The
“We treat
people, not just problems.”
John L. Pfenninger, M.D.
(989) 631-4545
Visit our
website at: MPCenter.net
|
PAP SMEAR INFORMATION |
The frequency at which Pap smears should be
performed depends on individual considerations.
Rarely do I ever recommend going longer than 1 year between
examinations. We now know the Pap can
miss up to 25% of lesions even when done correctly. Some women may have risk
factors which necessitate Pap smears on an every four or six month basis.
In the past, Pap smears were reported to our office
according to a system based on “classes” and were graded Class I through Class
V. You may be more familiar with this
old system.
In 1988, a new system was adopted. They do not report classes as before, but
rather describe more of what they see.
This new way of giving reports is called the Bethesda System. In 2001,
the
Terminology/Reports
1. Negative (previously
Class I): This is a negative smear with no abnormal or unusual cells
seen. The smear is clean and clear of
any inflammatory cells and is easy for the pathologist to read as not having
any evidence of malignancy (cancer).
2. Atypical (previously Class
II): This is further broken down into two terms: Atypical squamous cells,
cannot exclude high grade lesions (ASC-H) and atypical squamous cells of
uncertain significance (ASC-US). With
these smears it is more difficult for the pathologist to unequivocally say that
it is negative. There may be evidence of
regeneration of cells on the cervix or changes in the cells related to
infections or the trauma of childbirth. Depending on other descriptions the
pathologist uses, you may need treatment for infection, a repeat Pap smear,
special DNA testing, observation, or further diagnostic testing with
colposcopy. Your doctor will tell you
what steps to take. Some type of
follow-up is needed.
3. Low-grade squamous
intraepithelial lesion (previously Class III, mild dysplasia): This
classification is for abnormal cells, which may be considered as mild dysplasia
or with mild “premalignant” potential.
This same category would be used if there is any sign of the human
papilloma (wart) virus. Dysplasia
is a precancerous change, and this finding requires further evaluation. If left alone, these changes may revert to
normal, may stay the same, or may progress to malignancy over a period of
years. The interval for the development
of malignancy from dysplasia is variable but commonly felt to be as little as 3
or most likely as long as 10 years.
Office colposcopy, a special technique using a microscope to look at the
cervix, will probably be recommended.
Biopsies will be performed. If
only mild changes are confirmed, usually no treatment is required. However, more frequent Pap smears will be
needed. In some instances of large
lesions or persistent changes, treatment will be recommended.
4. High-grade squamous intraepithelial lesion (previously Class
III, moderate to severe and Class IV): This classification is indicative of
a high degree of precancerous change.
The changes in the cells are severe enough to warrant very prompt and
complete evaluation with colposcopy.
Treatment with freezing or excision of the abnormality is usually
needed.
5. Cancer (previously Class
V): This classification indicates a high probability of cancer and
again, warrants prompt and complete evaluation to determine the extent of the
problem. A plan of treatment for best results
can be determined.
Modern research has now shown that the genital wart
virus (human papilloma virus, also called condyloma) causes cervical
cancer. This virus is very contagious –
with just one sexual contact there is an 80% chance of becoming infected. Be sure to tell your physician if you or your
partner have or did have genital warts.
Unfortunately, only about 20% of genital warts can be seen without using
special techniques. The remaining 80%
must be stained with vinegar and properly evaluated to be seen. If a woman has warts in her vagina or around
the external genitals, there is a 75-80% chance she has changes on her cervix.
It takes 10 days to 2 weeks to get the Pap results
back. Please call our office if you have
not heard from us in 2 weeks’ time.
HIGH RISK
FACTORS FOR DEVELOPING CERVICAL CANCER
You
are in a higher risk group for developing cancer of the cervix if:
·
You have had more than three sexual partners in your lifetime
·
You first had sexual intercourse before the age of 18
·
You have had genital warts (papilloma virus) or other venereal diseases
·
A sexual partner of yours has had intercourse with a women who developed
cervical cancer or abnormal pap smears, or had genital warts
·
You smoke or your partner smokes
·
Your mother took DES (diethylstilbestrol) during pregnancy with you
·
You have had a previous pap smear which showed abnormal or suspicious
cells
·
You have a poor diet (less than five helpings of fruits and vegetables
per day)
·
You have AIDS or other conditions that suppress your immune system
Only a small percentage of women are classified as
low risk. The vast majority of women
have one or more of the above and are, therefore, considered at much greater
risk for developing cancer of the cervix.
Due to this trend, most women should be screened at least once a year,
as a general rule, to insure early diagnosis of the disease.
The wart virus is spreading rapidly. New cases of genital warts now outnumber new
cases of gonorrhea and Chlamydia combined.
Discuss any concerns you might have with your doctor. We do
have two videotapes available on these topics which you can view at home if you
would like. Ask the receptionist for
more information.
TO IMPROVE
YOUR PAP SMEARS
(1) Do not
douche for three days prior to your appointment.
(2) Do
not have intercourse for three days prior to your appointment.
(3) Schedule
your appointment when you are not bleeding.
(4) If
you have an unusual discharge, tell your doctor so this can be treated before
your pap.
(5) Tell
you doctor of any risk factors you may have.
(6)
If you are on Depo-Provera shots, have the Norplant/Implanon in, or are
no longer menstruating (and are not taking estrogens), you may need to take
estrogens before your visit. Discuss this with your doctor.
TO PREVENT
CERVICAL CANCER
(1) Be
monogamous (stay with one partner)
(2) Don’t
smoke (your partner either)
(3) Eat
five helpings of fruits and vegetables per day (the more green, red, orange,
yellow the better)
(4) Take
multivitamins with folic acid.
(5) Get
regular pap smears every year
(6)
Wait until at least age 21 before having sex
Copyright, 2011. John L. Pfenninger, M.D. 02/10