Every year, thousands of women are diagnosed with cervical cancer. However, far more women are diagnosed with precancerous cervical lesions for which they are treated. This prevents them from ever developing more serious forms of the disease. Pre-cancerous diagnoses are possible because the Pap smear test is a routine part of women’s healthcare.
According to the American Cancer Society (ACS), more than half of women who are diagnosed with cervical cancer have not had a Pap smear in at least five years. Some have never had a Pap smear. This is because women who get regular Pap smears are far less likely to be diagnosed with cancer. Instead, with regular Pap screening, pre-cancerous lesions can be identified and treated before they become frank cancers. Unlike cervical cancer, the survival rate for cervical pre-cancers is nearly 100 percent.
The Pap smear is a method of collecting and examining cervical cells. It can identify pre-cancerous cells as well as cancers. In the United States, and other countries where it is widely used, the Pap smear has dramatically reduced the incidence of cervical cancer. It has also significantly decreased mortality.
The Pap smear is a part of a routine pelvic exam. A physician uses a soft brush to gently scrape cells from the cervix. He or she then places the cells into a small bottle of preserving solution, or spreads them on a microscope slide. The sample is then examined under a microscope. Sometimes, abnormal cells may mean that you have an infection. They may also indicate pre-cancer or cervical cancer.
In some women, the sample may also be tested for HPV. Cervical cancer is very unlikely in women who do not have HPV.
Preparing for a Pap
For 24 hours before the test, avoid:
- having a bath
- using any products inside the vagina
These can affect your Pap smear results. In addition, a Pap test should be done when you are not menstruating.
What to Expect
The test can be a little uncomfortable. You may feel cramping or pain. A small amount of bleeding may occur after the test.
Results of the Pap test take one to two weeks. The cell sample will be either negative, positive, or inadequate/indeterminate.
Not all positive results indicate cancer.
Pap smear guidelines have changed in recent years, and women are no longer encouraged to have an annual exam. According to the National Library of Medicine (NLM), the guidelines are:
- You should get your first Pap smear at age 21
- You should take the test every two years
- Women over 30, or with three consecutive negative results, only need to test every three years
- Women with new sexual partners should get a smear every two years. This is also true if their partners have new partners
Women over 65 do not need Pap smears if:
- they have had three negative tests in the last ten years
- they do not have a new sexual partner
In addition, most women who have had a total hysterectomy do not need a Pap smear. A total hysterectomy removes the cervix as well as the uterus.
Woman should receive Pap smears regardless of their sexual orientation. HPV can be transmitted between two women.
However, women should not have more than the recommended number of Pap smears. False positive tests can lead to unnecessary treatment and follow up. This can affect a woman’s future fertility.
For women over 30, a Pap smear may be combined with an HPV test. If both tests are negative, the interval between smears can be extended to five years.
HPV tests are not used for women under 30 because the virus is too common. Most HPV infections in young women will never cause problems.
Understanding Abnormal Pap Smear Results | Abnormal Results
Not all abnormal Pap smear results indicate cervical cancer. Some don’t even indicate cervical pre-cancer. That’s why it’s so important to understand the different possible results.
ASCUS, pronounced “ask us,” stands for “atypical squamous cells of unexplained significance.” These cells are abnormal for reasons that your doctor does not understand. They are not necessarily pre-cancerous cells.
Most women with an ASCUS diagnosis go back to having normal Pap smears within a few years.
Potential causes for ASCUS include:
- HPV infection
- a different sexually transmitted infection
- irritation from intercourse
Squamous Intraepithelial Lesion (SIL)
Squamous cells are the relatively flat cells that make up the outer layers of the cervix. A diagnosis of squamous intraepithelial lesion (SIL) means that there are pre-cancerous cells in the Pap smear sample. SIL is also known as dysplasia. There are two types of SIL diagnosis.
Low-grade SIL (LSIL) indicates mild changes to the cells. Many cases of LSIL resolve without treatment. They can also progress to become more severe lesions.
High-grade SIL (HSIL) indicates pre-cancerous changes. These cells are likely to become cancerous without treatment. High-grade lesions may represent:
- moderate dysplasia
- severe dysplasia
- carcinoma in situ (CIS)
These designations are part of the Bethesda system of classification.
In general, low-grade lesions (ASCUS and LSIL) do not require treatment. Instead, your doctor may recommend Pap smears every three to six months. This gives the lesions a chance to disappear on their own.
Such a watch and wait approach may seem inconvenient. However, it is better for your health. Repeated, unnecessary treatment can affect your ability to carry a pregnancy to term.
If you have had an abnormal Pap smear, your doctor may recommend a colposcopy. A colposcopy uses a large magnifying glass to examine your cervix. It does not touch your body.
To perform a colposcopy, you will lie with your feet in stirrups. The doctor will insert a speculum into your vagina and widen it to see your cervix.
He or she will then swab vinegar onto your cervix and vaginal walls to make it easier to see any lesions as they turn white in the presence of acetic acid. Then your doctor will look at your cervix with a colposcope.
If a lesion is seen, your doctor may take one or more biopsies. These tissue samples are used to look for the presence of cancerous cells.
If lesions are visible during a colposcopy, you may need one or more biopsies. These are small tissue samples.
A biopsy may be slightly more painful than a standard Pap smear. You may feel a pinch or cramp every time a sample is taken. There may be a small amount of bleeding after the test.
If you have heavy bleeding after your biopsy, call your doctor. It could be a sign of a more serious medical problem.
Cervical Intraepithelial Neoplasia (CIN)
An abnormal, precancerous biopsy result will usually be reported as cervical intraepithelial neoplasia (CIN). This is a way of grading dysplasia. It is similar to SIL. However, in a biopsy the lesion is seen in context. Therefore, it is given a different name.
There are several grades of CIN:
- CIN 1 indicates mild dysplasia
- CIN 2 indicates moderate dysplasia
- CIN 3 indicates severe dysplasia or carcinoma in situ
CIN is not cancer. It only means that abnormal cells are present. If discovered early enough, it can be treated.
A cone biopsy removes a cone of tissue from the cervix. It can also be used as a treatment. If the boundaries of a cone biopsy are clean, no further treatment is needed. However, multiple cone biopsies can prevent a woman from carrying a pregnancy to term. Therefore, they should not be used unless necessary.
A cone biopsy is also called conization.