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Abnormal Pap Smears

One in 10 Pap smears will have some abnormality, so don't panic if you get a call from your doctor's office asking you to return. Don't panic, but do go! Most of the time abnormal results are due to collection errors, changes associated with inflammation, or a precancerous lesion. The good news is that most cervical abnormalities detected by Pap smears are treatable.

There are basically four stages of cervical disease as reported by the Pap smear:

  1. Healthy - although inflammation or infection may be present, no atypical cervical cells are noted. If you have inflammation or infection, your doctor may recommend treatment and repeating the Pap smear in 3-6 months.
  2. Low-grade disease - which can include "ASCUS", meaning "atypical squamous cells of undetermined significance". If a Pap smear shows questionable or low-grade changes, your doctor may recommend repeating your Pap smear in three to six months. But if you've had a previous abnormal Pap or a known sexually transmitted disease (STD), s/he may recommend further testing, including a test for human papilloma virus (HPV) that can be done in conjunction with the Pap smear as well as an in-office examination with a special magnifier called a colposcope. With the colposcope and a special dye, your doctor can perform one or more small cervical biopsies of the abnormal areas identified. This permits an accurate diagnosis and helps determine the extent of any pre-cancerous changes.
  3. Hi-grade disease - severe dysplasia, or "carcinoma in situ", where abnormal cells are limited to the surface of the cervix. In this case, conservative treatment is usually effective.
  4. Invasive cancer - where cellular abnormalities are found deep in the tissue of the cervix. In this case, hysterectomy is usually required.

The good news is that cervical cancer is preventable, diagnosable, treatable and curable if detected in its earliest stages. Cervical cancer is also generally a very slow growing cancer. When cervical cancer is detected at an early stage, the five-year survival rate is 92%. For those patients whose cervical cancers are not detected early, compelling clinical studies support a treatment strategy anticipated to cut the death rate in half by adding chemotherapy to radiation after hysterectomy. The increasing use of routine Pap smear testing with the newest technologies should continue to improve outcomes for women.

Created: 2/21/2005  -  Donnica Moore, M.D.

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