The Pap test, often done as part of a routine gynecologic exam, is a screening test for precancerous or cancerous changes in cervical cells.
The results of the Pap test, also known as a Pap smear, are classified according to what kinds and degrees of cell changes you have, if any. Many systems have been used over the years. At one end of all the scales is normal, and at the other end is cancer. In between are grades of dysplasia.
Sometimes it can be difficult to distinguish one stage or grade of dysplasia from the next, and different laboratories or practitioners may interpret a given cell sample differently. Since the addition of the HPV DNA test in 2003, many clinicians interpret results of the Pap test in conjunction with this newer test.
As many as 40 percent of all tested women will have an abnormal Pap test at some time during their life. We often feel anxious when we hear our results are “abnormal,” because we fear cancer, but there is no need to panic. Most cervical cell changes are very slow. Dysplasia is not cancer, and in about 80 percent of cases, dysplasia does not develop into cancer.
The cells of most women diagnosed with mild dysplasia will return to normal. But all cases of diagnosed dysplasia should be watched closely—with repeated Pap tests and other recommended procedures.If abnormal cells are found, many women get tested again after six months to see if the abnormalities are still present. Dysplasia should be treated if it is severe or if it progresses.
Clinicians sometimes recommend a colposcopy after an abnormal Pap test. This is an office procedure during which the cervix is swabbed with an acetic acid (dilute vinegar) solution to make the abnormal areas stand out. Selected biopsies of the most abnormal areas are then examined under a microscope by a pathologist to better define the extent and severity of the abnormalities.
Treatments for cervical dysplasia are based on age, severity of the dysplasia, and each woman’s personal history.
Medical Treatments for Cervical Dysplasia
Treatments for dysplasia (precancer) of the cervix vary widely. Different practitioners may have varying preferred treatments for each diagnosis, making it difficult sometimes to get appropriate treatment for your condition and avoid unnecessary or pointless diagnostic tests, treatments,and surgery.
For this reason, it’s important to get a second and sometimes even a third opinion. Procedures such as colposcopy, punch biopsy, and cone biopsy should be done only by medical practitioners who have special training, skills, and sufficient experience.
Minimal abnormalities often require no treatment. Mild (low-grade) abnormalities are usually managed with watchful waiting. Moderate or severe (high-grade) abnormalities require treatment or further evaluation. Treatments include:
Cryotherapy, which destroys abnormal tissue by freezing, can be done in the clinician’s office.
Laser, which uses a high-intensity light beam to evaporate abnormal tissue, is most often performed in an outpatient procedure center or occasionally in a hospital on an outpatient basis. Often, local anesthesia is given to numb the cervix.
Loop electrical excision procedure (LEEP), which uses a wire loop charged with a small electrical current, is usually performed in an office or outpatient procedure center with local anesthesia. Clinicians use LEEP to remove abnormal tissue. The sample can also be sent to a pathology lab for evaluation. Sometimes this procedure is also called a LLETZ (large loop excision of the transformation zone).
Cone biopsy, which removes a cone-shaped portion of the cervix, can be done in an outpatient procedure center, or in the hospital on an outpatient basis, with local or general anesthesia.Clinicians may use a scalpel, laser, or electrical loop as used in LEEP to remove the tissue. Because cone biopsy does not destroy tissue, the sample will be sent to the pathologist for evaluation.
Hysterectomy is not appropriate for cervical dysplasia, but it is recommended as the appropriate treatment for invasive cancer. This is major surgery, with serious risks and other health consequences. Long-term negative effects of laser and LEEP on the cervix are uncommon. Tissue damage may, on rare occasions, weaken the cervix, so it can be harder to carry a pregnancy to term. (This is more common with a cone biopsy, which also can produce scarring that might later interfere with dilation of the cervix during labor and birth, sometimes leading to a cesarean section.)
The following factors may increase a woman’s risk of cervical cancer:
- Never having a Pap test or not having had one for five or more years. Over half of new cervical cancer diagnoses every year are in women who have been exposed to HPV and who don’t get this screening test. Therefore, they do not get early intervention to prevent cancer from developing.
- History of sexually transmitted infections, since HPV is often transmitted along with other STIs.
- Smoking, which has been linked to cervical cancer in large population studies.
- Synthetic hormones such as those in birth control pills or exposure to DES in your mother’s uterus.
- Unprotected sex at an early age. Young cells in the vagina are more vulnerable to whatever may cause cervical abnormalities; these cells are gradually replaced during the teen years with more resilient cells.
- Exposure to infection. It takes only one sex partner with HPV to get an infection, but having more sex partners increases the chances of infection. If you or your partner have (or have had) multiple sex partners, your risks of developing abnormal cervical cells are greater. Barrier contraceptives (especially condoms) reduce such risks.
- Contact with cancer-causing substances (in mining, textiles, metalwork, or chemical industries) or sexual contact with a partner who has worked with these substances.
- A compromised or weakened immune system, which can result from being HIV-positive or using immune-suppressing medications such as chemotherapy. Yearly Pap tests are recommended for these women.
- Unhealthy living and working conditions and environmental hazards, often the result of having limited income. Women without access to a safe, clean environment are more likely to develop dysplasia and cancers—and at earlier ages—than other women.