the only relevant claim is 2 "most who do contract it do so soon after becoming sexually active."
::::As indicated by the dead link flag, the source has changed. [https://secure.wikimedia.org/wikipedia/en/w/index.php?title=Pap_test&diff=443671265&oldid=442266912 this edit fixed the dead link] However the source no longer supports this item.
::::In looking back through the [http://web.archive.org/web/20080410201813/http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_Can_cervical_cancer_be_prevented_8.asp? wayback archive for the page in question ] I have not yet found the version that did support the item. As such I have added a note indicating that additional/fresh citation would be helpful. [[User:Zodon|Zodon]] ([[User talk:Zodon|talk]]) 22:51, 10 September 2011 (UTC)
::::I have made an additional suggested change to the sentence in question, changing it from "Most women contract HPV soon after becoming sexually active" to "Most women who contract HPV do so soon after becoming sexually active." (Basically another phrasing of 2 above.) In this context this is the important observation. I hope that clarifies the matter.
::::Sorry if my edits were confusing or appeared to not acknowledge the discussion here, we were evidently both editing at once. I was in the middle of composing this response and it took longer than I expected. [[User:Zodon|Zodon]] ([[User talk:Zodon|talk]]) 23:06, 10 September 2011 (UTC)
== painful smear tests ==
There is a lot on the Internet about women finding smear tests very painful
It is totally unnecessary for there to be any pain or discomfort at all.
Women need to ask the nurse to use what is called a "virginal spectrum"
which is half the size of the normal spectrum but still large enough for the
nurse to see your cervix.
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 ==
I think searching for 'vaginal examination' should not direct here. [[Pelvic examination]] should be improved to cover internal vaginal exams during labour. <small><span class="autosigned">— Preceding [[Wikipedia:Signatures|unsigned]] comment added by [[User:Sarahjeantaylor|Sarahjeantaylor]] ([[User talk:Sarahjeantaylor|talk]] • [[Special:Contributions/Sarahjeantaylor|contribs]]) </span></small><!-- Template:Unsigned -->
I agree, vaginal examination and pap smear are not synonymous. A pap smear can be done during a vaginal exam, but that is where the connection ends. In fact, most vaginal exams do not include pap smear as pap smear is a specific test to screen for cervical dysplasia/cancer. [[User:D.c.camero|D.c.camero]] ([[User talk:D.c.camero|talk]])
== Medical Implementation ==
[[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. — [[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. — [[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)
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