The Pap Smear
‘Ri Teref-Ta APRN-CNM, MSN
The pap smear is a screening test done during a well woman exam that checks for precancerous or cancerous cells on the cervix. Recently, guidelines have changed about how often a woman should have this screening test.
Until the early 2000’s, it was not know what caused cervical cancer and the recommendation was for every woman to get a pap smear every year. Once it was discovered that HPV (Human Papilloma Virus) is responsible for 99% of all cervical cancers, the recommendation changed to start pap smear testing 1 yr after becoming sexually active and every year thereafter until age 30. At age 30, a woman who was at low risk and had had no abnormal pap tests could then get tested every 2 years. Women at high risk or who had abnormal results or had dysplasia (precancerous cells) still needed yearly testing after age 30.
Recently, in December of 2012, new guidelines were announced for pap testing. The new recommendation is now- begin testing at age 21, and every 3 yrs until age 30. If no abnormal paps, test for HPV at age 30. If negative, check a pap smear every 3-5 years.
Pap results can come back with 4 basic results: normal, ASCUS, LSIL and HSIL; as well as HPV negative or HPV positive. There are over 100 strains of HPV-some cause warts, including genital warts- which are benign, some strains have been identified but it is unknown if they do anything, and 14 strains are considered “high risk” for cervical cancer. If a test results comes back HPV positive- it is positive for one of the 14 high risk strains (the other strains are not checked).
ASCUS means there are atypical cells- they don’t look quite normal- and may be caused by many reasons: infection, inflammation, HPV, allergic reaction, etc.
LSIL and HSIL are higher grade abnormalities that are mostly related to HPV changes of the cervix that may be precancerous or cancerous. They are Low-grade and High-grade Lesions of the cervix.
If your pap smear is abnormal, your health care provider may need to take a closer look at the cervix. This is called a colposcopy. (Remember the pap smear is just a screening for abnormalities- a brush gathers cells from all over the cervix to be examined by a pathologist for changes that may need further evaluation)
A colposcopy is a procedure done in the office to get a closer look at the cervix. A colposcope is a microscope that is designed to get a better look at the cervix- the cervix is cleaned and then thoroughly examined with this specialized microscope. If any abnormalities are detected- a biopsy will be taken to see how deep these changes go.
The cervical biopsy results may be: normal, mild dysplasia, moderate dysplasia or severe dysplasia. Normal tissue and mild dysplasia may require just repeat paps check the area on a preset schedule. Moderate or severe dysplasia require treatment because these cells are becoming more cancer-like. There are many treatments to get rid of the precancerous cells such as : cryotherapy, cone biopsy, laser removal and LEEP- where a wire is used to remove the affected area of the cervix.
Treatments get rid of the tissue that is changing, not the virus that causes it. HPV is sexually transmitted. According to the CDC, 85% of the sexually active population over the age of 18 is HPV positive. It is important that if you have ever had an abnormal pap that you follow-up with your health care provider to learn when you need to return for your pap smears.
It is my recommendation that every woman has her yearly well woman exam- at that exam we discuss your risk for cervical cancer and how often you should come in for pap smears. This exam also can include other testing for sexually transmitted infections, a breast exam, family planning and other health maintenance testing such as thyroid screening and/or screening for diabetes or other problems. We discuss your schedule for mammograms based on your risk level and discuss hormonal changes with peri/postmenopause.
If you would like to know more, schedule your well woman exam with me at the Midtown Women’s Center at Saint Anthony’s Medical Plaza downtown OKC. 405-272-8498