What an abnormal pap smear means

By Dr Brigid Monda

Many of us would choose the pain of a dentist’s chair over the most compassionate and sensitive gynecologist’s examination table. You endure a cold speculum — which is torture enough — then it does not seem fair that at the end of it, you hear that your cervix is not perfectly healthy. Being told that you have an abnormal pap smear makes you feel like a time bomb ticking away because most women assume that the problem begins with a capital C — Cancer. But being told that you have a positive smear does not necessarily mean that you have cancer. A negative result means that abnormal cells were not detected. A positive result means that abnormal cells were found but this does not automatically mean that you have cancer. Pre-cancerous cells, means cells that have early changes, which could develop into frank cancer with time.

Your pap smear may be

Normal: No abnormal cells are detected and you won’t need any further treatment or testing until you are due for your next scheduled Pap smear.

Inflammatory: This is usually due to infection. The smear is repeated after the infection is treated and cleared, usually after six to eight weeks because the inflammatory cells may have obscured abnormal cells.

Atypical Squamous Cells of Undetermined Significance (ASCUS): This means the Pap smear showed slightly abnormal cells but it is impossible for the Pap test to tell exactly what is causing the abnormal cells to appear. The cause could be anything including a lot of things that have nothing to do with cancer. However, the abnormal cells may also be pre-cancerous. You would need to repeat the Pap smear every four to six months until you get three consecutive normal smears or the doctor may suggest another test to determine the cause of the abnormal cells.

Cervical Intraepithelial Lesions: This indicates that the cells seen on the Pap smear are consistent with abnormalities that may be pre-cancerous. This is also graded.

If it is Low-grade, the precancerous cells present are years away from becoming a cancer.

If 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.

How reliable is the Pap Smear?

The Pap smear is not foolproof but a properly performed pap smear is 98 per cent accurate.

You could receive a false-positive result, which means you have been told you have abnormal cells when you actually don’t. Or you could receive a false-negative result, which means that the Pap smear indicates there are no abnormal cells even though you do have abnormal cells. A false-negative result does not mean that a mistake was made, however. Many factors can cause a false-negative result, including:

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.

I have no symptoms so do I really need a Pap?

The early pre-cancerous and cancerous stages of cervical cancer have no symptoms so the only way you can protect yourself is by having your pap smears done regularly.

If you wait for symptoms of cervical cancer, you would most likely be at an advanced stage of the disease and your chances of survival would be greatly decreased. So get your pap done, now.

Are there people who do not need to have a pap smear done?

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 10 years, and women who have had hysterectomies for non-cancerous conditions like fibroids. But if the hysterectomy was because of cancer, the doctor may advise that a smear be taken from the top of the vagina — a Vault Smear and a regular pelvic examination.

If my pap is positive, will I need a hysterectomy?

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 our pap smear shows abnormal cells. This test provides a definitive diagnosis in contrast to the Pap test, which is a screening test.

A Colposcopy involves inserting a speculum into the vagina so that the doctor can see the cervix, which is then painted with a dilute solution of acetic acid, which shows up any abnormal cells. The cervix is then examined using a Colposcope, an instrument that illuminates and magnifies the cervix and several small biopsies may 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.

If the Colposcopy confirms that I have abnormal cells, what then?

One of these methods will be used to remove the abnormal cells.

Cryosurgery:

Small pre-cancerous 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 of tissue.

What if it really is cancer?

For some women, the fear of being diagnosed with cervical cancer will become a scary reality but even if the disease has advanced to frank cervical cancer, even this caught in its early stages is treatable and the outcome is usually a good one, with a survival rate of almost 100 per cent. The treatment will depend on the stage of the disease.

The early stages are treated by a hysterectomy, which includes the removal of the uterus and cervix. The late stages are treated with radiotherapy.

How to protect yourself against cervical cancer