How often should I have a Pap smear?
A woman's first Pap smear should be within three years of when you become sexually active, or when you are 21 years of age, depending on which comes first. Women should have a Pap smear once a year until well after menopause.
A Pap smear is a test your doctor performs to check for signs of cancer of the cervix. The cervix is part of your uterus (womb). A Pap smeal lets your doctor look at the cells within your cervix (lower part of the womb) to see if there are any problems, such as cancer. An abnormal Pap smear means the cells of the cervix show slight abnormal changes.
The Pap smear begins with the doctor placing an instrument, called a speculum, into your vagina. This instrument opens the vagina to allow the doctor to see your cervix and take a sample for testing. Your doctor cleans the cervix with a cotton swab and then collects a sample of cells by using a small brush, a tiny spatula or a cotton swab. This sample will be placed on a glass slide and checked under a microscope by a lab.
What is the sample checked for?
The cells from your cervix are checked for signs that they're changing from normal cells to abnormal cells. Before they turn into cancer, cells go through a series of changes. During the development of cells, the cells at the bottom layer move to the surface of the cervix. It is during this process that some cells may become abnormal or damaged. Damaged cells deelop differently, and in some cases, need to be removed to prevent cancer.
Abnormal cells indicate early precancer changes called dysplasis or cervical intraepithelial neoplasia (CIN). Dysplasis and CIN are graded as mild, moderate, or severe. Mild dysplasis usually goes away on its own, but moderate and severe dysplasis cells indicate more serious changes.
The results of a Pap smear can show whether your cells are going through these changes long before you actually have cancer.
What do the results mean?
A normal Pap smear means that all the cells in your cervix are normal and healthy. An abnormal Pap smear can be a sign of a number of changes in the cells on your cervix, including Inflammation (irritation). This can be caused by an infection of the cervix, including a yeast infection, infection with the human papillomavirus (HPV) the herpes virus or many other infections.
Abnormal cells. These changes are called cervical dysplasia. The cells are not cancer cells, but may be precancerous (which means they could eventually turn into cancer).
Human Papillomavirus (HPV) and Abnormal Pap Test Results
HPV infection is very common, especially in women younger than 20 years. The HPV is passed from person to person through sexual contact. Usually, the immune system clears the virus quickly, and the infection goes away by itself. However, in some women, HPV does not go away. A small number of women will go on to develop CIN. The longer HPV is present and the older the woman, the greater the risk to develop CIN. Usually it takes years for precancer changes in the cervix to cause cervical cancer.
Pap Test Results - The Bethesda System
If you receive an abnormal Pap test result, many of the terms you will hear can be confusing. Most labs use the "Bethesda System" to describe Pap test results. The term squamous intraepithelial lesion (SIL) is used to describe precancer changes. "Squamous" refers to the type of cells that make up the tissue covering the cervix. Using the Bethesda System, your Pap smear results will be placed in one of several groups:
* Normal (negative) -- This means there are no signs of cancer or precancer.
* Atypical Squamous Cells of undetermined significance (ASC-US) -- means, changes in the cervical cells have been found. The changes are almost always a sign of an HPV infection, but may indicate percancer is present. ASC-US is the most common abnormal Pap test result.
* Squamous Intraepithelial Lesion (SIL) -- means abnormal changes are seen in the cells and may be a sign of precancer. SIL can be low grade (LSIL) or high grade (HSIL). The grades relate to the grades of dysplasia and CIN. LSIL usually indicates an HPV infection is present, but is may also indicate mild precancer changes. LSIL is very common and usually goes awan on its own. HSIL indicates more serious cell changes. Carcinoma in situ (CIS) is a severe form of HSIL, and is the most likely to progress to cancer.
* Atypical squamous cells, cannot exclude HSIL (ASC-H) -- because changes in the cervical cells have been found. The changes are not exactly HSIL, but could be and further testing will be needed.
* Atypical glandular cells (AGC) -- means that cell changes are seen that suggest precancer of the upper part of the cervix or uterous.
* Cancer -- means that abnormal cells may have spread deeper into the cervix and/or other tissues.
What the Terms Mean
Cervical changes may be called dysplasia, squamous intraepithelial lesion (SIL), or cervical intraepithelial neoplasia (CIN). SIL is used primarily to describe Pap test results. CIN and dysplasia are terms used to describe the actual changes in cervical cells.
Mild Dysplasia would mean a 1 CIN, and low-grade SIL.
Moderate Dysplasia would mean a 2 CIN, and High-grade SIL.
Severe Dysplasia mean a 3 CIN, and High-grade SIL
If you are informed that you have an abnormal Pap test result, you may need further testing, and treatment and follow-up usually depends on your age and the grade of dysplasia.
Repeat Pap Test
For some women, an additional testing option is to repeat the Pap test in a few months. This may provide time for the cell changes to go away on their own. For women 21 years and older with ASC-US, the test is given every 6 months until two normal results are achieved. After that, a normal Pap smear routine can return. For women 20 years and younger with ASC-US or LSIL, the Pap test is usually repeated in one year.
Another option for some women is an HPV test. This test detects the presence of cancer-causing types of HPV in cervical cells. The cells used for the initial Pap test often can be tested, so a woman does not need to return to the office for another test.
Colposcopy, Biopsy, and Endocervical Sampling
Colposcopy lets your doctor look at the cervix in more detail through a magnifying device. It can detect problems of the cervix that cannot be seen with the eye alone. If an area of abnormal cells is found, your doctor may decide that a biopsy is needed. A small sample of tissue will be removed and senr it to a lab to be studied. Endocervical sampling also may be done, which involves the use of a small brush or other instrument to take a tissue sample from the cervical canal.
In this test, a sample of the endometrium (the lining of the uterus) is collected for study. Some women with an AGC result need to have this follow-up test.
Treating cervical changes depends on many factors. Cervical intraepithelial neoplasia (CIN) 1 usually goes away by itself. For this reason, CIN 1 in women 20 years and younger is monitored with repeat Pap tests. No treatment is needed unless there is an HSIL Pap test result. Women 21 years and older, treatment is not needed unless CIN 1 has been present for 2 years, the CIN becomes CIN 2 or CIN 3, or there are other medical problems.
Techniques used to treat cervical intraepithelial neoplasia (CIN):
Loop electrosurgical excision procedure (LEEP) is a thin wire loop that carries an electric current and is used to remove abnormal areas within the cervix. The LEEP is usually performed in the doctor’s office with local anesthesia. The areas that are removed are sent to a lab to be studied.
Cone biopsy is when a cone-shaped wedge of the cervix is removed for study. This procedure may be done in an operating room with general anesthesia or in a surgical center with other types of anesthesia. Most likely you will be able to go home the same day.
Freezing is also called cryotherapy, and is a technique to freeze abnormal tissue, which the body will later shed.
Laser treatment is using a beam of light to destroy abnormal tissue.
An abnormal Pap smear test result is scary and stressful, but when caught early, cervical cancer can be avoided. Don't put off having your annual Pap smear, and don't run away from the treatment!