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Pap Smear Abnormalities - What You Need to Know

Cervical cancer is one of the most common diseases in the world. In the US alone, 16,000 cases occur annually, and 4,800 deaths. It has been shown that increased screening and early treatment can decrease the incidence and mortality of cervical cancer by up to 40%. For this reason, it is important to have an annual Pap smear. These tests can show changes in the cervix before they become cancer, and allow you to treat it in time.

Who should get a Pap smear? Women who are of 18 years of age, or who are sexually active, should be screened annually. If you have three negative results in a row, and are in a monogamous relationship, your doctor may advise you to only get screened once a year.

However, certain risk factors can make it important to continue having the test annually. These include the age at which your first had sex and age of first pregnancy, as well as number of sexual partners. Other important factors are the presence of HIV, immunosuppressant conditions (from any cause), or HPV infection, prior or current. Smoking is also considered to be a risk factor.

When you receive your results, the word “negative” indicates that you are free from any problems; that is, that your cervical cells are healthy. There are many kinds of Pap smear abnormalities that might be reported on your results; while they all require monitoring, there is not usually reason to be alarmed right away. Most of the time “low-grade” (minor) abnormalities are monitored with repeat Paps.

In some cases, if the abnormalities are consistent with human papillomavirus (HPV) infection, your doctor may decide to perform HPV typing. This is because while there are many types of HPV (which can produce genital warts, changes in cervical cells, or no symptoms at all; often the body rids itself of HPV on its own), certain strains (16, 18, 45, 56) are more aggressive, and can proceed to cervical cancer more quickly.

What kind of Pap smear abnormalities can be found? The first kind is inflammation, caused perhaps by an infection (such as a yeast infection) or a herpes virus. The Pap should be repeated 3 to 6 months later.

It is also possible to see ASCUS on your results. This means Atypical Squamous Cells of Uncertain Significance. This means that there are slight changes to your cervical cells, but there is no clear indication of the cause. Here, your doctor may recommend that you repeat the Pap smear every 4 to 6 months, until you have three consecutive negative (normal) results; or, for up to two years.

If the ASCUS persists, your doctor may decide to perform a colposcopy, where small samples of tissue are taken from the cervix, and then biopsy the cells. If your results indicate “low grade squamous intraepithelial lesions,” which are slightly above ASCUS in severity, but can still be monitored with repeat Paps.

However, if you do not want to commit to repeat testing, or if you and your doctor decide that your risk for cervical cancer is high, you may decide to proceed straight to colonoscopy and even to have the lesion (abnormal cells) removed completely (known as ablation or excision).

Serious Pap smear abnormalities require more intensive treatment. If you have “high grade intraepithelial lesions,” “moderate dysplasia” or “severe dysplasia” on your results, this means that the changes in your cervical cells are possibly indicating a development towards cancer – or are already cancerous (though not spreading, called “in situ”).

In this case, your doctor will perform a colposcopy and biopsy to determine the extent of the abnormality, and then remove the entire affected area. If an invasive cancer is detected, your doctor will refer you to an experienced physician to discuss treatment options.

Having a positive (abnormal) result on your Pap smear is never easy. However, it is important to keep in mind that most low grade changes will disappear on their own – and if they do become more severe, they will proceed slowly, allowing you time to detect the changes and act accordingly.

Cervical cancer is one of the deadliest, yet most preventable, types of cancer that exist. Get your annual Pap smear and be completely honest with your doctor. And if you do have a Pap smear abnormality, commit yourself to the follow-up evaluations – for your health, and your life.

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