A Pap smear (named for George Papanicolaou, the inventor of the test) is a diagnostic procedure to detect precancerous and cancerous conditions of the cervix.
An abnormal Pap smear means that on examination under a microscope, there is the appearance of atypical cells.

What Does It Mean If You Have an Abnormal Pap Smear?

The presence of an abnormal Pap Smear often causes a woman much anxiety because it raises the specter of cancer. However, an abnormal Pap smear can occur for a number of different reasons:

• Inflammation caused by an infection
• Hyperkeratosis (an overabundance of skin cells) sometimes caused by wearing a cervical cap or diaphragm, or by infection
• Atypia (the presence of atypical cervical cells)
• ASC (atypical squamous cells)
• ASC-US (“atypical squamous cells - undetermined significance”). This means the cells are abnormal, but the pathologist doesn’t know why they became that way. It could be a vaginal infection or HPV infection. It may not be a serious problem.
• ASC-H (“atypical squamous cells – cannot exclude High-Grade Squamous Intraepithelial Lesion (HSIL)”). This means the atypical cells may be precancerous.
• AGC (atypical glandular cells). Glandular changes are more significant, and women with them are at a higher risk for cervical cancer.
• LSIL (Low-grade Squamous Intraepithelial Lesion). These indicate early changes in the size and shape of the cells. Sometimes, this is caused by HPV infection.
• HSIL (High-grade Squamous Intraepithelial Lesion). This result indicates significant abnormalities in the cells that are very likely precancerous.

Who Is More Likely To Have an Abnormal Pap Smear?

Women are more likely to have an abnormal Pap smear if they:

• Have HPV (human papilloma virus) infection
• Are smokers
• Have multiple sexual partners
• Became sexually active at a young age
• Had a mother who took DES (diethylstilbestrol duringpregnancy)
• Are immunocomprised for any reason

What Does Treatment for Abnormal Pap Smear Involve?

This is completely dependent on the type of abnormal smear. It is extremely important to recognize that HPV (which is sexually transmitted) is itself believed to be a causative agent of cervical cancer. These are the recommendations of the NCI (National Cancer Institute):

Diagnostic Follow-Up:

ASC-US:

• Follow up with HPV DNA testing to determine presence of HPV infection.
• Colposcopy:
• This is an in-office procedure performed during a pelvic examination. An instrument called a colposcope is used; it is a microscope that allows magnification and easier visualization of cervical changes. These include not only cellular changes, but capillary changes as well. These capillary changes can help to assess the degree of severity of the abnormalities in the cells because there is a correlation between these changes and the atypia of the cells (dysplastic cells grow faster and have neovascularization). This simply means that abnormal cells divide faster, and need new sources of blood supply. Particularly suspicious areas can be identified and biopsied to determine presence of possible malignancy.
• If infection or atrophy is present, these should be treated immediately with antibiotics or topical estrogen.
• Repeat cervical cytology in 4-6 months.

ASC-H:

• Colposcopy

AGC:

• Colposcopy and possibly Endocervical/Endometrial Biopsy

LSIL:

• Colposcopy and biopsy

HSIL:

• Colposcopy and biopsy

Treatment:

LSIL and HSIL treatment involves eradication of the lesions, which can be done by:

• Cryotherapy
• Laser surgery
• Electrocautery
• Excision

How Long Does It Take?

Depends on procedure.

How Many Treatments Are Required?

This depends on the procedure, though often serial colposcopies and cervical cytologies are performed to ensure that neoplastic changes are not continuing.

When Will I See Results?

You should start seeing a resumption of normal Pap smears soon after proper treatment.

What Are My Alternatives?

• There are no good alternatives here; diligent follow-up and treatment is essential to preventing further disease.

Will I Have Pain?

Some pain sometimes occurs during procedures such as colposcopy. However, it is minimal.

When Can I Go Back To Work Or School?

Generally speaking, these procedures are not incapacitating enough to necessitate taking significant time off from work or school.

Who Will Perform My Treatment?

One of our experienced gynecologic surgeons will prescribe the appropriate treatment.

How Much Does It Cost?

Depends on treatment prescribed. Please call TopSurgeons at 800-506-8084 for more information.

Will My Insurance Cover?

Insurance should cover the treatment subject to individual policy limitations.