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For women who have had repeated negative tests, the marginal gain from screening more often than every 3 years decreases sharply.
However, because of the difficulty in identifying patients at increased risk for cervical cancer, most physicians will recommend a Pap test be performed at least once-yearly.
Beginning at age 30, women who have 3 consecutive negative screens and who do not fit the criteria above for more frequent screening, may be tested every 3 years.
Co-testing with cervical cytology and high-risk human papillomavirus (HPV) typing is also appropriate and if both tests are negative, re-screening in 3 years is recommended.
Repeat Pap smears may be indicated 3 to 4 months following local treatment of vaginal infection/inflammation, and 2 to 3 months following a Pap test suggestive of mild dyskaryosis or if the initial Pap smear results were unsatisfactory due to inadequate sampling.
A standardized method of reporting cytology findings was developed by the National Cancer Institute called the "Bethesda System".
The cells are removed by brushing or scraping the cervix during a pelvic examination and then placing the cells on one or more glass slides.
Each slide typically contains hundreds of thousands of cells.
However, some clinical centers perform anal cytology to screen for anal cancer among high-risk populations (e.g., persons with HIV infection and MSM), followed by high-resolution anoscopy for those with abnormal cytologic results (e.g., ASC-US)." Observing that HIV-infected men and women with human papillomavirus (HPV) infection are at increased risk for anal dysplasia and cancer, the HIV medicine association of the Infectious Diseases Society of America (Aberg, et al., 2013) states that MSM, women with a history of receptive anal intercourse or abnormal cervical Pap test results, and all HIV-infected persons with genital warts should have anal Pap tests.
In the Bethesda System, atypical squamous cells fall into 2 categories: (i) ).
Other classification systems in use include the Dysplasia/CIN System and the Papanicolaou System.
The American Cancer Society, National Cancer Institute, and American Medical Association recommend that cervical cytology screening should begin within 3 years of onset of sexual activity or age 21.
The recommendation allows less frequent Pap testing after 3 or more annual smears have been normal, at the discretion of the physician.