“We treat people, not just problems.”
John L. Pfenninger, M.D.
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Abnormal Pap Smears
What if your Pap smear returns “abnormal”? What does that mean? There are several categories of reports. In the past, Pap smears were labeled as Class I, II, III, IV, or V. This method was replaced with what is called the Bethesda System. In this schema, Pap smears are labeled as normal, atypical, low-grade abnormalities, high-grade abnormalities, or cancer. When the Pap smear is normal on a regular basis, then everyone can pretty much be reassured. When the Pap smear shows cancer, then that is obviously bad news. It is those in-between classifications that require further evaluation.
The category of “atypical” is difficult for everyone. It is “almost normal” but also “almost precancerous”. Some physicians feel that all of these Pap smears need evaluation with special staining and evaluation under magnification (colposcopy). The areas that appear abnormal are then biopsied. The procedure only takes 10-15 minutes and is done in the physician’s office. Should all “atypicals” be biopsied? It depends. “Atypicals” may be due to infection, lack of estrogen, repair of traumatized tissue, or they may indeed be secondary to the human papilloma virus (HPV) and be a precancerous condition. If there is not an obvious benign reason for the “atypical” Pap smear, or if the patient is at high risk for cervical cancer (see our last column), then I perform colposcopy. Certainly anyone with two consecutive atypical Pap smears needs to be evaluated further. Studies now show that 10-15% of these Pap smears with supposedly minor abnormalities can indeed have high-grade abnormal changes.
For patients with low-grade changes or high-grade changes, colposcopy is recommended. For some women not at risk, the low-grade Pap smear may just be repeated. However, as we noted in our previous column, Pap smears can miss a significant number of abnormalities. Pap smears are much more likely to under-call the diagnosis, not over-call it. I almost always carry out a colposcopy when there is any type of low-grade or high-grade change.
Cervical cancer is quite rare.
There are only 13,000 cases per year in the
The important things to remember are obtain regular Pap smears, do not smoke, eat a lot of fruits and vegetables, and be sure to follow-up any abnormalities with your physician.
Copyright, 2011. John L. Pfenninger, M.D. Pap smears abnormal/ jw11/10