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Dr Anu Kaur MBBS,FRANZCOG
Specialist Obstetrician and Gynaecologist

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Abnormal Pap Smears and colposcopy

The Pap test (a method of cervical screening) is a quick and simple test that checks for particular changes to the cells of a woman’s cervix (the neck of the womb). These changes may lead to cervical cancer if left untreated. In Australia, regular Pap tests save more than 1,200 women each year from cervical cancer.

  • All women aged between 18 and 75 years should have regular two-yearly Pap tests, even if they have had the HPV vaccine.
  • An abnormal result from a Pap test rarely means cancer.
  • You should discuss the results of your Pap test with your doctor or nurse.
  • Some women who have had a hysterectomy may mistakenly believe they no longer need to have Pap tests.
  • Your risk of developing cervical cancer increases with age.
  • Over 80 per cent of women diagnosed with invasive cervical cancer have not had regular Pap tests.

Cervical cancer and the human papillomavirus (HPV)

Cervical cancer is almost always linked to HPV,Which is spread through genital-skin to genital-skin contact during sexual activity.

There are many different types of HPV. Some types cause warts on the hands, others cause papillomas on the feet. Around 50 types infect genital son. Some of these (types 6 and 11) can cause genital warts, which are harmless, though unpleasant. The other types cause silent or invisible infection. Some high-risk types of HPV (most commonly types 16 and 18) can cause cervical cancer .

Risk factors for developing cervical cancer include:

  • the presence of some types of HPV on the cervix
  • smoking
  • the presence of sexually transmitted infections such as chlamydia
  • early age of first intercourse
  • early age of first childbirth
  • number of sexual partners
  • long-term use of the contraceptive pill.

A Pap test does not check for ovarian cancer or any other types of cancer or conditions in the reproductive system. It does not check for sexually transmissible infections (STIs).

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Pap test abnormalities

Cervical cells pass through a series of changes before they become cancerous. An abnormal Pap test result means either a less serious low-grade abnormality (squamous intraepithelial lesion — mild) or more serious high-grade abnormality (intraepithelial lesion — moderate to severe), where some of the cells of your cervix differ in some way from the normal cells. It rarely means cervical cancer is present.

Many women will require more frequent Pap tests for a period of time after an abnormal result. During this time, the cells of the cervix may heal themselves. Regular Pap tests will check for this and also pick up any further changes that might occur The length of time between your repeat Pap tests will depend on the type of problem you have. Ask your doctor for advice on the right length of time for you.

Low-grade abnormalities detected by a Pap test

Most low-grade cell changes or abnormalities are caused by transient HPV infection. Low-grade changes are sometimes referred to as mild dysplasia or cervical intraepithelial neoplasia 1 (CIN 1). Some of these low-grade changes are also seen with other infections or occasionally in women after menopause (atrophic changes).

These minor cell changes usually clear up by themselves or require simple medical treatment. Most women with low-grade changes on their Pap tests will be asked to have another test in 12 months, rather than two years. High-grade abnormalities detected by a Pap test.

High-grade abnormalities

Mean the cell changes on the Pap test look more serious.
High-grade abnormalities include:

  • moderate dysplasia/cervical intraepithelial neoplasia grade 2 (CIN 2)
  • severe dysplasia/cervical intraepithelial neoplasia grade 3 (CIN 3).

Further tests after an abnormal Pap test result
An abnormal Pap test sometimes requires a follow-up test. This may be either a repeat Pap test (for low-grade abnormalities) or further tests (for a high-grade abnormality). Further tests may include:

  • Colposcopy — a colposcope (an instrument that magnifies the cells of the cervix) gives your doctor a closer view of the extent and nature of the problem
  • Biopsy — your doctor may take a small tissue sample from your cervix during the colposcopy and examine it in a laboratory.

Treatment of Pap test abnormalities

If a high-grade abnormality is confirmed with colposcopy and biopsy, your doctor will usually recommend treatment to remove the abnormal cells from your cervix. Techniques for this can include:

  • diathermy — a special heat-generating instrument is used to kill the abnormal cells. This can be done under general anaesthetic, or local anaesthetic if you prefer
  • wire-loop excision — the cells are gently scraped from the surface of your cervix using a loop of wire. Often performed under local anaesthetic.

Pap tests after treatment

Women who have had treatment for high-grade abnormal cell changes need more regular Pap tests for the first two years following treatment. A test for high-risk HPV types is also used to monitor whether the HPV infection has cleared from the woman’s body. This test, along with a Pap test, will be done every 12 months after treatment. Once a woman’s Pap and HPV tests return to normal for two years in a row, she can return to two-yearly screening.

Pap tests for older women

Menopause does not protect women from cervical cancer In fact, most cases of cervical cancer occur in women older than 50 years. The most common type of cervical cancer usually takes around 10 years to develop. Older women often mistakenly believe their risk of cervical cancer is low, perhaps because they have had a hysterectomy, are widowed, or are no longer sexually active.

Pap tests after hysterectomy

A hysterectomy is the surgical removal of the womb (uterus). Women who soil need regular Pap tests following a hysterectomy include those who:

  • still have their cervix
  • had their hysterectomy as part of treatment for gynaecological cancer
  • have ever had a significant abnormality detected on a Pap test
  • have never had a Pap test in their life or have not had regular Pap tests.

Some women undergo hysterectomy as treatment for cervical cancer Even if the cancer was totally removed during surgery, you need to continue having Pap tests (usually every year) for as long as your gynaecologist tells you it is necessa.

Some women who have had a hysterectomy don’t need to have any more Pap tests. This is the case when:

  • the operation was performed to treat non-cancerous conditions, such as endometriosis, uterine prolapse or menstrual problems
  • the woman’s cervix was removed during the hysterectomy (total or radical hysterectomy)
  • before the hysterectomy, the woman had regular Pap tests every two years and never had a significant abnormality detected.

Some women aren’t sure what kind of hysterectomy they have had. The easiest way to check is to ask your doctor.

Lesbians and Pap tests

Lesbians should have Pap tests every two years, as HPV is spread through genital-skin contact.

Long-term monogamy and Pap tests

Many older women who have been married and monogamous for decades wrongly believe that screening is only needed by women who have multiple sex partners. However, HPV can be passed on the very first time someone is sexually intimate, which is why regular Pap tests are important for women who have ever been sexually active, regardless of how many partners they’ve had.

Long-term abstinence and Pap tests

Since cervical cancer has been associated with sexual activity, women who have been celibate for some time — such as some divorced and widowed women — may wrongly believe they are no longer at risk. No matter how long it’s been since you last had sex, you should have regular Pap tests until the age of 70.

Social stigma and Pap tests
Since cervical cancer has been associated with sexual activity, some women may avoid having Pap tests because they believe other people might think they are promiscuous.