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The Pap test: questions and answers

1. What is a Pap smear? The Pap test (also called Pap test or Pap smear) is a way to examine cells collected from the cervix (the lower, narrow end of the uterus). The main purpose of the Pap test is detect cancer or abnormal cell changes that can turn into cancer. You can also find non-cancerous states, such as infection and inflammation.
   
2. What is a pelvic exam? In a pelvic exam, the doctor feels the uterus (womb), vagina, ovaries, fallopian tubes, bladder and rectum in order to find any abnormality in their shape or size. During a pelvic exam , uses an instrument called a speculum to widen the vagina and see the top of the vagina and cervix.
   
3. Why are important Pap test and pelvic exam? Pap test and pelvic exam are important parts of routine health care of a woman, and that they can detect abnormalities that can lead to invasive cancer of the cervix. These anomalies can be treated before cancer occurs. Most invasive cervical cancers could be prevented if women get regular Pap tests. ; In addition, like other cancers, cervical cancer can be treated successfully if detected early.
   
4. Who performs a Pap test? Doctors and other medical professionals specially trained as medical assistants, midwives and nurse practitioners, can perform Pap tests and pelvic exams. These people, generally, are known as clinical.
   
5. How is the Pap test? The Pap test can be performed in a doctor, clinic or hospital. As the woman lies on an exam table, the clinician places the speculum into the vagina to open it. For To test, collect a sample of cells in the cervix with a wooden scraper or a small cervical brush. The specimen (sample) is placed on a glass slide and kept in fixative and rinsed in a vial of fixative and sent to the laboratory for examination.
   
6. How often you need a Pap test? Women should talk to your doctor about when and how often they should have a Pap test. Under current guidelines, women should undergo a Pap test at least every 3 years. The first round should be made to 3 years after he started having sex, but before reaching age 21. Experts recommend that you wait for around three years after they started having sex to avoid excessive treatment for abnormal changes that are common and temporary. There is no danger if you wait 3 years, since usually Cervical cancer develops slowly. This type of cancer is extremely rare in women under 25 years of age.
   Women between 65 and 70 who received results at least 3 normal Pap tests and no abnormal results have been received in the last 10 years may choose to discontinue Pap tests after consulting with your health care provider. Women who have had a hysterectomy (surgery to remove the uterus and cervix) do not need a Pap smear test, unless the surgery was performed to treat a precancerous or cancerous.
   
7. When should the Pap test? woman should have this test when they are menstruating, the best time is 10 to 20 days after the first day of last menstrual period. If, on the day of your appointment, lowers the menstrual period women should doctor immediately to reschedule your appointment. Two days before the test Pap smear, women should avoid douching or using vaginal medicines or foams, creams or jellies (except as directed by your doctor). They may wash or hide abnormal cells. In addition, women should not have sex one or two days before the Pap test, as this may cause unclear results. After the test, she can return to normal activities and return to work immediately.
   
8. How are the results of a Pap test? Most U.S. labs use a set set of terms called the Bethesda System for reporting the results of the Pap test. Under this system, samples of the Pap test without cell abnormalities are reported as "negative for intraepithelial lesion or malignancy." samples with cell abnormalities are divided into the following categories:
   
   • ASC-atypical squamous cells. squamous cells are thin, flat cells that form the surface of the cervix. The Bethesda System, this category divided into two groups:
     
     
     1. ASC-US-atypical squamous cells of undetermined significance ( a typical s quamous c ells of or ndetermined ignificance s). Squamous cells do not appear completely normal, but doctors are unsure of the cell changes mean. Sometimes, change is related to an infection of human papilloma virus (see question 13 .) ASC-US are considered mild abnormalities.
        
     2. -ASC-H atypical squamous cells can not exclude intraepithelial lesions high grade squamous. The cells do not appear normal, but doctors are unsure of the cell changes mean. There is a greater risk that the ASC-H are precancerous.
        
   • AGC-atypical glandular cells. Glandular cells are mucus-producing cells found in the endocervical canal (opening in the center of the cervix) or the lining of the uterus. Glandular cells not appear normal, but doctors are unsure of the cell changes mean.
     
   • AIS-endocervical adenocarcinoma in situ. Precancerous cells are found in glandular tissue.
     
   • - LSIL low-grade squamous intraepithelial lesion grade ( l ow s quamous l i ntraepithelial Ezion .) Low-grade means there are early changes in size and cell shape, the word lesion refers to an area of \u200b\u200babnormal tissue; Intraepithelial refers to cells that make up the surface of the cervix. The LSIL are considered mild abnormalities caused by HPV infection.
     
   • HSIL- injury high grade squamous intraepithelial ( h igh-grade quamous s i l ntraepithelial Ezion ). High-grade means there are more marked changes in the size and shape of abnormal cells (precancerous ), which means the cells look very different from normal cells. The HSIL is more severe abnormalities and there is a higher likelihood to become invasive cancer.
     
9. How common are abnormal Pap tests? About 55 million Pap tests are performed each year United States. Of these, approximately 3.5 million (6 percent) are abnormal and require medical monitoring.
   
10. What abnormal results mean? A physician may simply describe to the patient that the results of the Pap test is "abnormal." Cells on the surface of the cervix sometimes appear abnormal but are very rarely cancerous. It is important to remember that abnormal conditions not always become cancerous, and that some conditions are more likely to lead to cancer than others. A woman may want to ask the doctor for specific information on the outcome of their Pap test and what it means that result.
    There are several terms that can be used to describe abnormal results.
    
    • dysplasia is a term used to describe abnormal cells. Dysplasia is not cancer, but can be a very early cancer of the cervix. The cells look abnormal under a microscope, but do not invade nearby healthy tissue. There are four degrees of dysplasia, classified as mild, moderate, severe or carcinoma in situ , depending on how abnormal the cells look the microscope. carcinoma in situ means the cancer is present only in the layer of cells on the surface of the cervix and has not spread to nearby tissues.
      
    • squamous intraepithelial lesion (SIL) is another term used to describe abnormal changes in the surface cells of the cervix. The word describes squamous cells are thin, flat and form the outer surface the cervix. The word lesion refers to abnormal tissue. An intraepithelial lesion means that the abnormal cells are present only in layer of cells on the surface of the cervix. A doctor can describe a squamous intraepithelial lesion as low grade (early changes in the size, shape and number of cells) or high-grade (precancerous cells that look very different from cells normal).
      
    • cervical intraepithelial neoplasia ( c ervical i ntraepithelial n eoplasia, CIN) is another term that is sometimes used to describe abnormal cells. Neoplasia means an abnormal growth cells. Intraepithelial refers to the layer of cells that form the surface of the cervix. The term CIN, along with a number (1 to 3), describes how much the thickness of the lining of the cervix contains abnormal cells.
      
    • atypical squamous cells are findings that are clear and not a definite abnormality.
    cervical cancer or invasive cervical cancer occurs when abnormal cells penetrate deeper into the cervix or other tissues or organs.
    
11. What if results are abnormal Pap test? If the test Pap shows an ambiguous or minor abnormality, the doctor may repeat the test to determine whether monitoring is necessary. Many times, cervical cell changes go away without treatment. In some cases, doctors prescribe a cream estrogen for women with ASC-US and are near menopause or have already gone through it. Because these cellular changes are often caused by low hormone levels, applying an estrogen cream in the cervix several weeks usually helps clarify the cause of cellular change.
    If the Pap test shows a result of ASC-H, LSIL or HSIL, the physician may then perform a colposcopy using an instrument much like a microscope (called a colposcope) to examine the vagina and cervix. The colposcope does not enter the body. For this test, the doctor covers the cervix with a diluted vinegar solution that causes abnormal areas turn white. If the colposcopy is abnormal tissue, the doctor may perform endocervical curettage or biopsy. A biopsy is the removal of a small amount of cervical tissue for examination under a microscope in a laboratory. In an endocervical scraping, scratch cells inside the canal of the cervix with a curette, an instrument small spoon-shaped.
    If the lab finds abnormal cells that have a high probability of becoming cancer, women will be under medical treatment. Without treatment, these cells may become invasive cancer. The treatment options are:
    
    • LEEP (loop electrosurgical excision procedure handle) is surgery that uses an electric current is passed through a thin wire loop that can be used as a knife.
      
    • The Cryotherapy destroys tissue abnormal by freezing.
      
    • The laser therapy is the use of a narrow beam of intense light to destroy or remove abnormal cells.
      
    conization
    • The pieces of tissue removed in a cone shape through the use of a knife, a laser or LEEP.
      
12. How do they compare in terms of abnormal Pap test and what are the appropriate tests and treatments?
    
    Pap Abbreviation ASC-H AIS

    Results			Known as testing and treatment
    atypical squamous cells of undetermined significance	ASC-US		HPV Test Pap smear Repeat colposcopy and biopsy Estrogen Cream
    atypical squamous cells-cannot exclude lesions of high grade squamous intraepithelial			colposcopy and biopsy
    atypical glandular cells	AGC		Colposcopy and biopsy or endocervical curettage
    endocervical adenocarcinoma in situ			Colposcopy and biopsy or endocervical curettage
    Grade squamous intraepithelial lesion LSIL low		mild dysplasia Cervical intraepithelial neoplasia-1 (CIN-1)	colposcopy and biopsy
    grade squamous intraepithelial lesion high	HSIL	moderate dysplasia dysplasia CIN-2 CIN-3 Carcinoma in situ (CIS)	Colposcopy and biopsy or endocervical curettage Additional Treatment: LEEP, cryotherapy, laser therapy, conization or hysterectomy

    
    
    
13. What is the relationship between human papilloma virus (HPV) and development of cervical cancer? human papilloma viruses are a group of more than 100 viruses. Some types of HPV cause common warts that grow on hands and feet. More than 30 types of human papilloma virus can spread from one person to another through sexual contact. Some of these HPV that are transmitted sexually cause tumors as genital warts, but these do not result in cancer. About 15 of the human papilloma virus is sexually transmitted are considered "high risk" because they are more likely to cause cancer.
    The infection of human papilloma virus is the major risk factor for cervical cancer. Almost 6 million new infections of HPV occur each year in the U.S.. However, although HPV infection is very common, only a very small percentage of women infected with untreated HPV will actually develop cervical cancer.
    
14. Who is at risk of contracting an infection from human papilloma virus? This infection is more common among younger age groups, especially among women 17 to 29 years. Because HPV is spread mainly through sexual contact, risk increases when you have multiple sex partners. Women who are becoming sexually active at a young age, who have many sexual partners whose sexual partners have other partners, in turn, are at greater risk. Women who are infected with the human immunodeficiency virus (HIV ) also have a higher risk of becoming infected with HPV and have abnormalities neck. The non-sexual transmission of human papilloma virus is rare. The virus often disappears but sometimes can be detectable for years after infection.
    
15. Is it always a precancerous condition or cancer, infection with a type of human papilloma virus linked to cancer? No. Most HPV infections appear to disappear on their own without causing any type of anomaly. However, persistent infection with types of human papillomavirus associated with cancer may increase the risk that anomalies Mild become more severe abnormalities or cervical cancer. With regular medical observation of trained clinicians, women with precancerous cervical abnormalities can be treated before developing cancer.
    
16. Need women who have been vaccinated against human papilloma virus still get Pap smears? Yes Pap tests remain essential for the detection of cervical cancers and precancerous changes, even in women who have been vaccinated against HPV.
    The Food and Drug Administration (FDA) approved Gardasil ® recently, a highly effective vaccine in preventing infection with four HPV types. Two of these four HPV cause 70 percent of cervical cancers and the other two cause 90 percent of genital warts (1 ). Another promising vaccine, Cervarix ™, is being studied but has not yet been approved by the FDA. These vaccines do not protect against all HPV types that cause cervical cancer. Also, do not protect or treat women already infected with HPV. Therefore, it is important that women who received the vaccine continue to test for cervical cancer as has been recommended that women that have not been vaccinated.
    
17. Are there any studies that examine the evidence of human papilloma virus and treatment options for mild abnormalities that result from a Pap smear? The National Cancer Institute (NCI), a component of the National Institutes of Health (NIH), funded and organized a major clinical trial (research study with people), the A SCUs / L SIL riage S T tudy (ALTS) . The results indicate that it is more effective testing of human papillomavirus in cervical samples of women with ASC-US results to perform an immediate colposcopy or repeat Pap test to identify abnormalities of ASC-US need treatment. In women with ASC-US HPV negative test can provide assurance that there is this cancer or a precancerous condition.
    
18. What are the false positives and false negatives? The Pap test is a selective review of detecting and, like all such tests is not entirely accurate. Although false positives and false negatives do not happen very often, can cause anxiety and can affect the health of women.
    A false positive Pap test occurs when a patient is said to have abnormal cells when the cells are actually normal. A false negative Pap test occurs when declaring a normal sample, but the woman has a significant abnormality that was missed. A false negative Pap test can delay diagnosis and treatment of a precancerous condition. However, the screening tests done regularly help make a false negative result. If no abnormal cells were detected once, there are good chances that next time will be detected.
    
19. What methods are being developed to improve the accuracy of the Pap test? In April 1996, the Consensus Development Conference on Cervical Cancer , which was convened by the National Institutes of Health (NIH) concluded that about half of false negative Pap tests are due to inadequate collection samples. The other half are due to the failure to identify or correct interpretation of the specimens. Although the conventional Pap test is effective in most cases, the conference made it clear that new methods are needed for collecting and reading of samples to reduce the number of false negatives.
    Under the Bethesda System requires laboratories to determine if a sufficient number of cervical cells in the sample to make a proper evaluation. This requirement helps to improve the quality of samples and collection. Under such system, a sample should be qualified as "satisfactory for evaluation" or "unsatisfactory for evaluation."
    A new method for collection and analysis of samples, called preparation the slide in liquid-based thin can facilitate the distinction of abnormal cells. The cells of the cervix are collected with a brush or other collection instrument. The instrument is rinsed in a vial of liquid preservative. ; The vial is sent to the laboratory, where an automatic device for preparing thin-layer slide slide for examination. The results indicate that this method is as sensitive as normal Pap tests, or more than they, for important anomaly detection.
    are also being used automatic readers computer to improve reading Pap smears. This technology uses a microscope that conveys a phone to a computer, which analyzes the image for the presence of abnormal cells.
    

Bibliography

1. Koutsky LA, Ault KA, Wheeler CM, et al. A controlled trial of a human papillomavirus type 16 vaccine. New England Journal of Medicine 2002, 347 ( 21) :1645-1651.