Abnormal Pap Smears Discussed

The HPV Virus

Colposcope

If you have gotten a call about an abnormal pap smear you probably want to know a lot about what this means. Especially if you've not had an abnormal result before. It is a big subject to try to cover all the important aspects of this topic in a simple blog post and I always encourage women to write down their questions and know that when you come in for your consultation or your second opinion appointment with us we will provide you with hand outs and pictures that will help you tell the whole story! When patients come for consultation and discussion of management of a prior abnormal pap smear it's important we know their age, their previous STD history, their actual pap smear results, any prior cervical treatments. The current classification system for pap smears is the Bethesda 2001 classification. You probably have been told whether this test is showing a cancer, a precancerous or an indeterminate type of cell that needs further study. Human Papillomavirus (HPV) is a virus that causes genital warts and may cause subclincial cell changes leading to cervical cancer in women, and causes virtually all the significantly abnormal pap smears that women have. HPV disease occurs in men as well, and if you have a partner you probably want him to get evaluated for lesions and the Gardasil vaccine. HPV is one of the most common viral infections in humans. The virus can be transmitted to men and women through sexual contact including vaginal, anal, or oral sex, and while condoms offer protection the protection is not complete. Even if you have an abnormal pap smear if you have not been vaccinated against HPV disease you are still a candidate if you fall within the right age groups. HPV is one of the most common sexually transmitted diseases and affects over 20 million Americans Estimates from different studies vary, but approximately 50 percent of sexually active adults worldwide will be infected with HPV at some point in their lifetime, and one million new cases are diagnosed each year.  Many statics were reviewed with her, including 50% of cervical cancers have HPV 16 DNA, 20% have HPV 18. But only 1% of women infected by high-risk HPV will ever develop preneoplastic or neoplastic change. Before a woman gets an actual cancer of the cervix they usually are diagnosed with a precancerous change called Cervical Intraepithelial Neoplasia, known as "CIN" . That diagnosis has to be made by a microscope test called a colposcopy.  If you get CIN II or III only 12% ever progress to invasion. Other co-factors are the complexities of our biology, like our HLA type, variations in the form of our p53 gene, variants of the high risk subtypes of the HPV itself and own immune system health such as other STDs and whether you are a smoker. Most women (about 90%) completely clear their infection in 40 months, but some seem to clear more quickly. If your partner has infection still, it's your own immunity that seems to work to clear your virus and thus it's not typical to get reinfected by a partner. At greatest risk are the 10-15% who never clear their HR HPV types. Average age for developing cervical cancer is 40 in spite of the fact that first abnormal pap smears occur at a much younger age. So there is time to become cured of pre-cancer of the cervix if you do have that abnormal pap. If you have that abnormal pap, the first step will be to understand the actual test result. The next step is to see if additional tests, like an HPV test or an STD test is necessary. For a firm diagnosis a colposcopy with a biopsy probably has to be done. And finally then can the treatment plan be undertaken. Treatment plans also depend on your plans: for pregnancy, for contraception, and your age.