Unique to Women
Please note: this web content supplements the material on cervical health found in the print edition of Our Bodies, Ourselves.
Pap Smears and Other Cervical Tests
Several different kinds of tests are now being used to detect abnormal cells, cancer and other cervical conditions. The goal is to get the appropriate test for your age and situation.
Traditional Pap smear. Cells are scraped from the cervix using a small spatula or brush, then spread on a slide, sprayed with a fixative and sent for analysis at the lab. For most women most of the time, this is still the appropriate test.
Liquid Based (LB) Pap (ThinPrep or Surepath, formerly AutoCyte). Cells taken from the cervix are placed into a vial filled with liquid. At the lab it is processed by special machinery that separates out mucous, blood, and debris from the cervical cells. A thin layer of cells is then spread on a slide to read.
One disadvantage is that LB Paps are more expensive and you may be asked to pay the difference. A second disadvantage is that LB Paps may give more false-positive diagnoses, especially in young women and also in women taking birth control pills. If you get a false-positive diagnosis, you may have unnecessary further tests and procedures that can be costly and uncomfortable.
One advantage of the Liquid Pap is that cells from the same sample can also be used to test for HPV if and when the provider orders this second test (see below). The HPV part of the test can cost about $50 additional. A second advantage is that LB Paps are better at diagnosing AIS/adenocarcinoma, a cancer of the uterine or cervical lining. Medicare does reimburse if the test is required, but other insurance coverage varies, and you may be asked to pay out-of-pocket.
HPV DNA test or HC (Hybrid Capture) II HPV test. This test checks for 13 types of HPV associated with cervical cancer. It may be done separately or using cells from the same sample taken for the Liquid Pap. Women with “high risk” viruses need more frequent Pap tests.
Automated reinspection of Pap smears (with PAPNET or AutoPap) is effective for confirming uncertain results. Insurance companies rarely cover the cost of these tests, which are probably not necessary for women with no history of abnormal Pap smears. However, if you or family members have ever had abnormal cervical cells, or if you are a DES daughter (see sidebar) or have other risk factors, you may want to invest in this test. (Other new systems for improved Pap testing are under consideration by the FDA.)
How to Read a Pap Test Report
Pap smears can produce both false-positive and false-negative readings, and labs can be unreliable.
If you have any kind of abnormal Pap smear, you should have a second Pap test and perhaps an HPV test. Regular follow-up is important, since serious problems are slow to develop and repeat testing is more likely to find problems in time to treat them effectively.
The Bethesda System created two new diagnoses that are very controversial. ASCUS (Atypical Squamous Cells of Undetermined Significance) means something unusual is happening in some cells of a certain type. In most instances, your provider will recommend a repeat Pap smear in three to six months. Over 65% of ASCUS diagnoses revert to normal by the second Pap smear. In most instances, your provider will recommend a second Pap test plus the HPV test.
AGCUS (Atypical Glandular Cells of Undetermined Significance) is very rare (about 1% of all Pap smears) but is much more likely to be serious. It indicates possible adenocarcinoma—cancer of the endometriosismetrium (uterine lining) or of the glands in the cervical canal. Bladder cancer and other growths outside the uterus can also show up as persistent AGCUS. Careful further testing, including an HPV test, and monitoring are very important.
SIL (squamous intraepithelial lesions) will usually be ranked Low-grade or High-grade on the lab report (equivalent to mild, moderate or severe dysplasia or CIN 1, 2, or 3). Most SILs also show HPV. Your practitioner may do a colposcopy for more thorough evaluation of your cervix.
Sometimes the colposcopy shows no abnormalities. If an abnormality does appear, a tissue (punch) biopsy may be done to find out what it is. Interpretation of colposcopies and punch biopsies can also vary, and all tests may need to be repeated for diagnostic monitoring.
Public Health Perspectives on Cervical Cancer
Access to screening is the single most important factor in cervical cancer prevention.
More than half the women who develop cervical cancer in the United States have never had a Pap test. Globally, there are approximately 500,000 new cases of cervical cancer per year, and most deaths occur in countries where women do not get Pap smears. Easier access to basic screening technologies for all women can save more lives than a search for "better" technologies.
Despite the fact that men with HPV (which causes cervical dysplasia and cancer) can transmit the virus to their partners (male and female), cancer prevention messages are targeted most often to young women. And, prevention is being presented more often in terms of sexual behavior. Women considered “at risk” are those who have sex, especially with more than one partner, and at least one government publication recommends abstinence as “the only 100% way to avoid the risk of HIV/AIDS and STDs.” In fact, disease prevention is everyone’s responsibility.
Environmental and occupational hazards.
Few researchers or policymakers are looking at the social, economic, and industrial conditions that may make some women more vulnerable to cancer. Our exposure to toxins—which is affected by race, class, age, citizenship status, geography, and occupation—may well be a factor in the development of cervical abnormalities, and these issues deserve to be investigated fully.
Businesses are using direct-to-consumer advertising and expensive public relations firms to market tests, drugs and procedures. They are motivated by profits and the “bottom line,” not necessarily women’s health needs. Women in countries where participants in research studies are not fully informed may be particularly at risk from certain corporate practices related to testing new products. It is important to separate what is good for women from what is good for companies.
Written by: Our Bodies Ourselves
Last revised: March 2005
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