I am worried about the results of my last pap test which were abnormal. What does this mean?
Abnormal pap results mean that there are changes in the cells of the cervix. Cervical cell changes are most often caused by inflammation. Inflammation may be the result of infections such as yeast infections, bacterial vaginosis, Trichomonas, human papilloma virus (HPV) which causes genital warts, and rarely gonorrhea, Chlamydia, or herpes.
Cervical cell changes can also signal cancerous or precancerous conditions that need to be examined further.
If my pap test is abnormal, does this mean I have cancer?
No. For most women, an abnormal pap tests does not lead to a diagnosis of cancer. Early treatment of precancerous conditions can prevent cancer from ever occurring. Yearly pap tests and complete follow up care ensure that even if cervical cancer is present, it will be detected early enough that it can usually be treated successfully. That is why it is so important to return to your doctor for follow up care.
How do I know whether I have a serious condition, or an infection?
You should consult your doctor for an explanation of your pap results, but the following list of some common classifications of pap smears can help interpret any changes seen in the cervical cells:
SIL CIN Description
Low Grade HPV-linked changes CIN 1 Mild dysplasia
High Grade CIN 2 Moderate dysplasia
CIN 3 Severe dysplasia
Carcinoma in situ
Invasive Cancer Invasive Cancer Invasive Cancer
ASCUS: Atypical Squamous Cells of Undetermined Significance: Cells may not be normal, but it is hard to tell exactly what is wrong with them.
SIL: Squamous Intraepithelial Lesion: Cells show certain distinct changes, known as dysplasia. SIL is either low grade or high grade (See above table)
Dysplasia also called Cervical Intraepithelial Neoplasia (CIN): Abnormal cells have replaced normal ones and could develop into cancer over a period of years. CIN is not itself cancer and is usually 100% curable by treatment. It is divided into three grades:
CIN 1 mild dysplasia or HPV linked changes
CIN 2 moderate dysplasia
CIN 3 severe dysplasia and carcinoma in situ (CIS) is a precancer, not true invasive cancer.
Invasive Cancer: Unhealthy, cancerous cells are seen; cancer has spread into the cervix and possibly to other organs. Even invasive cancer has a cure rate of 80% to 90% if it is found early enough!
Is the Pap test always accurate?
Although the pap test is very effective in detecting changes in the cervix, like any test it is not 100% accurate. Sometimes there are problems with the sample or its interpretation. There may be too few or too many cells in the sample to allow an accurate reading, or an infection may temporarily be “covering up” abnormal cells.
Although no test is perfect, remember that because the pap test can find cell changes at an early stage - when treatment is more successful, it helps prevent cancer of the cervix. Since the pap test was introduced 50 years ago, the number of deaths from cervical cancer has decreased by 70%. If we have a question with your pap, especially if it was done in an outside lab that we are not familiar with, we will request the slides for a 2nd opinion in our lab which we trust very much.
If my pap indicates atypical (ASCUS) or inflammatory cells, what do I do next?
We may prescribe a treatment for heavy inflammation or infection, if we think it is necessary, and you may be asked to have a repeat pap test following treatment. Wait 3-6 months before repeating the test to give the cervical cells a chance to recover. If cell changes are detected again on a repeat pap test, further diagnostic tests may be needed. We may also recommend a colposcopy (see below) for ASCUS.
What are these tests?
A Colposcopy is performed in the doctor’s office and allows direct viewing of the cervix through a special magnifying microscope (colposcope). Any abnormal cells seen by colposcopy may be removed (biopsy) to accurately diagnose the problem. Biopsy is usually done in the doctor’s office. It may cause slight discomfort for a few seconds.
How will dysplasia be treated?
Because abnormal cells are removed by biopsy, the procedure can also serve as a method of treatment. There are several types of biopsies:
Minor surgery may be used to treat genital warts, dysplasia, and early stages of cancer. The affected tissue is removed, and new tissue gradually grows and heals the cervix. Several methods are used: cryosurgery which freezes the affected tissue; electrosurgery which destroys affected tissue with heat and; laser treatment which removes abnormal tissue with high intensity light.
Who is at increased risk of developing cervical cancer?
Women who have had multiple sexual partners or whose partners have had multiple partners, women who have had many pregnancies or who became pregnant in their teenage years, and women with a history of genital warts are at increased risk. Women who smoke are also at increased risk.
You may not be able to change your risk factors, but you can prevent cervical cancer by having yearly pap tests and returning for follow-up treatment if the results are abnormal.
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