OncologyTier 2Topic

Papanicolaou test (Pap smear)

The test

Cervical cytology screening (traditionally the Pap smear, now largely superseded by primary HPV testing in most modern screening programs) - detects pre-malignant and malignant cervical changes before they become clinically apparent
Cervical screening programs have produced one of the largest reductions in cancer-specific mortality of any cancer screening intervention, given the long pre-malignant (dysplastic) phase available for detection

Cervical cancer is caused almost exclusively by persistent high-risk HPV infection (predominantly types 16 and 18), progressing through defined dysplastic stages (CIN 1-3) before invasive carcinoma - a long window (often years) during which screening can detect and treat pre-malignant change

Primary HPV testing (with reflex cytology if HPV-positive) has replaced cytology-alone screening in most current Australian and comparable programs, given superior sensitivity for detecting the underlying causative infection - a change from older cytology-first screening protocols
Screening interval and starting age are determined by the specific national program (in Australia, 5-yearly HPV testing from age 25, following HPV vaccination status)
Colposcopy with biopsy for tissue diagnosis when screening is abnormal

Abnormal screening results are managed by risk-stratified pathways (repeat testing, colposcopy referral, or treatment) depending on HPV type and cytology grade, not a single fixed threshold
Pre-malignant lesions (high-grade CIN) are treated with excisional or ablative procedures (LLETZ/cone biopsy), which are typically curative and fertility-preserving

HPV vaccination (reduces but does not eliminate the need for screening, since it does not cover all high-risk HPV types), cervical intraepithelial neoplasia, HIV (higher risk of persistent HPV infection and progression)
HPV vaccination combined with primary HPV screening is projected to make cervical cancer a rare disease in vaccinated, screened populations - one of the clearest examples of a largely preventable cancer

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