Abnormal Pap Smears And HPV
- Abnormal Pap Smears are typically caused by strains of the Human Papilloma Virus, HPV.
- An abnormal pap smear result does not mean you have cervical cancer.
- High risk strains can cause more serious cellular changes.
- Typically, both high and low risk strains of HPV go away within 24 months.
- It's recommended that you get your first pap smear at age 21.
WHAT CAUSES AN ABNORMAL PAP SMEAR RESULT?
HPV, Human Papiloma Virus, causes abnormal Pap smear results because HPV is a virus which infects skin cells. When subclinical HPV infects the skin cells in the cervix (skin cells on the cervix are called squamous cells), it causes the cells to change and become abnormal. When HPV causes abnormal cell changes on the cervix this is called cervical dysplasia. It is important to note that there are other reasons besides HPV for abnormal Pap smear results such as infection, although the most common reason for abnormal Pap smear results is HPV. Pap smears are screening tests and do not tell you specifically what is causing the abnormal results.
The abnormal cell changes can be mildly abnormal or seriously abnormal. The degree of abnormal cells on the Pap smear is what helps your healthcare provider make recommendations for your follow-up. The most common categories of abnormal cell changes on the cervix (cervical dysplasia) are listed below.
- ASCUS (Atypical squamous cells of undetermined significance). This means your Pap smear results are borderline, between normal and abnormal.
- ASC-H (Atypical squamous cells of undetermined significance-cannot exclude HSIL). This means your Pap smear results are borderline but may be more serious.
- LSIL (Low grade squamous intraepithelial lesion). This means that there are mildly abnormal cell changes on your cervix.
- HSIL (High grade squamous intraepithelial lesion). This means that the cell changes on your cervix are more serious.
There are more categories of Pap smear results, including ones which indicate cervical cancer. Cervical cancer is such a slowly progressing cancer, it is unusual for young women or women who have been getting regular screening to have these results. Sometimes bacteria or other viruses such as Herpes are identified on Pap smear results. When this happens, Women's Health Specialists may attempt to contact you to offer you further evaluation and treatment.
DOES HPV CAUSE CERVICAL CANCER?
Most women with HPV and/or abnormal Pap smear results do not get cervical cancer. Researchers now believe that almost all cervical cancer is caused by HPV6. Cervical cancer is diagnosed in 12,900 women in the United States each year and 4,400 women die of cervical cancer in the U.S. each year. There are currently 140 million women and girls living in the United States. The majority of women who are diagnosed with cervical cancer are over the age of 30 and have not had access to healthcare or regular Pap smears.
The medical community now views cervical cancer as a preventable cancer because Pap smears can detect abnormal cell changes in the cervix long before they become cancerous. Also not all types of HPV cause the cell changes that can lead to cancer of the cervix. The HPV test, which is now available, can tell generally what types of HPV you have. Results of the HPV test do not specify exactly what type you have but do distinguish between the high risk types of HPV and low risk types. Both the low risk types and the high risk types of HPV can cause abnormal cell changes in the cervix and abnormal Pap smear results. Researchers now know that 90% of Pap smears with results that are classified as LSIL and 70% of Pap smears that are HSIL will become normal once your body's defense system has cleared the HPV virus. 7 8 The types of HPV which cause the genital warts you can see are not the high risk types that can lead to cervical cancer.
WHAT ARE MY OPTIONS FOR FOLLOW-UP OF AN ABNORMAL PAP SMEAR?
If your pap smear is mildly abnormal (ASCUS or LSIL) you can choose to repeat the Pap smear in 6 months or have a colposcopy.
If the Pap smear is HSIL the recommendation is for you to have a colposcopy. A colposcope allows your healthcare provider to view the cells on your cervix more closely (it's like looking under a microscope) and possibly take samples of abnormal cells for further evaluation by a laboratory. This is called a biopsy.
You may also choose to have a test for HPV. This test will tell you if you have the high or low risk types of HPV. The HPV test is helpful if the results indicate that you have the low risk types of HPV because you will know that there is little chance that the cell changes found on your Pap smear will get worse. If the HPV test comes back with results that indicate the high risk types of HPV it is helpful because you may choose to get close follow-up.
Remember both high risk and low risk types of HPV can go away within 24 months.
8 ACOG Announces New Pap Smear and Cancer Screening Guidelines
On Friday, November 20, 2009, the American College of Obstetricians and Gynecologists announced that women should have their first cancer screening at age 21 and can be rescreened less frequently than previously recommended.