The Pap smear revisited. Controversies and recent developments

Despite the widespread acceptance of the Pap smear as an effective means to reduce morbidity and mortality due to cervical carcinoma, many experts now recommend less frequent screening for women with a negative cytologic history and factors carrying a low degree of risk. This view has been countered by those who feel that less frequent screening may result in a dangerous delay in diagnosis and treatment for some women. The trend toward a longer screening interval places a burden on the primary care physician, the pathologist, and cytotechnologists to minimize false-negative smears through optimum communication, technical preparation, and quality control. In addition to the changes in thinking regarding frequency of Pap smear screening, the concept of cervical carcinogenesis is undergoing striking modification. The human papillomavirus has been associated with many lesions that have classically been considered low-grade dysplasias. Termed flat condylomas, these lesions frequently regress spontaneously but may be associated with the full spectrum of preinvasive and invasive disease. Cervical condylomas require biopsy and appropriate treatment.