By Dr Brigid Monda

You have just visited your doctor for your regular health check. He announces the results of the pap smear as negative and you sigh in relief.

A positive result means abnormal cells have been detected but this does not automatically mean that you have cancer of the cervix.

Many of you have emailed me questions on what normal and abnormal pap smears portend. Here are some answers.

Normal pap smear: No abnormal cells are detected and you will not need any further treatment or testing until you are due for your next scheduled pap smear.

Inflammatory: It results from infection and the pap smear needs to be repeated after the infection is treated and cleared. This is usually after six to eight weeks because the inflammatory cells may have obscured abnormal cells. The infection is usually an overgrowth of the yeast or bacteria that live normally in the vagina.

Atypical Squamous Cells of Undetermined Significance (ASCUS): This means the pap smear showed slightly abnormal cells but it is impossible to tell the exact cause. It could be many things other than cancer.

However, the abnormal cells may also be precancerous. You would need to repeat the pap smear every six months until you get three consecutive normal smears. The doctor might also suggest another test to determine the cause of the abnormal cells.

Atypical Glandular Cells of Undetermined Significance (AGUS): This means the pap smear showed slightly abnormal cells of the cervical glands. The condition requires further investigation compared to the ASCUS. You will require a colposocopy and a sample of the tissue taken because these cells have a higher chance of being abnormal.

Cervical Intraepithelial Lesions: This is graded and indicates that the cells are consistent with abnormalities that are precancerous. If it is low-grade, the precancerous cells are years away from developing into cancer.

If it is high-grade, the precancerous cells are further down the road to cancer and this has to be confirmed with another diagnostic test called a colposcopy.

Q: How reliable is the pap smear?

A: The pap smear isn’t foolproof of cervical cancer but it is 98 per cent accurate. You could receive a false-positive result, which means you have abnormal cells when you actually don’t.

You could also receive a false-negative result if the pap smear indicates there are no abnormal cells even when you have some. However, a false-negative result does not mean the doctor made a mistake.

Many factors can cause a false-negative result, including:

- The cervical swab catching only an area of normal cells in a cervix that has abnormal cells.

- An inadequate collection of cells.

- A small number of abnormal cells.

- Inaccessible location of the abnormal cells.

- Blood or inflammatory cells obscuring the abnormal cells.

Although abnormal cells can go undetected, time is on your side because cervical cancer takes many years to develop. And if one pap test does not detect the abnormal cells, the next test most likely will.

Q:I have no symptoms. Do I really need a pap?

A: The precancerous and early stages of cervical cancer have no symptoms so the only way you can protect yourself is by taking pap smears regularly.

If you wait for symptoms of cervical cancer, most likely you will be at an advanced stage of the disease with your chances of survival greatly reduced.

Q: Are there people who do not need to have a pap smear done?
A: Yes. Young women below the age of 18 who are not sexually active; women aged 70 and above who have had three normal pap tests in a row in the last ten years and; women who have had hysterectomies for non-cancerous conditions like fibroids.

But if the hysterectomy was done because of cancer, the doctor may advise a smear be taken from the top of the vagina — a vault smear — as well as a regular pelvic examination.

Q:If my pap is abnormal, will I need to have my uterus removed?

A: The whole idea of the pap smear is that it picks up early cancerous changes in the cells that are easily treatable without resorting to drastic measures. A second examination called a colposcopy is done if your pap smear shows abnormal cells. This provides a definitive diagnosis in contrast to the pap test, which is a screening test.

A colposcopy involves the cervix getting examined using a colposcope — an instrument that illuminates and magnifies the cervix and several small biopsies could be taken.

In some cases, any obviously pre-cancerous areas can be immediately removed.

Once treated, you will need regular pap smears in case the problem recurs.

Success rates are virtually 100 per cent so long as the treatment is given at the pre-cancerous stage of the disease.

Q: If the colposcopy confirms I have abnormal cells, what then?

Several methods are used to remove the abnormal cells.

Cryosurgery: Small precancerous lesions can be frozen off the cervix using nitrogen with a wand-like device.

Loop Electrosurgical Excision Procedure (LEEP): An electric wire loop is used to slice off the diseased tissue.

Cone biopsy: This involves removing a cone-shaped piece of cervical tissue.

Q: What if it really is cancer?

A: Even if the disease has advanced to cervical cancer, when caught in its early stages, it is treatable though surgery. And usually the outcome is good with a survival rate of almost 100 per cent. But it all depends on what stage the disease is at.