Abnormal Pap Smears

The impact of the Pap smear on early detection and prevention of cervical cancer is one of the most dramatic public health success stories. In developing countries, where Pap smears are not done, cervical cancer is still a leading cause of death. In the US, the rate has been extremely low since the 1960s, when routine Pap smears were introduced. Every year 3.5 million women get that stomach-dropping phone call or letter. Only 13,000 have a true cancer. The rest either have nothing wrong with their cervix, or have dysplasia, a treatable, pre-cancerous condition.

It is important to keep in mind that screening is just that; it identifies who might have cancer or pre-cancer, which by necessity also includes many people who do not. While these tests often create anxiety and generate additional procedures, women who are found to have an early cancer or pre-cancer on a routine Pap smear rarely question the benefit of the screening test that saved their lives.

Frequently, “atypical cells of unknown significance” (ASCUS) are detected on your Pap smear. Cells on the surface of the cervix replace themselves every few months and it is not unusual for a group of cells to look slightly atypical due to infection or hormonal changes. If you have an ASCUS result, we will then check for the presence of the HPV virus, a sexually transmitted virus that is associated with the development of cervical cancer. If a high-risk HPV is not present, chances are a repeat PAP smear will be normal.

Dysplasia refers to an abnormal growth pattern. Most dysplasias go away without treatment, but some may eventually progress to cervical cancer. When a Pap smear is abnormal, the next step is usually colposcopy, a microscopic examination of the cervix that allows the gynecologist to inspect the surface of the cervix under magnification.  Treatment is then determined by the extent and severity of the problem.

Even in the event that the abnormal cells are an indication of a true pre-cancerous change, changes occur very slowly.

In many cases we will wait a few months and repeat the Pap smear to see if your immune system clears the virus and repairs any abnormal cells.