Pap smears and HPV
If there was no such thing as cervical cancer there would be no need to get pap smears. Pap smears look for HINTS of cervical cancer, just like mammograms look for HINTS of breast cancer. Just like mammograms, pap smears results only last for a few years. The cells on the cervix may change over time, getting better or getting worse. How often a woman needs a pap smear depends upon her age and her previous pap smear results.
A pap smear is a test that looks at individual cells, one at a time. Those cells are collected during a normal pelvic exam via a cell scraping. Normal cells look like fried eggs, while abnormal cells look like a slice of hard boiled egg, where the yellow part takes up almost the entire area. Today, most pap smears are sent to the lab in a little bottle but in the “old days” pap smears were sent to the lab on a slide. Pap smears are really just a Hint of what is going on with the cervix. True diagnosis of a problem is done with a biopsy of the cervix. We can biopsy your cervix when doing colposcopy.
Abnormal pap smears – One way to explain the pap smear grading system is to refer to “levels:”
- 0 is NORMAL
- ½ is ASCUS
- 1 is mildly abnormal (LGSIL)
- 2 and 3 are potentially serious (HGSIL)
- 4 could be indicative of cancer
A level “0” pap smear is normal, and simply gets repeated routinely. A level 2 or 3 or a cancer pap smear MUST be evaluated with colposcopy. Colposcopy is a special magnified look at the cervix, looking for a group of abnormal appearing cells. There is a “special” pap smear result which is not normal and not abnormal. This is called ASCUS, and we call it “level ½.” What to do about an ASCUS (level ½) pap smear is explained somewhere else.
Colposcopy – This is a special magnified look at the cervix. A biopsy of the cervix can be done at the time of colposcopy. The biopsy result is the answer, and the decision to do treatment, or not, is based on the biopsy result, NOT the pap smear…[read more]
Follow up – The MOST IMPORTANT part of this entire process is getting the next pap smear. As long as you keep getting pap smears we should be able to prevent cervical cancer. Most of the women who get cervical cancer here in the USA fall in one of two groups: they have never had a pap smear OR they have not had a pap smear in five or more years. As long as you keep getting pap smears you should be fine.
The Bethesda System – There is a very complex and always changing system to “name” abnormal pap smears. The last Bethesda System update was in 2001. The Bethesda system calls abnormal cells on the cervix “squamous intraepithelial lesions.”
Human Papilloma Virus
Abnormal pap smears are caused by the human papilloma virus, known as HPV. HPV strikes fear in the hearts of many, mainly because no one really understands what it means. HPV is just another way of saying you have an abnormal pap smear. There are MANY different HPVs….and each one is given a number. While just about every HPV can cause an abnormal pap smear, only a handful of HPV’s actually cause cervical cancer. The dangerous, or high risk HPV’s can cause cancer, but they do not always cause cancer. In fact, many women have the high risk HPV, but only a few women actually get cancer.
How You Get HPV
HPV is sexually transmitted. Condoms do not effectively prevent HPV. Any touching “down there” can pass HPV from one person to another. You can get HPV without having sex. The only way to avoid getting HPV is to avoid physical intimacy. This is not practical for most, so…. The practical way to not get HPV is to have as few partners as possible. You can not see HPV, so there is nothing reliable to look for on a man or on a woman.