What is the pap smear?
The pap smear is a screening test for cervical cancer. Usually done annually, it collects cells from the cervix which are then reviewed by a pathologist for evidence of abnormal cells. The pap smear is an ideal screening test because cervical cancer usually takes several years to develop so regular pap smears allow us to diagnose the pre-cancerous changes so that we can intervene before they develop into cancer.
The results of your pap smear will be reported in several different categories:
- Negative (normal)
- Atypical squamous cells of undetermined significance (ASC-US)
- Atypical squamous cells suspicious for high grade intraepithelial lesion (ASC-H) 4. Low grade intraepithelial lesions (LSIL). The LSIL category includes changes consistent with HPV, mild dysplasia, or CINI (grade 1 cervical intraepithelial neoplasia).
- High grade intraepithelial lesions (HSIL). HSIL includes changes consistent with moderate or severe dysplasia, CIN n or HI, and carcinoma in situ (CIS).
- Atypical glandular cells (AGC) may be endocervical, endometrial, or other glandular cells
- Endocervical adenocarcinoma in situ (AIS
What causes abnormal paps?
The most common abnormal paps that we see are ASCUS and LSIL. The majority of abnormal paps are caused by an infection with a virus known as the human papillomavirus (HPV). HPV is the most common sexually transmitted disease. By age 50, over 80% of women will have been infected with HPV. The majority of people do not have any symptoms of the infection and will clear the infection on their own.
There are over 100 strains of HPV and over 30 of them are involved with genital infections. The different strains are categorized into “low risk” and “high risk” groups. High risk strains cause abnormal paps and can lead to cancer of the cervix, vagina, vulva, anus or penis. Low risk strains can cause mildly abnormal changes in pap smears and also cause genital warts.
How do we manage abnormal paps?
Once you have an abnormal result on your pap smear, your doctor will probably recommend you undergo colposcopy. Colposcopy is a procedure done in the office during which your doctor will look carefully at your cervix with a colposcope (a kind of microscope for the cervix). If any abnormal cells are seen, biopsies will be taken. The procedure takes 15-20 minutes and does not require any anesthesia. You may want to take 600-800 mg of ibuprofen before the procedure to help with cramping.
If the biopsy shows evidence of dysplasia, management may include simply repeating your pap in 4-6 months, cryotherapy (freezing of the abnormal cells on the cervix) or removal of the infected part of the cervix (a procedure called a LEEP or a cone). Your doctor will tell you which is the best choice for you after the biopsy results come back.
You can also make some lifestyle changes that will help your body to clear the infection on its own. If you smoke, quit! Cigarette smoking helps the HPV virus to grow more quickly. If you are currently a smoker, quitting may be enough to return your pap smear to normal. Also, recent evidence suggests that increasing your folic acid to 800 micrograms a day may also help your body get rid of the infection.