Understanding Abnormal Pap Smears
By Sharon B. Diamond, MD, FACOG, MSW
October 16, 2017
Category: Women's Health
Tags: abnormal pap smear  

Pap smears are an important part of the gynecologic examination and Dr. Sharon Diamond in the Upper East Side of New York, NY, urges abnormal pap smearher patients and all women to make sure they see their doctors regularly.  How frequently to have a Pap test is determined by an individual woman’s history and risk factors and is an important part of the healthcare discussion with her physician.  The incidence of advanced cervical cancer in the United States has decreased by about 50 percent in the past 30 years in large part because of widespread screening with the Pap test and so having this important test is an integral part of well women care.

Pap smears

The Pap test involves analyzing the superficial cells of the cervix for abnormalities and should be performed for women starting at the age of twenty-one. The doctor will sweep a plastic spatula across the cervix and use a tiny soft brush called the cytobrush to obtain some cells from the external part of a woman's cervix and from the internal, lower part of the cervix.  These will then be examined under the microscope in a laboratory. If no abnormal cells are found, the results will come back as negative. An important additional test is also run on smears from women over the age of thirty or on smears from women of any age if the Pap is abnormal- this is testing for Human Papilloma Virus (HPV) which is a virus that, although often not significant, may have the potential to cause serious abnormalities in the cervix including cervical cancer, especially if present for many years.

Abnormal Pap Smear Classification System

Dr. Diamond uses the standard Pap classification system in her Upper East Side office in New York. This system  analyzes patients' results so that they can better understand them:

  • Normal/Negative: This means there are no cancer or pre-cancer cells.
  • Atypical squamous cells of undetermined significant (ASC-US): this is one of the more common abnormal results and is usually not significant unless also accompanied by the presence of HPV.  Depending on whether or not HPV is present, the Pap may just be repeated in 6 months or a year or additional testing may be needed – colposcopy.  Colposcopy is an examination performed with the use of a binocular magnifier that enables abnormal areas to be seen and biopsied.
  • Squamous intraepithelial lesion (SIL): There is a low-grade form (LSIL) which is caused by HPV cells that typically go away on their own, and a high-grade (HSIL) form which means there may be a more serious problem present.  Depending on the age of the patient and other risk factors colposcopy may be performed for women with LSIL but is always warranted when HSIL is present.
  • Atypical squamous cells, cannot exclude HSIL (ASC-H): Further testing including colposcopy is needed at this stage.
  • Atypical glandular cells (AGC): This is indicative of the presence of pre-cancer cells within the cervix or uterus and colposcopy, sonography and biopsies of the lining of the uterus may also need to be performed.
  • Cancer:  a very rare finding in women who have been having regular Pap smears but which must be addressed immediately.

For more information on Pap smears, just call Dr. Diamond at her Upper East Side, NY, office at 212-876-2200 and arrange for an office consultation and examination.

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