Evolution of the evidence-based Papanicolaou smear.

Cervical cancer rates have decreased over the past century, but rates have remained relatively constant during the last decade. Evidence-based management of the abnormal Papanicolaou (Pap) smear and the use of additional testing at the time of the Pap smear are discussed in light of the current evidence. Also explored in-depth is the evidence base for Papanicolaou smear collection and retrieval methods, especially as it relates to their influence on the validity of the smear results. In addition, issues that need to be considered by the clinician, including the use of colposcopy, especially in light of health service implications such as the need for adequately trained personnel, increased clinical visit time, and increased cost are presented.