WOMENS-HEALTH Messages for March, 1999: Re: abnornal cells found on my recent recent yearly pap test

Re: abnornal cells found on my recent recent yearly pap test

From: William D. McIntosh, MD (anonymous@obgyn.net)
Sun, 14 Mar 1999 11:10:19 -0600 (CST)

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In reply to: Dee: "abnornal cells found on my recent recent yearly pap test"

At Sun, 14 Mar 1999, Dee wrote: >
>I went for my annual check up on Feb 3, 99. and received a phone call
>from my doctors office saying they found some abnormal cells on the
>yearly pap smear and we scheduled a
>colposcopy for next week. I have a copy of my lab's pap
>results, the diagnosis is EPITHELIAL CELL ABNORMALITY,
>LOW GRADE SQUAMOUS INTRAEPITHELIAL LEASION, The report
>was faxed to us, and the PHOTOMICROGRAPH is rather dark and
>unclear. The specimen 2 Cervical HPV Swab result is HPV-DNA
>POSITIVE, HIGH RISK TYPES. I have a history of "NORMAL"
>pap smears, NEVER "abnormal" till this one. My prior test
>test was Feb 13,98, then Feb 97, Feb 23, 96 and each February since the
>birth of our son in 1989. I'm 38 my
>husband is 47, we are both professionals and have been
>monogomous, and are very safe. THIS HAS US BOTH SCARED
>BEYOND BELIEF!!! is this an indication of a pre-cancerous
>situation, would the pap test have picked up malignacy if it were
>present?? is it ever Fatal, at this point??? We are
>are both extremely scared of the outcome and have spent many sleepless
>nights since being infomed of this on March 2, 1999. Please explain
>what this means in detail and the
>possible diagnosis and treatment, is it ever fatal at this point, is
>there reason for alarm??
>Thank you for your time

OK, first take a deep breath, because you are not going to die, you are not even going to lose your uterus in all probability. There are entire text books written to answer your questions, but let's see if I can give you the thumbnail sketch to carry you over to your colposcopy.

First, pap smears are screening tests, meaning that they are cheap, easily performed, and broadly applicable, but not specific enough to be a diagnostic test. An abnormal pap is simply a red flag that this is someone that needs a closer look. The closer look is the planned colposcopy, a technique for looking at the cervix under magnification in order to make a diagnosis.

The underlying problem that causes abnormal pap smears is NOT cancer (the pap is very poor at identifying actual invasive cancer), but rather dysplasia, which in turn is caused by, or has as a prerequisite, a virus called Human Papilloma Virus (HPV). While generally considered a sexually transmitted disease, virtually all sexually active humans have it from early in their sexual lives. The virus, once acquired, never leaves your body, and will usually lie dormant for years, decades, even for your whole life. The reason we do pap smears on everyone, a test designed to look for the activity of this virus, is because everyone has this virus for practical purposes. There are even reports that babies can acquire this virus in utero. So, the question is not do you have the virus or not, but rather, is the virus causing any problems.

Dysplasia is a condition that could lead to cervical cancer if left to its own devices. The cervix does not turn cancerous in a heartbeat, like flipping a light switch, but goes through several intermediate stages, a process that takes many years generally, and which regresses to normal far more often than it progresses to cancer. In your case low grade SIL is just not very far at all, and assuming that biospy confirms that is really what is going on, you have a 70% probability that this will regress to normal within 1 year, 25% chance that it will stay the same, and only 5% chance that it will progress to high grade SIL, which I hasten to point out is still not cancer.

Assuming biopsy confirmed low grade SIL, then the usual treatment is nothing. Simply repeat the pap every 4 months until you have 3 in a row that are normal, or in the unlikely event of progression, until there is a change for the worse, in which case treatment can be undertaken at that time. There are some practitioners that like to treat low grade SIL, but since the chance that the process will prgress is so small, most of us feel that this is overkill, especially since the treatment of high grade SIL is the same as for low grade SIL. If treatment is considered, or if it turns out that you have high grade SIL, there are several treatment options (hysterectomy is not one usually), the most common of which is LEEP, a proceedure usually performed in the office under local anesthesia.

The take home message is that this is really analogous to tarter on your teeth. If you visit your dentist as scheduled, brush your teeth, and so on, you get to keep your teeth for life. If you don't, then you have problems. Good luck!

-- William D. McIntosh, MD Clarksville, TN

This is for educational purposes only. It is not intended to replace consultation and examination by your physician or other health care provider.

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In reply to: Dee: "abnornal cells found on my recent recent yearly pap test"

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