Abnormal Pap Smear Results. What Does it Mean?

>> Tuesday, September 25, 2012

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Many of you wonder what it means when your pap comes back with abnormal results. So many of you may be confused by what your healthcare provider does or does not tell you and also by the so called "new" recommendations.

New recommendations (sometimes reflecting a view toward saving healthcare dollars by delaying care)suggest that pap smears not be repeated if abnormal unless dysplasia is present, and that frequency should be every 2-3 years. They also recommend the delay of pap smears in teens until they are 18 - 21 years old, unless they are sexually active earlier. We have seen the same recommendations for Medicare patients with paps and mammograms. Medicare has decided to only pay every other year for these studies in women who have had no history of cancer, but even then we have to fight to get them to pay for these patients to receive care more often. It is the high risk patients that we are very concerned about.

The sad thing is, the American Cancer Society has worked hard and made huge strides in decreasing the numbers of breast and cervical cancer in women because of increases in routine yearly screening. Now, are we expected to make giant steps in reverse? The American Cancer Society & The American College of Obstetrics and Gynecology still recommend that all women age 18 and over have a pelvic examination and a Pap test at least once a year. In most cases, the laboratory will report that the Pap smear is normal. However, in 5-10% of cases, Pap test results will be abnormal.

Abnormal results on a Papanicolaou (Pap) test mean that there are changes in the cells of the cervix – the opening of the uterus (womb). Cervical cell changes are most often caused by inflammation. Inflammation may be the result of infections, such as gonorrhea, herpes, genital warts, bacterial vaginosis, Chlamydia, trichomonas, or yeast infections.

Cervical cell changes can also signal cancerous or precancerous conditions that need to be examined further by your physician. Not all abnormal paps are signals for cancer, but they should used as tools to evaluate what is causing the inflammation. It should not be filed away for next year. You should be called back for another check-up to evaluate the reasons for the inflammation so that it can be treated.

Inflammation on a Pap smear can be found in a patient of any age and may be attributable to a benign infection — such as Candida vaginitis — that need be treated only if the patient is symptomatic. Sexually transmitted infections can also cause an inflammatory reaction on the cervix and should be treated accordingly.

If a Pap result comes back as "inflammation," but the smear is otherwise satisfactory (assuming the previous test was satisfactory and normal), the Pap can be repeated in one year, but again, go see your doctor to find out what's causing your inflammation.

You should consult your physician for an explanation of your test results, but here are some common classifications of Pap smear results that help interpret any changes seen in the cervical cells:

  • Atypical or inflammatory: Bacterial or inflammatory cells are seen, usually suggesting an infection or disturbance on the surface of the cervix.
  • Cervical intraepithelial noeplasia (CIN 1-3): Abnormal cells have replaced normal ones and could develop into cancer over a period of year. CIN is not itself cancer and is usually 100% curable by treatment. CIN is usually subdivided into three grades: 1 - mild dysplasia (abnormal cells); 2 - moderate dysplasia; and 3 - severe dysplasia. Dysplasia is a change in the size, shape, or organization of cells.
  • 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.

Although the Pap test is very effective in detecting changes in the cervix, like any test, it is not always 100% accurate. Sometimes there can be problems with the sample itself or with the interpretation of it. 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. Thankfully, the new liquid paps have made it easier for pathologists to read pap tests when blood or discharge is present.

As we know, no test is perfect. Remember that, because the Pap test can find cell changes at an early stage (when treatment is more successful), it can help prevent cancer of the cervix. Since the Pap test was introduced 50 years ago, the number of relevant deaths has decreased by 70%.

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