When Should I Get a Pap Smear?

So what is the truth about pap smears? Everywhere we read, it says something different about how often we need to get a check-up with the gynecologist. And we hear, “. . . if you've had a hysterectomy you never need to have a pap again.”

The so-called guidelines suggest that no one needs a pap smear until age 18 – 21, regardless of the age of the first sexual experience. But, consider how prevalent HPV is, and how easily it is transferred to women during sex – and knowing it is the #1 cause of cervical, anal, and oral cancers.

There is also the worry of infertility that can be caused by STDs. When exams are encouraged at an early age, this can be minimized and treated, if necessary.

Pap smears may be discontinued after surgery for a total hysterectomy, unless it was performed for cervical cancer or any type of pre-invasive diagnosis found on pap smear. This includes high risk HPV, uterine, ovarian, breast, bladder or anal cancer. Yearly paps and pelvic exams should be continued if you have ever had, or currently have, any of these cancers.

Having a compromised immune system for any reason – from diabetes, HIV, Lupus or other auto-immune disorders – can put you at risk for cancer and pre-invasive disease, even if you have never been diagnosed with it. It is so important to get yearly exams and not assume that you are not at risk just because you are too young, too old, not currently having sex, or because you have had a hysterectomy.

The most important thing is to put yourself first. We, as women, can easily ignore our own needs and health as we take care of our families. Let me say this, it's not worth it, because you deserve to be healthy and feel good. Most cancers, if caught early, are curable and never advance to the point of even needing drastic treatment like chemotherapy or radiation. You and your family deserve to have you happy and healthy.

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Abnormal Pap Smear Results. What Does it Mean?

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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Can I still get pregnant after a Leep procedure?

“Dear KnowYourV, ,

My husband and I have been trying to get pregnant and now with my abnormal pap results my doctor wants to do a ‘LEEP procedure’ to remove the abnormal tissue from my cervix. Will this interfere with my ability to get pregnant?”

I hear this from so many woman because, with the ‘LEEP procedure’, a very small portion of the cervix is actually removed. Therefore, many women worry that this will weaken their cervix and cause them to miscarry their pregnancies.

The Loop Electrode Electro-cautery Procedure (LEEP) is done in the doctor’s office. It replaced the cervical cone biopsy which was performed in the OR (Operating Room) under anesthesia. The LEEP procedure removes a small, flat, nickel-sized portion of tissue. By contrast, the Cone Biopsy was developed for cervical cancer diagnosis and evaluation, so a very large, deep biopsy was taken, and often it did extend so deep that the risk was higher.

Once the tissue is removed with the LEEP procedure, it is sent to pathology to be examined by the pathologist. It is important to determine if there are any cancerous cells present and also if the margins (or edges) of the specimen are clear of any abnormality. That way, healthy new tissue can replace the diseased or infected tissue, so the next pap results should be normal.

The other popular method for cervical tissue removal is ‘cryotherapy’, where the cervix is frozen, causing the abnormal tissue to be destroyed. Again, healthy tissue will generally take its place. This is done in only mildly abnormal cases, because all the tissue is destroyed in the freezing method, leaving no specimen for the pathologist.

So, in answer to your question about pregnancy, the ‘LEEP procedure’ is not going to interfere with your body’s ability to become pregnant or maintain the pregnancy. I have had many women have successful pregnancies over and over after having this procedure done.

I hope you all stay safe, and enjoy life and work wherever you may be this week. Write to us if you have anything on your mind that we can help you with.

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