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Abnormal Pap Smears

The Papanicolaou test (Pap Smear) is a method of cervical screening that is used to detect potentially precancerous and cancerous developments in the cervical canal of the female reproductive system.  A Pap smear is not the same as the Well-woman examination, which is recommended yearly and includes a breast and pelvic exam.

When you get a Pap smear, your healthcare provider will use a speculum to open the vaginal canal to allow for the collection of cells from the cervix.  These cells will be examined for potentially precancerous changes, called cervical dysplasia (CIN), which are caused by a human papilloma virus (HPV).  HPV testing may be performed either as indicated for abnormal Pap results, or in some cases co-testing is done, where both a Pap smear and HPV test are done at the same time.  Abnormal Pap smear findings are followed by more precise diagnostic methods.  If required, interventions that prevent progression to cervical cancer are utilized.  Almost all abnormal Pap smears are associated with exposure to the Human Papilloma Virus (HPV).

Cervical dysplasia (abnormal cells found on the cervix) is linked to the presence of high-risk HPV.  HPV is very common in the general population.  Most women clear the virus or suppress it, with clearance higher in younger women.  The small percentage of women who do not clear the virus are at risk for persistence or progression of cervical dysplasia.  Smoking doubles the risk of progression.

When combined with a regular program of careening the Pap test can reduce cervical cancer deaths by up to 80%.  More than half of all invasive cancers occur in women who have never received a Pap smear.  Additionally, 10 to 20% of cancers occur in women that have not had a Pap smear in the past five years.

How often should I be screened?

Cervical cancer screening should begin at age 21, regardless of the onset of sexual activity.  As long as results are normal, women between the ages of 21 to 29 should have a cytology testing (a Pap smear) every 3 years.  As long as results are normal, women between the ages of 30 to 65 should have cytology (Pap) and HPV co-testing every 3 years.  Women age 65+ do not need to be screened if they have had adequate prior screening and are not otherwise at high risk for cervical cancer—i.e., 3 consecutive negative cytology results or 2 consecutive negative HPV results within 10 years before cessation of screening, with the most recent test within 5 years.

Women who have received the HPV vaccination should still be screened according to the guidelines recommended for non-vaccinated women in the same age group.

PAP Classification

● ASC-Atypical Squamous Cells

○ ASCUS-Atypical Squamous Cells of Undetermined Significance
○ ASC-H Cannot exclude HSIL (high grade lesion)

● LGSIL-Low-grade Squamous intraepithelial lesions

○ Human Papillomavirus, mild dysplasia, cervical intraepithelial neoplasia (CIN) I

● HSIL-High-grade squamous intraepithelial lesions

○ Moderate and severe dysplasia, carcinoma in situ, CIN 2 and 3

● Glandular Cell

○ Atypical glandular cells (AGU)
○ Atypical glandular cells, favor neoplastic
○ Endocervical adenocarcinoma in situ (AIS)
○ Adenocarcinoma

Follow-up and Treatment

An ASCUS pap may require further testing for the presence high risk HPV.  If testing is negative for high risk HPV, routine screening is recommended.

Colposcopy is indicated for the following Pap results:

● ASCUS with positive high risk HPV
● CIN 1, 2 and 3

Colposcopy is an office procedure where the cervix is visualized through a microscope after application of vinegar.  Biopsy (removal of a small piece of cervical tissue) may be performed to confirm the degree of dysplasia.

Treatment recommendations are made based on the findings of the colposcopy and may include:

  1. Follow up Pap smear at a closer interval (4-6 months) or
  2. Treatment of the abnormal area with freezing (cryosurgery), laser or LEEP) Loop electrosurgical excision procedure), all of which may be performed as office procedures depending on your individual findings.  Rarely a more extensive biopsy of the cervix is required, a conization, and is performed as an outpatient surgery under anesthesia.

Following treatment or evaluation of an abnormal Pap, close follow up and a repeat Pap at closer intervals (4-6 months) is often recommended.

More information is available at the following sites:

www.cancer.gov/cancertopics/factsheet/risk/HPV
www.nlm.nih.gov/medlineplus/hpv.html
www.acog.org/acm
http://www.ashasexualhealth.org/std-sti/hpv.html

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Address: 6512 S McCarran Blvd, Suite D, Reno, NV 89509
Phone: (775) 826-1285 - Fax: 775-284-4093


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