Hi. I'm Denise Richardson, for howdini.com. If you're a woman who takes care of her health, you probably get a Pap smear once a year. Usually, of course, everything's normal. But sometimes we hear that we've had an abnormal Pap smear. How serious is it? Here to help us understand abnormal Pap smears is Dr. Jennifer Wu. What is a Pap smear? And then let's talk about abnormal ones.
So, a Pap smear is a screening tool. Basically, it's a brush across the surface of the cervix, and it collects cells, which are then analyzed. Most doctors are using a liquid-based, versus the old microscopic slides, because it's more accurate. And occasionally you can get some abnormal cells there. What we're really trying to determine is whether there are any precancerous or cancerous cells there.
I associate an abnormal Pap smear with a doctor saying to me you have cancer. Is that the only possibility?
Basically, an abnormal Pap smear means that there are atypical cells there, or abnormal cells there. And you can get abnormal cells if you have a very bad yeast infection, or inflammation in the vagina. One way to help differentiate whether an abnormal cell may lead to cancer is whether HPV is present or not. So most of the time, when a mild abnormality comes back, there will also be an HPV test with it. And it'll tell the doctor, OK, there's a mild abnormality, and HPV is present. Then the doctor will likely go on to more extensive testing.
What kind of testing is that person going to undergo?
It's probably going to be a colposcopy, which is a test using a colposcope, which gives a magnified view of the cervix. So the gynecologist is looking at the cervix on a magnified view, and paints the cervix with some acetic acid. I know it sounds terrible, but it doesn't burn, and it doesn't hurt. And the acetic acid will turn abnormal cells white. So then the gynecologist will likely take pinch biopsies from those sites.
And there must be ranges of abnormal readings.
There are. There are. The mildest of abnormality is atypical squamous cells of undetermined significance. It's when you have these atypical cells plus HPV that you're concerned that there actually could be a precancerous lesion there. More serious abnormalities involve LGSIL and HGSIL, which are low-grade lesions or high-grade lesions. Basically the progression is atypical cells, low-grade lesions, high-grade lesions, and then cancer.
Low-grade lesions. Treatment for that.
Often, in young healthy patients, with a normal immune system, low-grade lesions will go away on their own.
And the next step would be--
High-grade lesion. And treatment for that.
Usually if patients have high-grade lesions, then you may want to do an excisional biopsy, meaning taking out that portion of the cervix that looks abnormal. To certain populations of patients you may not want to be so aggressive. Like a very young patient, a teenager, you probably don't want to take out part of their cervix, if at all possible.
And once you say cancer.
Well, when it's cervical cancer, there are various treatments available for that, also. They can be surgical and radiation.
Do people make mistakes in the readings?
Oftentimes Pap smears can miss certain lesions, or the readings can be a little bit ambiguous. Usually patients who go yearly for checkups, we will catch anything before it becomes cancer.
But if it's ambiguous, do you continue to test, or do you say let's wait it out to see if it changes in six months?
Oftentimes we'll just follow these Pap smears to see that it doesn't seem to progress on to a higher-grade lesion. So patients with abnormal Paps may then need Pap smears every four to six months for a while, to make sure that they're not developing into a higher-grade lesion.
Dr. Wu, thank you. I'm Denise Richardson, for howdini.com.