When you have a Pap smear, your doctor is screening the cells on your cervix to make sure that there are no abnormal or precancerous changes. In most instances, this is the case.
However, for some women, a Pap smear result may show a type of slightlly abnormal cell changes . The condition is called cervical dysplasia but your doctor may use several other terms to describe the finding. These terms can include :
·
Abnormal cell changes
·Precancerous cells changes
·CIN (cervical intraepithelial neoplasia)
·SIL (squamous intraepithelial lesions)
·"Warts" on the cervix
All of these terms mean similar things - that an abnormality was found.
Most of the time, these cell changes are the result of
an infection with the human papilloma virus or HPV.
There are, in fact, many types of HPV infection that can
cause cervical dysplasia including those that have
been linked to an increased risk of cervical cancer.
But just because you have cervcal dysplasia, does not
mean you will develop cervical cancer. What it does
mean is that your doctor should monitor your health
very closely - and that you may be a candidate for
treatment that can prevent further cell changes from
occuring.
·
When Your Pap Smear Result Is "Abnormal" - What It Means
The term "abnormal Pap smear" is broad and not very specific. There are many different systems that health care providers use to classify a Pap smear. Within each system, there are different degrees of severity or abnormalities. Different classification systems and degrees of severity include:
·Descriptive System: mild, moderate, or severe dysplasia
·CIN System: CIN (cervical intraepithelial neoplasia) 1, 2 or 3
·Bethesda System: ASC-US (Atypical Squamous Cells of Undetermined Significance - which means the results look borderline between "normal" and "abnormal");
ASC-H (Atypical Squamous Cells - borderline, but may really include High-Grade lesions); Low-Grade or High-Grade SIL (squamous intraepithelial lesion) Class System: Class 1 though Class 4.
Women with abnormal Pap smears are usually examined further for cervical problems. This may involve coming back for a colposcopy and biopsy, or coming back in a few months for another Pap smear. If the Pap smear result is "ASC-US," then a test for HPV may be performed to see whether HPV is causing this borderline "normal-abnormal" Pap smear result.
It is important for a female to get a Pap smear at regular intervals by the time she reaches 18 years of age, or by the time she becomes sexually active - which ever comes first.
What's the difference between a Pap smear, a biopsy and an HPV test?
A Pap smear is a screening to find abnormal cell changes on the cervix (cervical dysplasia ) before they ever have a chance to turn into cancer. The majority of precancerous cervical changes are caused by HPV.
A biopsy is similar to a Pap smear, but a larger cluster of cells is removed from the cervix to see if there are abnormal cell changes. It is a good way to confirm the earlier Pap smear result and to rule out cancer. If a biopsy is done, it will be performed at the same time as the colposcopy.
An HPV test is different than a Pap smear or biopsy. This test checks directly for the genetic material (DNA) of HPV within cells. The only commercially available test for HPV is called Hybrid Capture II), produced by Digene.
It is most convenient if the HPV test is done in the laboratory from a liquid-based Pap test sample. The most common commercially available liquid-based test is called ThinPrep®, manufactured by Cytyc.
When is the HPV test used?
If a Pap smear result is borderline between "normal" and "abnormal." This is usually called "atypical squamous cells" or "ASC-US." The HPV test is most commonly used to determine which women with a borderline result are likely to have precancerous changes on their cervix (HPV positive) and which are most likely to be normal cells (HPV negative). It helps to rule out whether HPV is causing the borderline abnormal cells.
When is the HPV test NOT used?
·If the Pap smear results show dysplasia or precancerous changes. This is because it is automatically assumed that the HPV is the cause.
·The HPV test can not be used on males.
·The HPV test is only FDA approved to be used on the female's cervix.
Can a male find out if he has the cell changing-types of HPV?
Research has shown that the HPV test usually shows false negative results in men. This is because it is difficult to get a good cell sample to test from the thick skin on the penis.
Most people will not have visible symptoms if they are exposed to HPV. Therefore, for most, the virus is subclinical (invisible). This is especially true for males. If a male is exposed to the cell-changing types of HPV, he would be unlikely to have symptoms. If there are no symptoms for males, it is hard to test for it.
Most of the time, men will not have any health risks such as cancer with the "high-risk" types of HPV. It is the female's cervix that needs to be monitored.
How can a person get the types of HPV that cause cell changes?
·Any person who is sexually active can be exposed and get the cell-changing types of HPV. Most people are exposed to the cell-changing types of HPV at some point, but not everyone (especially males) will actually have abnormal cell changes (dysplasia).
·The types of HPV that cause abnormal cell changes are usually spread by direct skin-to-skin contact during vaginal, anal, or possibly through oral sex, with someone who has this infection. The cell-changing types of HPV are most likely to be given to a partner when dysplasia is actually present.
·Very little is known about passing subclinical (invisible) HPV to sex partners. Some experts think it may be less contagious than when the cell changes are present. The types of HPV that cause abnormal cell changes do not typically cause symptoms on other body parts such as the hands.
·Recent research studies have shown a relationship between a cell-changing type of HPV and some rare head and neck cancers, but there is not much evidence that oral sex definitely transmits these types of HPV.
How can someone reduce the risk of getting HPV?
Any one who is sexually active can come across this common virus. Ways to reduce the risk are:
·Not having sex with anyone.
·Having sex only with one partner who has sex only with you. People who have many sex partners are at higher risk of getting other STDs.
·If someone currently has abnormal cell changes, he or she should not have sexual activity until after the cells have been treated or have self resolved. This may help to lower the risk of transmission.
·Condoms (rubbers), used the right way from start to finish each time of having sex may help provide minimal protection - but only for the skin that is covered by the condom. Condoms do not cover all genital skin, so they don't give 100% protection.
·Spermicidal foams, creams and jellies are not proven to act against HPV, but they work against some other STDs. These are best used along with condoms, not in place of condoms.
·If someone was exposed to the types of HPV that can cause abnormal cell changes, it would be unlikely that he or she will become re-infected with those same types since immunity will be set-up at some point.
·Realize that most people are exposed to one or more HPV types in their lifetime, and most will never even know it because they will not have visible symptoms.
·It is important for partners to understand the "entire picture" about HPV so that both people can make informed decisions based on facts, not fear or misconceptions.
How are abnormal cells treated?
·Currently, there is no treatment to cure HPV; there is no cure for any virus at this point. However, there are several treatment options available for treating the abnormal cells. Sometimes treatment may not even be necessary for mild cervical dysplasia . These cells can heal on their own and the health care provider will just want to monitor the cervix. HPV may then be in a latent (sleeping) state, but it is unknown if it totally gone or just not detectable.
·The goal of any treatment will be to get remove the abnormal cells. This may also end up removing most of the cells with the HPV in them.
·If the abnormal cells are treated, or if they have healed on their own, it may possibly help reduce the risk of transmission to a partner who may have never been exposed to the cell-changing types of HPV.
·When choosing what treatment to use, the health care provider will consider many things including:
· * location of the abnormal cells
· * size of the lesions on the cervix
· * degree or severity of the Pap smear results
· * degree or severity of the colposcopy and biopsy results
· * HPV test results (if this test was needed)
· * age and pregnancy status
· * previous treatment history
· * patient and health care provider preferences
There are a variety of treatments for cervical dysplasia:
·Cryotherapy (freezing the cells with liquid nitrogen).
·LEEP (Loop Electrosurgical Exision Procedure)
·Conization (also called cone biopsy)
·Laser (not as widely used today due to high cost, lack of availability, and not all doctors are well-trained with using it. LEEP is more commonly used)
·No treatment at all since even mild abnormal cell changes may resolve without treatment. The health care provider may just monitor the cervix by either doing a colposcopy, repeat Pap testing, or a test for HPV.
What about pregnancy, HPV, and cervical dysplasia?
·For some pregnant women, cervical dysplasia may increase. This may be due to hormone changes during pregnancy, but this is not proven.
·If a woman has an abnormal Pap smear during pregnancy, even if it's severely abnormal, many health care providers will not do treatment. They will just monitor the cervix closely with a colposcope during the pregnancy.
·Sometime (a few weeks) after delivery of the baby, the provider will look at the cervix again and do another Pap smear or another biopsy. Many times after pregnancy, the cell changes will have spontaneously resolved - and no treatment will be necessary.
·The reason that many health care providers do not want to do treatment during pregnancy is because it may accidentally cause early labor.
·The types of HPV that can cause cell changes on the cervix and genital skin have not been found to cause problems for babies.
What about HPV and other cancers?
Anal dysplasia and anal cancer:
·Anal cancer is a rare occurrence that has been strongly linked to "high-risk" types of HPV. Abnormal cell changes in the anal area (anal dysplasia or anal neoplasia) are more common among individuals who engage in receiving anal sex.
·However, anal dysplasia has also been reported in some females who have a history of severe cervical dysplasia
·Treatment is available for anal dysplasia and anal cancer Penile Intraepithelial Neoplasia (PIN) and penile cancer: Cancer of the penis is extremely rare in the United States, and HPV is not always the cause
There are also some cases of cell changes (neoplasia) on the penis, which are caused by "high-risk" types of HPV.
·Most males do not ever experience symptoms or health risks if they get one or more "high-risk" types of HPV.
·There is no cancer screening for the penis because this disease is extremely rare, and because it is difficult to get a good cell sample.
.
Vaginal Intraepithelial Neoplasia (VAIN) and vaginal cancer:
·HPV has been linked with some, but not all, cases of cell changes in the vagina and with vaginal cancers.Various treatment options are available for vaginal neoplasia, depending on how mild or severe the cell changes are in this area.
Vulvar Intraepithelial Neoplasia (VIN) and vulvar cancer:
·HPV has been linked with some, but not all, cases of cell changes on the vulva (outside female genital area) and with vulvar cancers.
·Various treatment options are available for vulvar neoplasia, depending on how mild or severe the cell changes are in this area.
From American Social Health Association
