Abnormal Pap Smear is not Cancer
What is an Abnormal Pap Smear?
About 55 million Pap tests are performed each year in the United States. Of these, approximately 3.5 million (6%) are abnormal and require follow-up.
After we perform an office pap smear, we send to pathology and have the result within 7-10 days. If normal, you will receive a letter from the office letting you know. Occasionally, we will call you to let you know that your Pap smear result was not completely normal. This is not cause for worry, we will explain that we just want to follow you closer.
We are checking for several things:
- adequacy of sample
- normal squamo-columnar junction (transformation zone)
- the presence of high-risk HPV. The latter is only checked in women over age 30.
In the event you have an "abnormal pap" screening test, we will likely ask you to come in for a closer look at your cervix, for a more definitive evaluation: the colposcopy (or microscope of cervix and vagina.)
Abnormal results are classified into these main areas:
- ASCUS (atypical cells of uncertain significance): These changes may be due to infection with HPV but may also mean there are precancerous changes present, this is most common abnormal result - a "wastebasket" term.
- LGSIL (low-grade dysplasia): mild abnormality, caused by low-risk HPV, in general.
- HGSIL (high-grade dysplasia): This means precancer changes are likely to be present; the risk of cancer is greater if the result is HSIL.
- Carcinoma in situ (CIS): severely abnormal changes, are likely to progress to cancer.
- Atypical glandular cells (AGC): Cell changes are seen that suggest precancer of the upper part of the cervical canal or inside the uterus.
What does HPV have to do with Cervical Disease?
Some strains of HPV are associated with genital warts and others with the development of cervical cancer?
HPVs are a group of more than 150 viruses. Some types of HPV cause the common warts that grow on hands and feet. Over 30 types of HPV can be passed from one person to another through sexual contact. Some sexually transmitted HPVs cause wart-like growths on the genitals but do not lead to cancer.
About 15 sexually transmitted HPVs are referred to as “high-risk” because they are more likely than other HPV types to lead to the development of cancer.HPV infection is the primary risk factor for cervical cancer. However, although HPV infection is very common (about 6 million new genital HPV infections occur each year in the United States), only a very small percentage of women with HPV infections develop cervical cancer.
Who is at risk for HPV infection?
Infection with sexually transmitted HPV types is more common in younger age groups, particularly among women in their late teens and twenties. Women who become sexually active at a young age, who have multiple sexual partners, and whose sexual partners have other partners are at increased risk of genital HPV infection, as are women who smoke. Women who are infected with HIV are also at higher risk for being infected with HPVs and for developing cervical abnormalities. Most HPV infections are transient, or temporary, but sometimes an infection can remain detectable for many years.
Does infection with a high-risk type HPV always lead to a precancerous condition or cancer?
No. Most HPV infections appear to go away on their own without causing any kind of abnormality. However, persistent infection with cancer-associated HPV types increases the risk that mild abnormalities will progress to more severe abnormalities or to cervical cancer. With regular follow-up care by trained clinicians, women with precancerous cervical abnormalities can have these abnormalities removed or treated before cancer develops.
Do women who have completed the HPV Vaccine series still need to have Paps/HPV testing?
Yes. Pap tests continue to be essential to detect cervical cancers and precancerous changes, even in women who have been vaccinated against HPVs, because current HPV vaccines do not protect against all HPV types that cause cervical cancer. Therefore, it is important for vaccinated women to continue to undergo cervical cancer screening in accord with recommendations for women who have not been vaccinated.
What happens if I have an abnormal Pap?
If the results of your screening test are abnormal, further testing is needed to confirm the result and determine the severity of the abnormality. Colposcopy is the test that is usually recommended in this case. It allows us to look at your cervix using magnification.
Not all women with an abnormal cervical screening test will need treatment. Colposcopy can help to determine if and when treatment of the abnormality is needed.
Why Do I Need Colposcopy?
The colposcope magnifies the appearance of the cervix. This allows the clinician to better see where the abnormal cells are located and the size of any abnormal areas. The size and location of abnormal cells helps to determine how severe the abnormality is and also helps to determine what treatment, if any, is needed. When monitored and treated early, pre-cancerous areas usually do not develop into cervical cancer.
Preparing for a "Colposcopy"
Before your colposcopy appointment, you should not put anything in the vagina (eg, creams). Colposcopy can be done at any time during your menstrual cycle, but if you have heavy vaginal bleeding on the day of your appointment, call us to ask if you should reschedule.
If you take any medication to prevent blood clots (aspirin, warfarin, heparin, clopidogrel), please call the office in advance. These medications can increase bleeding if you have a biopsy during the colposcopy. If you know or think you could be pregnant, let us know prior to the procedure. Colposcopy is safe during pregnancy, but we not usually do biopsies of the cervix if you are pregnant.
Colposcopy appointment takes approximately 20 minutes, but most of the visit is spent discussing the possibilities and then painless looking through the colposcope at your cervix.
Colposcopy positioning is the same as that for a routine pelvic examination, while you lie on an exam table, we will place a speculum lightly inside your vagina to look at your cervix. We will then will look at your cervix using the colposcope. The colposcope is like a microscope on a stand - it does not touch you. You'll feel a gentle application of a dilute acetic acid (vinegar) to your cervix.
This solution helps to highlight any abnormal areas, making them easier to see with the colposcope. When this solution is used, you may feel a cold, but it does not hurt. During colposcopy, any abnormalities that are visualized will be biopsied (with a small cervical tissue sampler.)
Having a biopsy does not mean that you have precancerous cells. Anesthesia (numbing medicine) is not usually used before the biopsy because the biopsy causes only mild discomfort or cramping. The tissue sample will be sent to a laboratory and examined with a microscope.
Some women also need to have a biopsy of the inner cervix during colposcopy; this is called endocervical curettage (ECC). Pregnant women should not have ECC because it may disturb the pregnancy. The ECC may cause crampy pain, although this resolves quickly in most women.
If you have a biopsy, we may apply a yellow-brown paste to your cervix. This acts as a liquid bandage.
If you have a biopsy of your cervix, you will likely have a small amount of vaginal spotting. If we used the liquid bandage solution to stop bleeding, you may have brown or black vaginal discharge that looks like coffee grounds. This is not your cervix sloughing off - just the paste being passed. This resolves within a few days.
Most women are able to return to work or school immediately after having a colposcopy. Some women have mild pain or cramping, but this usually goes away within one to two hours.
Please do not put anything in the vagina (creams, douches, tampons) and do not have sex for one week after having a biopsy.
If you have a biopsy, your test is sent to pathology, and we will have your results usually within 14 days. In most cases, further testing and treatment will depend on the results of the biopsy.
If you have low-grade dysplasia or persistent atypical squamous cells, we will repeat your Pap smear in 6 months. If the biopsy shows high-grade dysplasia, we will recommend removal of the transformation zone, a small portion of your cervix, that is diseased, so it will not progress, in an outpatient procedure called LEEP (Loop Electrosurgical Excision Procedure.)
For the next 2 years, we will repeat your Pap smears every 6 months until you have 2 consecutive normal results, then you will return to annual screening.