The abnormal Papanicolaou smear

Despite its limitations, the Pap smear is a widely accepted, powerful screening technique for cellular abnormalities of the cervix. Abnormal Pap smears are found in 1% to 5% of the screened population, depending on the population characteristics. It is therefore important for all clinicians caring for women to be familiar with the principles of Pap smear screening, its strengths and weaknesses, the terminology used to interpret results, and the options for appropriate response to an abnormal smear. High-grade lesions require colposcopic examination and treatment; low-grade lesions require colposcopic examination and either treatment or close follow-up; atypical smears require some response, either repeated cytology or further investigation; glandular lesions require colposcopic examination and investigation of the endocervix. A tremendous amount of research is going on to assess the safest, most cost-effective approach to the detection, evaluation, and management of cervical epithelial lesions. It can be expected, therefore, that these recommendations will change over the next several years. All physicians providing health care for women should keep abreast of these changes.