Improving the adequacy of Pap smears

Several of the risk factors and pathophysiologic mechanisms for cervical carcinoma implicate the transformation zone of the cervix as the most important area for cytologic sampling. Improved screening can be achieved by ensuring that the transformation zone has been sampled, as evidenced by the number of endocervical cells on the smear. Use of the endocervical brush, combined with feedback from the laboratory about inadequate smears, may improve the technique for obtaining Pap smears.