What is the Pap Test?
The Pap test (Pap smear) is a screening test for cervical cancer. Dr. Georgios Papanikolaou was an early pioneer in women’s health. You clinician uses a soft brush to collect cells form the edges of where the inner and outer ‘skin’ of the cervix is located. The brush is placed in a collection solution, and then the cells from the cervix reviewed by a pathologist. The Pap test is an ideal screening test because cervical cancer usually takes several years to develop. Regular Pap tests allow us to diagnose the pre-cancerous changes so that we can intervene before they progress into cancer of the cervix.
Pap testing results are reported in terms that describe the cellular abnormality, and range from normal to cancerous.
- Negative for Intraepithelial Lesions (normal, NIL)
- Atypical squamous cells – of undetermined significance (ASC-US)
- Atypical squamous cells – suspicious for high grade intraepithelial lesion (ASC-H)
- Atypical glandular cells (AGC), which may be endocervical, endometrial, or other glandular cells
- Low grade intraepithelial lesions (LSIL). The LSIL category includes changes consistent with HPV effect, mild dysplasia, or CIN I (grade 1 cervical intraepithelial neoplasia).
- High grade intraepithelial lesions (HSIL). HSIL includes changes consistent with moderate or severe dysplasia, CIN II or III, and carcinoma in situ (CIS).
- Cancer findings.
What Causes Abnormal Paps?
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 more than 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 if they go undiagnosed and untreated. Low risk strains can cause mildly abnormal changes in Pap tests and also cause genital warts.
Please consider receiving the HPV vaccine (Gardasil), to reduce your risk of cervical cancer. See the HPV Vaccine information on this Gynecology webpage.
How Do We Manage Abnormal Paps?
An abnormal Pap test means that some of the cells collected were of concern. Identifying a specific location on your cervix and determining the severity of the disease is the next step. Your practitioner will probably recommend you undergo a colposcopy. Colposcopy is a procedure done in the Arbor ObGyn office during which the physician 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 exam takes only 5-10 minutes and does not require any anesthesia. Some women find it helpful to take 600-800 mg of ibuprofen before the procedure to help with unexpected cramping.
The goal of colposcopy is really to determine the appropriate follow-up interval. We want you to return for evaluation often enough that we can identify if your cervical health worsens, but we don’t want the exams to be so frequent that they are a burden to you. If the biopsy shows evidence of mild dysplasia (pre-cancer), management typically is simply to repeat your Pap test in one year. It is important that your return for this appointment!
More severe dysplasia may require closer interval observation, cryotherapy to freeze the abnormal cells, or removal of the infected part of the cervix with a LEEP procedure (see information on the Surgery webpage). Your doctor will advise you on treatment options 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 advance more quickly. If you are currently a smoker, quitting may be enough to return your Pap test 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. Most importantly, because HPV is sexually acquired, reducing potential sexual exposure is recommended.
Additional Resources:
U.S. DHS, Office on Women’s Health, Pap and HPV tests: https://www.womenshealth.gov/a-z-topics/pap-hpv-tests
National Cervical Cancer Coalition: http://www.nccc-online.org/