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Alaska Women's Health, PC  
4115 Lake Otis Parkway  
Anchorage, AK 99508  

awh@akwomenshealth.com  






Pap Smears
Diagram from The American Academy of Family Physicians

A pap smear (or pap test) is a test that checks for changes in your cervical cells. It is performed by a provider inserting a speculum into your vagina so that the provider can view the cervix. The provider will then swab a collection of cells off of the cervix and send it to a lab for analysis. A pap smear can detect infection, abnormal/unhealthy cervical cells, and cervical cancer. It is important for a woman to have a pap smear, pelvic exam, and breast exam as part of her routine health care. If a patient has a series of abnormal pap smears, her provider may suggest human papillomavirus (HPV) testing in order to determine if that is the cause of the patient's repeat abnormal pap smears. Some types of HPV are strongly linked to the development of cervical cancer.

You should get a pap smear if:

  • You are 21 years old or older; or
  • You are under 21 and are sexually active.

There is no age limit for having a pap smear, even women who have gone through menopause still need to have a pap smear.

The American College of Obstetricians and Gynecologists recommends the following pap smear guidelines:

  • If you are younger than 30, you should have a pap smear every year.
  • If you are age 30 or older and have had three normal pap smears in a row, talk with your provider about spacing out your pap smears to every two to three years (unless, of course, one of these subsequent pap smears comes back as abnormal).
  • If you are 65 to 70 years old and have had at least three normal pap smears and no abnormal pap smears for 10 years, ask your provider if you may stop having pap smears.

You should have a pap smear annually no matter what your age if:

  • You have a weakened immune system because of organ transplant, chemotherapy, steroid use, or chronic disease.
  • Your mother was exposed to diethylstilbestrol (DES) during her pregnancy.
  • You are HIV-positive or have AIDS. HIV-positive women and women with AIDS are at a higher risk of cervical cancer and other cervical diseases. The U.S. Centers for Disease control suggest that HIV-positive women get an initial pap smear and get re-tested six months later. If both of these tests are normal then the patient may get pap smears annually after that.

The only women who do not need regular pap smears are:

  • A woman over age 65 who has had a number of normal pap smears and has been told by her provider that she doesn't need anymore pap smears.
  • A woman who does not have a cervix and has a low risk of cervical cancer. You should still speak with your provider in order to determine if stopping pap smears is a good idea.

A woman can increase her risk of getting cervical cancer by:

  • Having sex prior to age 18;
  • Having many sex partners;
  • Having sex partners who have other sex partners; and/or
  • Has or has had a sexually transmitted disease (STD).

Treatments and further testing after an abnormal pap smear can include:




Cervical Disorders

Cervicitis

Cervicitis is inflammation of the cervix that can cause symptoms. Cervicitis is quite common in women during their childbearing years. Cervicitis causes include:

  • Infections, especially from sexually transmitted diseases (STD's) such as bacterial infections (e.g., gonorrheal or chlamydial infections), viral infections (e.g., herpes or genital warts), or trichomonas (an organism that can cause vaginal infections).
  • Irritation from a foreign body such as an Intrauterine Contraceptive Device (IUCD or IUD), a forgotten tampon, or a pessary (a device placed in the vagina to hold sagging pelvic organs in place).

Sometimes the cause of cervicitis cannot be determined. Cervicitis can cause a vaginal discharge and foul odor, tenderness or pain in the pelvic region, and/or spotting between periods or after sex.

 

Polyps

Polyps are benign (non-cancerous) growths or tumors that can grow on the cervix. They can vary in size and can cause vaginal bleeding. Most often polyps are discovered during a pelvic exam or a colposcopy. Usually cervical polyps can be removed in the office with no anesthesia.

 

Genital Warts

Genital warts or condyloma are growths that are caused by certain types of human papillomavirus (HPV). HPV is usually transmitted sexually. Some types of HPV have been linked to the development of cervical cancer. Anyone with a known or suspected HPV infection should have regular checkups and pap smears. Genital warts can usually be treated in the office and should be treated as soon as possible since they can spread easily to your sexual partner(s). Genital warts can return at any time, even after treatment. Safe sex is of the utmost importance, particularly when a person is infection with HPV.

 

Cervical Dysplasia

Cervical dysplasia is when there are changes to surface cervical cells. This is when normal (benign) cervical cells are replaced by abnormal cells. Dysplasia is not cancer but, if not treated, these cells can become cancerous. Dysplasia can usually be treated successfully. Dysplasia is more common in young women and teens but can be found in women of any age. Dysplasia ranges from mild, moderate, severe, and carcinoma in situ (CIS). CIS is not a true form of cancer but will most likely develop into cancer if left untreated. There are a number of terms that you will hear in reference to cervical dysplasia. Cervical intraepithelial neoplasia (CIN): CIN 1 includes mild dysplasia, CIN 2 includes moderate dysplasia, and CIN 3 includes severe dysplasia and CIS. The terms CIN and dysplasia can refer to a pap smear or biopsy result. Squamous intraepithelial lesion (SIL) includes low-grade (CIN 1) and changes linked to HPV OR high-grade (CIN 2 and 3) and CIS. Risk factors for dysplasia and cervical cancer include:

  • Having genital warts;
  • Having had more than one sexual partner (or having a sexual partner who has had more than one partner);
  • Having sex at a young age; and/or
  • Smoking.

 cervical%20dysplasia.jpg

Invasive Cervical Cancer

Invasive cervical cancer is when cancerous cervical cells move into deeper tissue layers and spread to other organs. Cancer is when cells grow out of control and cannot perform their normal function. Only cancer (malignant) cells spread. They travel throughout the body via blood and lymph. Cancer cells also spread throughout the tissue next to the cervix. Cancer is most treatable (curable) when it is found before it spreads. Cervical cancer is most common in women between 35-50 years of age, although it can occur at any age.

Symptoms of cervical cancer can include abnormal bleeding, spotting, or vaginal discharge. Advanced cancer can cause pain, urinary problems, and/or leg swelling. These symptoms can be caused by many different things and don't mean you have cancer but you should see a physician without delay to make sure and to determine what is causing these symptoms.

If a woman is diagnosed with invasive cervical cancer, her physician will determine the size of the tumor and the extent (if any) to which it has spread. This is referred to as staging cancer. Cancer stages range from Stage I through Stage IV.

  • Stage I cancer is the earliest stage and is the most easily treatable, it means that the cancer is confined to the cervix and has not spread anywhere else in the body.
  • Stages II and III refer to the cervical cancer starting to spread throughout the cervix and into the surrounding tissue.
  • Stage IV is the most advanced stage, and the most difficult to treat. This is when the cancer has spread to other organs in the body.

The earlier stages of cancer are easier to treat and are more likely to lead to a cure than Stage IV disease. The cure rate for cervical cancer ranges from 85-90% for Stage I to as low as 5-10% for Stage IV. Needless to say, early detection saves lives!


Websites of Interest

Alternatives in Gynecology: Treatment of Cervical Dysplasia

American Cancer Society

American College of Obstetricians and Gynecologists (ACOG) Resource Center

Centers for Disease Control: National Breast and Cervical Cancer Early Detection Program

The HPV Test

Lab Tests Online: Pap Smear

National Cervical Cancer Coalition (NCCC)

WomensHealth.gov: PAP Test











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