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All About Pap Smears

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Dysplasia

The next most common finding (in about 25 of every 1,000 tests) is low-grade SIL, which includes mild dysplasia or CIN I and changes caused by HPV. Unlike cancer cells, these cells do not invade normal tissues. Women are most susceptible to cervical dysplasia between the ages of 25 and 35. Typically, dysplasia causes no symptoms, although women may experience abnormal vaginal bleeding. Because dysplasia is precancerous, it should be treated if it is moderate or severe.

Treatment of dysplasia depends on the degree of abnormality. In women with no other risk factors for cervical cancer, mild precancerous changes may be simply observed over time with repeat testing, perhaps every four to six months. This strategy works only if women are diligent about keeping later appointments. Premalignant cells may remain that way without causing cancer for five to ten years, and may never become malignant.

In women with positive results or risk factors, the gynecologist must perform colposcopy and biopsy. A colposcope is an instrument that looks like binoculars, with a light and a magnifier, used to view the cervix. Biopsy, or removal of a small piece of abnormal cervical or vaginal tissue for analysis, is usually done at the same time.

High-grade SIL (found in three of every 50 Pap tests) includes moderate to severe dysplasia or carcinoma in situ (CIN II or III). After confirmation by colposcopy and biopsy, it must be removed or destroyed to prevent further growth. Several outpatient techniques are available: conization (removal of a cone-shaped piece of tissue), laser surgery, cryotherapy (freezing), or the "loop electrosurgical excision procedure." Cure rates are nearly 100% after prompt and appropriate treatment of carcinoma in situ. Of course, frequent checkups are then necessary.

Cancer

HPV, the most common STD in the United States, may be responsible for many cervical cancers. Cancer may be manifested by unusual vaginal bleeding or discharge, bowel and bladder problems, and pain. Women are at greatest risk of developing cervical cancer between the ages of 30 and 40 and between the ages of 50 and 60. Most new cancers are diagnosed in women between 50 and 55. Although the likelihood of developing this disease begins to level off for Caucasian women at the age of 45, it increases steadily for African-Americans for another 40 years. Biopsy is indicated when any abnormal growth is found on the cervix, even if the Pap test is negative.

Doctors have traditionally used radiation therapy and surgery to treat cervical cancer that has spread within the cervix or throughout the pelvis. In severe cases, postoperative radiation is administered to kill any remaining cancer cells, and chemotherapy may be used if cancer has spread to other organs. Recent studies have shown that giving chemotherapy and radiation at the same time improves a patient's chance of survival. The National Cancer Institute has urged physicians to strongly consider using both chemotherapy and radiation to treat patients with invasive cervical cancer. The survival rate at five years after treatment of early invasive cancer is 91%; rates are below 70% for more severe invasive cancer. That is why prevention, risk reduction, and frequent Pap tests are the best defense for a woman's gynecologic health.

BOOKS

Berek, Jonathan S., Eli Y. Adashi, and Paula A. Hillard. Novak's Gynecology. 12th ed. Baltimore: Williams & Wilkins, 1996.

Hoffman, Eileen. Our Health, Our Lives: A Revolutionary Approach to Total Health Care for Women. New York: Pocket Books, 1995.

Illustrated Guide to Diagnostic Tests. 2nd ed. Springhouse, PA: Springhouse Corporation, 1998.

Slupik, Ramona I., ed. American Medical Association Complete Guide to Women's Health. New York: Random House, 1996.

PERIODICALS

Brotzman, Gregory L., and Thomas M. Julian. "The Minimally Abnormal Papanicolaou Smear." American Family Physician 53 (March 1996): 1154-62, 1165-66.

Morgan, Peggy, and Linda Rao. "Abnormal Pap? What to Do Next." Prevention 48 (November 1996): 90-6.

Nuovo, Jim, Joy Melnikow, and Mary Paliescheskey. "Management of Patients with Atypical and Low-Grade Pap Smear Abnormalities." American Family Physician 52 (December 1995): 2243-50.

Perlmutter, Cathy, and Toby Hanlon. "The Smart Pap: How to Wage a Successful Smear Campaign to Improve the Accuracy of Your Results." Prevention 48 (October 1996): 82-5,155-7.

ORGANIZATION

American College of Obstetricians and Gynecologists. 409 12th St. SW, PO Box 96920, Washington, DC 20090-6920. (202) 863-2518. <http://www.acog.com>.

National Cancer Institute, Office of Communications. 31 Center Dr., MSC 2580, Bethesda, MD 20892-2580. (800) 4-CANCER. <http://cancernet.nci.nih.gov/>.