Q: I had an abnormal pap smear and had to have another one repeated in four months. My friend had an abnormality as well, but she needed to have a colposcopy. Why the difference?
A: About 3.5 million women in America have abnormal pap smears each year, but the overwhelming majority of them have no serious disease, such as invasive cervical cancer. Usually, an abnormal pap smear can be repeated at varying intervals depending on the severity of the abnormality and the individual risk factors of the patient.
However, some new guidelines have just been established that we hope will lead to a faster diagnosis, while making sure that women receive the most effective and up-to-date treatment.
First, the new guidelines recommend following less serious Pap smear abnormalities -- test results known as ASC-US (atypical squamous cells of undetermined significance) -- with testing for human papillomavirus (HPV), a sexually transmitted infection closely linked to cervical cancer. If human papillomavirus is detected and is one of the high-risk strains, further assessment can take place immediately.
Second, for pap smear results indicating LSIL (low-grade squamous intraepithelial lesion), a more serious abnormality, the guidelines recommend following up with colposcopy, a procedure involving examining the cervix and obtaining a tissue sample, which yields immediate results. It's still important to remember however, that most women whose results are in this category usually have no cervical cancer, or either a low-grade lesion that could go away on its own, or be removed during a biopsy.
And third, the recommendations for the most serious pap smear results, HSIL (high-grade squamous intraepithelial lesion), less than .005 percent of all pap smears, advise colposcopy and aggressive assessment of the findings. 75 percent of women with HSIL lesions have a precancerous condition, while up to 2 percent have invasive cervical cancer.
It's important to remember that if women have Pap smears and pelvic exams regularly, most abnormalities can be treated before cancer develops. And, as with many types of cancer, cancer of the cervix is more likely to be treated successfully if it is detected early.
Current guidelines recommend that women who are or have been sexually active, or have reached age 18, should have Pap tests and pelvic exams regularly. Discuss how often with your OB-Gyn or primary care physician.
