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Cytology involves observing cells sample under a microscope in order to screen for a cancer or lesions that may develop into cancer.
Gynecological cytology, also known as PAP test, involves observing a cervical sample under a microscope in order to screen for a cancer or lesions that may develop into cervical cancer.
Cervical cancer is the third most common malignancy in women worldwide.
The frequency varies considerably between developed and developing countries
Cervical cancer is the second most common cancer in developing countries, but only the tenth most common in developed countries. Similarly, cervical cancer is the second most common cause of cancer-related deaths in women in developing countries but is not even among the top 10 causes in developed countries
Cervical cancer is the most common gynecological cancer in the developing countries and it’s responsible for the most gynecological cancer related deaths in the developing countries
In the United States, cervical cancer is relatively uncommon. This trend has been attributed to mass screening with Pap tests. Cervical cancer rates continue to rise in many developing countries, however.

Early intercourse/ coitache
Early marriage
Multiple child births
Multiple sexual partners
Human papilloma virus infection
Women who are immunosuppressed (HIV positive)
Smoking habits
Oral pill users
There is low risk of cervical cancer developing in fundamental religious groups e.g. Nuns, Amish, Jews, Muslims, it is rare in virgins

Intervals: All sexually active women should be screened starting from the age of 21 years or after 3 years of vaginal sex
Screening should be every 3year (Pap smear only) OR every 5year (for HPV or pap smear/HPV co testing.
Screening should be done till the age 65years, if the consecutive smears in the last 10 years is negative
Age 21‒24: No screening/before pap smear every 3years
Age 25‒29: HPV test every 5 years (preferred), HPV/Pap cotest every 5 years (acceptable),Pap test every 3 years (acceptable)
Age 30‒65: HPV test every 5 years (preferred), HPV/Pap cotest every 5 years (acceptable),Pap test every 3 years (acceptable)
Age 65 and older: No screening if a series (3)of prior tests were normal
Women who are receiving immune suppression therapy; women who are infected with HIV; or women who were exposed to diethylstilbestrol (DES) in utero, should continue to be screened annually.
Women who are HIV positive should have cervical cytology testing every 6 months after diagnosis, and then annually after 2 consecutive normal test results

This is the mainstay of cervical cancer screening
Exfoliated cells from the transformation zone or squamocolumnar junction are obtained for cytology
Benefits: The objective of screening is to reduce the incidence and mortality from cervical cancer. This achieved through early detection of premalignant lesion
Pap smear test has been effective reducing the incidence of cervical cancer by 80% and the mortality by 70%.
As a result of Pap test, more and more preinvasive carcinoma is detected

Should be done outside menses
The woman should avoid intercourse, douching for 24 to 48hour prior to the procedure
Treat any preexisting infection before the procedure

The speculum is placed in the vagina after it has been lubricated with water only.
With the cervix exposed using bivalve speculum a specially designed plastic or wooden spatula is applied to the cervix and rotated 360 degrees to abrade the surface slightly and to pick up cells from the squamocolumnar area of the cervical os.
Next, a cotton-tipped applicator or a small brush (cytobrush) is inserted into the endocervix and rotated 360 degrees.
These 2 specimens can be mixed or placed on the slide separately according to the preference of the examiner.
A preservative (95% alcohol) is applied immediately to prevent air drying, which would compromise the interpretation.
The slide is sent to the laboratory with an identification sheet (cytology form) containing pertinent history and finding

Reporting of Pap smear is done using Bethesda classification: adequacy of sample is either satisfactory or unsatisfactory

Liquid-based Cytology (LBC): Cervical smear is taken using a plastic spatula. The spatula is rinsed in a liquid media.
Cells are separated by centrifugation. Thin layer smears are made.
National Institute of Clinical Excellence (NICE) has recommended to replace the conventional smear with LBC.
LBC avoids the risk of false-positive, false-negative or unsatisfactory smears

Follow up with result of investigation which is usually according to the Bethesda classification
Woman with abnormal Pap smear are usually sent for colposcopy

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