The PAP Test and HPV Screening
The PAP Test is a simple test that analyzes cells taken from your cervix. It tells your doctor if there are any abnormal cells on the cervix that may lead to cancer.
A PAP test is simple, fast, and painless. It is generally performed as part of your annual gynecological exam. The doctor uses a brush to scrape a small number of cells from the cervix. The cell sample is sent to a laboratory for testing. At the lab, the sample is carefully examined using a microscope to see if abnormal cells are present in your cervix.
Who Should Have a PAP Test?
PAP tests are an important part of your overall health care. When and how often you should have a PAP test depends on your age and health history. You should have annual PAP tests if:
• You are 21 years of age or older.
• You are or have been sexually active, even if you are younger than 21.
It is important to remember that you can have cervical cancer even if you are not sexually active or are not having menstrual periods. Most women should continue having annual PAP tests after menopause.
The PAP test is the best way to find cell changes that may lead to cancer of the cervix.
How Often Should You Have a PAP Test?
All women should have a routine pelvic exam every year. It is generally recommended that if you are under 30, you should have a PAP test every year. If you are over 30 and have had three normal PAP tests in a row, you can choose to continue to have annual PAP tests or choose to have a PAP test only every 2 or 3 years.
You should talk with your doctor about how often you should have a PAP test. If you have had a hysterectomy, talk with your doctor about whether or not you still need a PAP test.
Certain risk factors might mean that you should have a PAP test every year:
• If you have previously been treated for cancer
• If you have the HIV infection
• If you have a weakened immune system
• If you were exposed to the drug diethylstilbestrol (DES) before birth
The Test Results
Most labs in the United States use the “Bethesda System” to describe PAP test results. This standard system helps doctors plan any treatment that may be needed. Under this system, you PAP test results will be placed in one of several groups.
It is best to talk with your doctor about what the results of your PAP test mean and about any follow-up testing or treatment that may be needed.
• Normal (negative): Only normal cells are seen; there are no signs of cancer or precancer.
• Atypical Squamous Cells (ASC): Some cells were seen that cannot be called normal, but that do not meet the requirements to call them precancer. The abnormal cells may be caused by an infection, irritation, recent intercourse, or may be precancerous.
• Squamous Intraepithelail Lesion (SIL) Cells: Changes were seen in the cells that may show signs of precancer.
• Atypical Glandular Cells: Cell changes were seen that represent an abnormality that needs to be evaluated more closely.
• Cancer: Abnormal cells were seen that have spread deeper into the cervix or to other tissues; these cells have become cancer.
Follow Up Testing
If your PAP test shows the appearance of abnormal cells, your doctor will most likely recommend additional testing. Follow up testing may be as simple as a repeat PAP test. Sometimes an exam called a colposcopy is recommended. This exam uses a device like a microscope to look at your cervix. The exam is done in the doctor’s office.
Your doctor may also want to test for the human papillomavirus (HPV). HPV is a group of related viruses, a few of which are linked to changes in the cells of your cervix.
Recent studies have shown that some types of HPV cause cancer of the cervix. For this reason, your doctor may recommend that you have a genetic test that looks for certain high-risk types of the HPV known to cause cancer.
This recommendation is most often made for women over 30. Women under 30 are not good candidates for this HPV DNA test because they often test positive for HPV that will clear up on its own.
Talk to your doctor about the vaccine that is available that protects against the two types of HPV that most often lead to precancer of the cervix.
Abnormal PAP Smear
The PAP smear is the test your doctor uses to detect any changes that occur in the cells of your cervix. If your PAP smear shows changes to your cervix, the test result will be called abnormal. In some cases, these abnormal cells may be precancerous and may lead to cancer. An annual or semi-annual PAP smear is one of the best ways you can ensure your gynecological health.
Most problems that cause abnormal PAP test results can be treated, especially when they are found early.
• Abnormal Results
• Further Testing (Hyperlink to paragraphs below)
A PAP test result that is not normal is usually caused by an infection such as human papillomavirus (HPV) or by types of vaginal irritation. Abnormal results may also be caused by a change in cervical cells called squamous intraepithelial lesion (SIL); SIL may also be referred to as cervical intraepithelial neoplasia (CIN). Both SIL and CIN are referred to as dysplasia, or an abnormal development of body tissue, and are graded according to their severity.
Squamous Intraepithelail Lesion (SIL)
SIL is found in women of all ages and can range from mild, moderate, and severe to carcinoma in situ (CIS). CIS is not yet cancer, but if not treated, it is the type of SIL most likely to progress to cancer.
Risk Factors for SIL
• You are HIV positive.
• You have a weakened immune system .
• You have a history of dysplasia or certain cancers.
• Your mother took diethylstilbestrol (DES) while she was pregnant with you
Human papillomavirus (HPV)
Human papillomavirus is a very common infection that can be passed from person to person. Some types of HPV can be spread through sexual contact. Sometimes, an HPV infection causes an abnormal PAP test result. In this case, an HPV test can often be done to clarify the PAP test results. A negative HPV test result means that the cell changes that were detected in your PAP test are not likely to be related to precancerous development. If you have an abnormal PAP test result and a positive HPV test result, your doctor will recommend further testing.
There is no treatment for an HPV infection and most women with this type of infection do not develop precancerous changes of the cervix. However, certain types of HPV are linked to cancer of the cervix; therefore, it is especially important to have annual PAP tests once you know you are infected with HPV.
Talk with the doctors at Fair Ridge Ob/Gyn Associates about the HPV vaccine, which protects you against the two types of HPV that cause the most cases of cervical cancer.
If you have an abnormal PAP test result, you will need further testing to determine the cause of the abnormal result. Sometimes, you may only need a repeat PAP test because many cervical cell changes go away on their own and do not need to be treated. Other times, your doctor may recommend a colposcopy or a biopsy to help identify the reason for the abnormal test result and to determine if treatment is needed.
A colposcopy lets your doctor look at the cervix through a special device similar to a microscope. This device can detect problems of the cervix that cannot be seen with the eye alone. The colposcopy is used to help diagnose SIL and cervical cancer.
In this procedure, a speculum like the one used during a PAP test is placed in the vagina. The colposcope remains outside of the vagina, but is used to see the cervix. The cervix is painted with a mild vinegar solution that sometimes causes a slight burning. This liquid makes abnormal cells on the cervix easier to see.
The key to treating cervical changes is finding them early. The best way to find problems early is to have regular pelvic exams and regular PAP tests.
If abnormal cells are seen during your colposcopy, your doctor may decide that a cervical biopsy is needed. For a biopsy, the doctor removes a small sample of cervical tissue and sends it to a lab to be studied. You may have a pinching or cramping feeling when the tissue is removed.
The treatment recommended by your doctor depends on the severity of the problem. For instance, low-grade SIL cell changes may not need to be treated; you may just need to have a repeat PAP test. High-grade SIL cell changes, on the other hand, have an increased risk of progressing to cancer and may need to be treated with surgery.
Electrosurgical excision is often used if high-grade SIL cell changes are detected. During this procedure, a thin wire loop that carries an electric current is used to remove abnormal areas of the cervix. This electric energy also is used to close off the blood vessels on the surface of the cervix. This lowers the risk of bleeding after the procedure.
A cone biopsy is also used to obtain a tissue sample from your cervix. In this procedure, a cone-shaped wedge of the cervix is removed. The procedure is usually done in a hospital or outpatient surgery clinic. General or spinal anesthesia is used and you should be able to go home the same day.
Freezing and Laser Treatment
With cryotherapy, or freezing and laser treatment, abnormal cervical tissue is frozen and later sheds. This procedure is relatively painless and is performed in your doctor’s office.
The HPV Vaccine
Human papillomavirus (HPV) is a very common infection that can be passed from person to person. Some types of HPV are spread through sexual contact. Sexually transmitted HPV can spread through vaginal, oral, or anal sex. Studies suggest that at least three out of every four people who have sex will get a genital HPV infection at some time during their lives. To lower your risk of infection, limit your number of sexual partners and use condoms.
Some types of HPV cause cancer of the cervix. This type of cancer develops over a long period of time. HPV causes cells on or around the cervix to become abnormal. In some cases, these cells may progress to precancerous.
A vaccine is available that protects you against the two types of HPV that cause the most cases of cervical cancer and the two types of HPV that cause the most cases of genital warts. The vaccine triggers a woman’s immune system to fight off these viruses if she is exposed to them.
The vaccine is given in three doses over a six-month period. It is most effective when administered to girls and women before they become sexually active. The vaccine is approved for use by girls and women between 9 and 26 years of age and is recommended as a routine vaccination for all girls aged 11 to 12 years.
There is no cure for HPV so the best course of action is to take steps to prevent becoming infected with the virus. Do this by:
• Limiting your number of sexual partners; the more partners you have, the greater your risk of infection.
• Using condoms to reduce your risk of infection when you have vaginal, oral, or anal sex.
Here are a few things to note about the HPV vaccine:
• You do not need to be tested for HPV before you get vaccinated.
• It is best to get the HPV vaccine before you start having sex.
• If you are between 13 and 26 and have not received the vaccine, you should do so regardless of whether or not you are already sexually active.
• The vaccine does not protect you from all types of HPV.
• The vaccine is not a treatment for current HPV infections.
• The vaccine will not prevent all cases of cervical cancers.
• You should still have regular PAP tests even after you receive the vaccine.
• You should get the vaccine even in you already have an HPV infection because the vaccine can protect you from other types of HPV.
• The vaccine is not recommended for pregnant women, but is safe for women who are breastfeeding.
• Research regarding women over 26 years of age and males is currently underway.