Abnormal Pap Smears / HPV


 

Cervical cancer screening should begin at the age of 21 and occur annually thereafter for adolescents. Almost all abnormal Pap smears are associated with exposure to the Human Papillomavirus (HPV). Risk Factors for Human Papillomavirus include multiple sexual partners, male partner with multiple sexual partners, history of other sexually transmitted diseases, and early age of first intercourse.

PAP Classification

  • ASC - Atypical Squamous Cells
    • ASCUS - Atypical Squamous Cells of Undetermined Significance
    • ASC-H - Cannot exclude HSIL (high grade lesion)
  • LGSIL - Low-grade Squamous intraepithelial lesions
    • Human Papillomavirus, mild dysplasia, cervical intraepithelial neoplasia (CIN)I
  • HSIL - High-grade squamous intraepithelial lesions
    • Moderate and severe dysplasia, carcinoma in situ, CIN 2 and 3
  • Glandular cell
    • Atypical glandular cells (AGU)
    • Atypical glandular cells, favor neoplastic
    • Endocervical adenocarcinoma in situ (AIS)
    • Adenocarcinoma

The natural history of CIN (dysplasia) is linked to the presence of high-risk HPV. HPV is extremely common in the general population. Most women clear the virus or suppress it over time, with clearance higher in younger women. The small percentage of women who do not clear the virus are at risk for persistence or progression of cervical dysplasia. Smoking doubles the risk of progression.

The goal of PAP testing is the prevention of invasive cervical cancer. It is a screening test. If a PAP result is abnormal further evaluation and or procedures may be required.

An ASCUS pap may require further testing for the presence of high risk HPV. If testing is negative for high risk HPV, routine screening is recommended.

Colposcopy is indicated for the following Pap results:

  • ASCUS with positive high risk HPV
  • LGSIL or HGSIL

Colposcopy is an office procedure where the cervix is visualized through a microscope after application of vinegar. Biopsy (removal of a small piece of cervical tissue) may be performed to confirm the degree of dysplasia.

Treatment recommendations are made based on the findings of the colposcopy and may include 1) follow up PAP at a closer interval (4 - 6 months) or 2) treatment of the abnormal area with freezing (cryosurgery), laser or LEEP (Loop electrosurgical excision procedure), all of which may be performed as office procedures depending on your individual findings. Rarely a more extensive biopsy of the cervix is required, a conization, and is performed as an outpatient surgery under anesthesia.

Following treatment or evaluation of an abnormal PAP close follow up and repeat PAP at closer intervals (4 - 6 months) is often recommended.


More information is available at the following sites:
www.cancer.gov/cancertopics/factsheet/risk/HPV
www.nlm.nih.gov/medlineplus/hpv.html
www.ashastd.org/hpv/hpv_overview.cfm

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1441 Pullman Dr
Reno Sparks, NV 89434
Phone: 775-432-1343
Fax: (775) 324-0858
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