Background: According to ACOG, women should have a Papanicolaou(PAP) test alone every 3 years for cervical cancer screening but PAP smear had a sensitivity of 55.4 percent. Some post-operative pathologic results revealed abnormal tissues although the PAP smear reported no malignant cells. Case: A 55-year-old woman admitted to our clinic due to actinomyces of PAP smear results and bilateral ovarian cysts on ultrasonography. She had taken medication to treat hypertension, diabetes mellitus, and bronchiectasis. Although she had no precancerous or malignant lesion in uterus, we decided to do total abdominal hysterectomy and both salpingo-oophorectomy under spinal anesthesia due to high risk of operability. After the surgery, post-operative pathology reported Squamous cell carcinoma in situ of cervix, both paratubal cyst, and fibroma of left ovary. Conclusion: It is a challenging task for gynecologists and pathologists to enhance the accuracy of cervical cancer screening with PAP smear. Reducing inadequate PAP smear collection and using liquid-based cytology could reduce the false negative rate.