Abnormal Pap Smears

The Pap smear is a cancer-screening test.  It is only a part of the examination and will not screen for all female cancers.  It detects abnormal cells on the cervix – the opening to the uterus.  It will not detect cancers of the ovary, the upper portion (or body) of the uterus, or the fallopian tube. Prior to the Pap smear, cervical cancer was the most common female cancer after cancer of the breast.  As a result of Pap smear testing, cervical cancers are now infrequent.

In performing a pap smear, cells are brushed from the cervix and placed on a glass microscope slide.  The slide is sent to the lab where a pathologist looks for abnormal cells.  The results are not immediately available, but will be sent to the office several days after your appointment.

Pap smear results can show normal cells and cancer cells; cancer cells on the Pap smear are extremely rare.  The value of the Pap smear is that it can detect abnormal cells that are not cancer, but if left unattended may develop into cancer.  Not only can the Pap smear detect these abnormal cells, but it can grade the degree of abnormality and show how close the changes are to becoming a cancer.  It gets confusing because there are many names for these abnormal cells, many meaning the exact same thing.  You may hear the terms “Dysplasia”, “CIN” (Cervical Intraepithelial Neoplasia), “LGSIL” (Low Grade Squamous Intraepithelial Lesion), and “HGSIL” (High Grade Intraepithelial Lesion).

Mild Dysplasia  =  CIN 1  =  LGSIL

Moderate Dysplasia  =  CIN 2  =  HGSIL

Severe Dysplasia  =  CIN 3  =  HGSIL

A pap smear is only a screening test and does not make a diagnosis.  If the Pap smear is not normal, you will need additional testing that is more accurate.  This test is called a colposcopy.  It is performed in the office using a magnifying instrument to determine the location of the abnormal cells on the cervix.  Once identified, this abnormal area will be biopsied for a more accurate understanding of the changes.  Once the results of the biopsy are known, a treatment plan can be determined.

The majority of abnormal pap smears are caused by the HPV (Human Papilloma Virus).