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By Jill Max, HealthAtoZ contributing writer
Every year, nearly 3.5 million women have a heart-clutching moment when their Pap smears come back inconclusive. Their lab results don't show cervical cancer but these results are not completely normal. You may hear words like "atypical" or "of uncertain significance." This means the doctor will follow you more closely than if the results came back completely normal.
In the past, women would return several times only to find that they did not have cervical cancer - after spending a good deal of money and going through extreme anxiety and worry about the possibility that they had cancer. Since 2001, new lab techniques such as "liquid Paps" and HPV testing have made it easier for doctors to follow-up.
Liquid Paps
The most important breakthrough in cervical cancer screening has been the use of liquid-based Pap tests where cells are rinsed into a liquid preparation instead of being smeared on a slide. The liquid Paps generally pick up more abnormalities than conventional Paps.
"One advantage is that it provides a more uniform distribution of cells than on a glass slide, which many labs find easier to evaluate," says Diane Solomon, M.D., a senior investigator at the National Cancer Institute. Still, the United States Preventive Services Task Force (USPSTF) has not found enough evidence to determine whether this technology is more effective than conventional Pap screening in terms of cervical cancer screening.
Another advantage of liquid-based Pap tests is that there is leftover material for labs to use to do more tests, such as the test for the human papillomavirus (HPV), which is the cause of most cervical cancers.
Guidelines help doctors
In addition to better screening technology, physicians now have better guidance on how to handle abnormalities found on Pap tests, thanks to a revised system for reporting Pap test results known as the 2001 Bethesda System and treatment guidelines.
The revised Bethesda System along with updated treatment guidelines were published together in 2002 in the Journal of the American Medical Association (JAMA). The treatment guidelines were developed by a panel of experts participating in a consensus conference sponsored by the American Society for Colposcopy and Cervical Pathology.
Together, the updated reporting and guidelines provide "a powerful uniform reference that clinicians can use to screen and care for women with abnormal Pap test results," says Solomon who was the lead author of the JAMA article.
The guidelines for screening after an abnormal Pap are based on how the cells look under the microscope. If Pap cells look like they could become cancer or invasive cancer, then further treatment is needed. A colposcopy is done with a biopsy. A colposcopy is a lighted instrument used to examine the vagina and cervix under magnification. The surface tissue is coated with a vinegar solution that makes abnormal areas turn white. Unlike a Pap, which only examines surface cells, these suspicious areas are biopsied. That means that a small, deeper tissue specimen is removed and examined under the microscope. If the biopsy is found to be cancer, then further treatment is offered in the form of a larger biopsy, such as a conization or LEEP excision.
If a Pap test shows cells that are slightly abnormal, or "atypical," then an HPV test is done. If the HPV test is positive, then a colposcopy is done with possible biopsy. If the HPV test is negative then two repeat Pap tests four to six months apart are done.
Importance of screening
When caught early through a Pap test, cervical cancer is almost 100 percent treatable. But new tests and guidelines won't go very far in fighting cervical cancer if women don't use them, experts say.
"In order to have the biggest impact on cervical cancer in the United States, we need to broaden screening to include women who have not benefited from regular cancer screening," Solomon says. "Under-screened and unscreened women are at the greatest risk for cervical cancer."
With the new vaccine for cervical cancer now available, the incidence of cervical cancer could plummet even more for the next generation of women. The Centers of Disease Control recommends that all girls receive the vaccination at age 11 or 12.
Gynecological exams
Remember that Pap tests are not the only reason to see your gynecologist annually. The pelvic examination also involves evaluation of the ovaries and uterus. Other exams, such as breast exams, will be performed during the evaluation, and at that time, a woman can speak with her physician about whether a mammogram is advisable for her.
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External Sources
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National Cancer Institute
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Wright Jr. TC, Cox JT, Massad, S, et al. 2001 consensus guidelines for the management of women with cervical cytological abnormalities. JAMA. 2002; 287:2120-2129.
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This article was reviewed and updated June 2007.
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