The frequency at which Pap smears should be performed depends on individual considerations. Rarely do I ever recommend going longer than 1 year between examinations. We now know the Pap can miss up to 25% of lesions even when done correctly. Some women may have risk factors which necessitate Pap smears on an every four or six month basis.
In the past, Pap smears were reported to our office according to a system based on “classes” and were graded Class I through Class V. You may be more familiar with this old system.
In 1988, a new system was adopted. They do not report classes as before, but rather describe more of what they see. This new way of giving reports is called the Bethesda System. In 2001, the Bethesda group updated their recommendations. The following are the various reports possible:
1. Negative (previously Class I): This is a negative smear with no abnormal or unusual cells seen. The smear is clean and clear of any inflammatory cells and is easy for the pathologist to read as not having any evidence of malignancy (cancer).
2. Atypical (previously Class II): This is further broken down into two terms: Atypical squamous cells, cannot exclude high grade lesions (ASC-H) and atypical squamous cells of uncertain significance (ASC-US). With these smears it is more difficult for the pathologist to unequivocally say that it is negative. There may be evidence of regeneration of cells on the cervix or changes in the cells related to infections or the trauma of childbirth. Depending on other descriptions the pathologist uses, you may need treatment for infection, a repeat Pap smear, special DNA testing, observation, or further diagnostic testing with colposcopy. Your doctor will tell you what steps to take. Some type of follow-up is needed.
3. Low-grade squamous intraepithelial lesion (previously Class III, mild dysplasia): This classification is for abnormal cells, which may be considered as mild dysplasia or with mild “premalignant” potential. This same category would be used if there is any sign of the human papilloma (wart) virus. Dysplasia is a precancerous change, and this finding requires further evaluation. If left alone, these changes may revert to normal, may stay the same, or may progress to malignancy over a period of years. The interval for the development of malignancy from dysplasia is variable but commonly felt to be as little as 3 or most likely as long as 10 years. Office colposcopy, a special technique using a microscope to look at the cervix, will probably be recommended. Biopsies will be performed. If only mild changes are confirmed, usually no treatment is required. However, more frequent Pap smears will be needed. In some instances of large lesions or persistent changes, treatment will be recommended.
4. High-grade squamous intraepithelial lesion (previously Class III, moderate to severe and Class IV): This classification is indicative of a high degree of precancerous change. The changes in the cells are severe enough to warrant very prompt and complete evaluation with colposcopy. Treatment with freezing or excision of the abnormality is usually needed.
5.Cancer (previously Class V): This classification indicates a high probability of cancer and again, warrants prompt and complete evaluation to determine the extent of the problem. A plan of treatment for best results can be determined.
Modern research has now shown that the genital wart virus (human papilloma virus, also called condyloma) causes cervical cancer. This virus is very contagious – with just one sexual contact there is an 80% chance of becoming infected. Be sure to tell your physician if you or your partner have or did have genital warts. Unfortunately, only about 20% of genital warts can be seen without using special techniques. The remaining 80% must be stained with vinegar and properly evaluated to be seen. If a woman has warts in her vagina or around the external genitals, there is a 75-80% chance she has changes on her cervix.
It takes 10 days to 2 weeks to get the Pap results back. Please call our office if you have not heard from us in 2 weeks’ time.
HIGH RISK FACTORS FOR DEVELOPING CERVICAL CANCER
You are in a higher risk group for developing cancer of the cervix if:
– You have had more than three sexual partners in your lifetime
– You first had sexual intercourse before the age of 18
– You have had genital warts (papilloma virus) or other venereal diseases
– A sexual partner of yours has had intercourse with a women who developed cervical cancer or abnormal pap smears, or had genital warts
– You smoke or your partner smokes
– Your mother took DES (diethylstilbestrol) during pregnancy with you
– You have had a previous pap smear which showed abnormal or suspicious cells
– You have a poor diet (less than five helpings of fruits and vegetables per day)
– You have AIDS or other conditions that suppress your immune system
Only a small percentage of women are classified as low risk. The vast majority of women have one or more of the above and are, therefore, considered at much greater risk for developing cancer of the cervix. Due to this trend, most women should be screened at least once a year, as a general rule, to insure early diagnosis of the disease.
The wart virus is spreading rapidly. New cases of genital warts now outnumber new cases of gonorrhea and Chlamydia combined. Discuss any concerns you might have with your doctor. We do have two videotapes available on these topics which you can view at home if you would like. Ask the receptionist for more information.
TO IMPROVE YOUR PAP SMEARS
1. Do not douche for three days prior to your appointment.
2. Do not have intercourse for three days prior to your appointment.
3. Schedule your appointment when you are not bleeding.
4. If you have an unusual discharge, tell your doctor so this can be treated before your pap.
5. Tell you doctor of any risk factors you may have.
6. If you are on Depo-Provera shots, have the Norplant/Implanon in, or are no longer menstruating (and are not taking estrogens), you may need to take estrogens before your visit. Discuss this with your doctor.
TO PREVENT CERVICAL CANCER
1. Be monogamous (stay with one partner)
2.Don’t smoke (your partner either)
3. Eat five helpings of fruits and vegetables per day (the more green, red, orange, yellow the better)
4. Take multivitamins with folic acid.
5. Get regular pap smears every year
6. Wait until at least age 21 before having sex
Republished with the permission of John L. Pfenninger, M.D. – mpcenter.net