Abnormal pap smears
The pap smear is a screening tool used to detect precursors of cervical cancer. Women should have their first pap smear 3 years after their first intercourse or by the age 21, which ever comes first. The pap smear is an important part of the pelvic examination and involves the removal of cells from the surface of the cervix with the speculum in the vagina.
When a pap smear is abnormal it is often necessary to evaluate the cervix with a colposcope. The colposcope is a device with a magnifying lens which is used to look at the cervix closely for changes which may indicate cervical dysplasia. Cervical dysplasia is the medical term describing a precursors of cervical cancer. Cervical dysplasia is further categorized as levels of cervical intraepithelial neoplasia or CIN. The level of CIN is determined by cervical biopsy. CIN 1 is the lowest level of cervical dysplasia and is thought to regress in the majority of instances and can be followed with frequent pap smears. CIN 2 and CIN 3 are higher more significant levels of dysplasia and are treated with excision of the transformation zone of the cervix in women who are more than 20 years old. This procedure is referred to as a LEEP procedure or a cervical conization. Women who are less than 20 years old can be followed with frequent pap smears.
Cervical dysplasia and cervical cancer are caused by the human papilloma virus or HPV. HPV is very common affecting most people at some point in their lives. It is sexually transmitted. The human papilloma virus infection natural history is that of an infection which is cleared over time by the immune system in most people. The amount of time until clearance varies with age. Excision procedures, such as a LEEP or cervical conization, for CIN may help clear the virus preventing progression to cervical cancer. For women with an HPV infection or an abnormal pap smear it is important to follow up with visits and pap smears as recommended by their treating physician.
My favorite website reviewing pap smears and cervical health is www.asccp.org. It is the website of the American Society for Colposcopy and Cervical Pathology and I encourage anyone to visit it who has questions about the human papilloma virus, abnormal pap smears, and cervical dysplasia. It is an authoritative reference. There is a wonderful section on HPV which can be accessed from the home page (It is labelled “HPV”) which is directed at questions that women may have about the infection. There is also a very good section on patient education.
There is no way to completely prevent an HPV infection except to never have sex. Now there is a HPV vaccination, Gardisil, produced by Merck which provides protection against the 4 most common strains of HPV and can be beneficial to many women. If you would like more information on the vaccination you may visit the website www.gardisil.com.
HPV vaccination as well as cervical evaluation with pap smear, colposcopy, and excisional procedures as necessary are available in our office.