An abnormal pap smear or test, also known as a cervical cytology screening is a screening process, which is undertaken to determine the development of any abnormalities or malignancy (dysplasia or cervical intraepithelial neoplasia (CIN)) in the epithelial lining of the cervix (the lower part of the womb). An abnormal pap smear is indicative of an infection, presence of abnormal cells; however, it is essential to note that an abnormal pap test does not indicate the existence of cancer. Having regular annual pap tests is instrumental in detecting dysplasia (abnormal cells that can be pre-cancerous), which may turn into cervical cancer over an extended period of time. Dysplasia or CIN is categorised as mild (CIN 1), moderate (CIN 2) and severe (CIN 3).
Minor or mild abnormal changes may clear out automatically. However, for more significant changes (moderate and severe) further testing and treatment as instructed by your gynaecologist may be required. In general, abnormal results on a pap test are followed by a repeat pap smear after 6 months or 1 year.
The following are the outlined causes for an abnormal pap smear result:
Infection or Inflammation
Recent Sexual Activity
However, the main cause linked to an abnormal result is infection with Human Papillomavirus Virus (HPV) many types of which have been understood to be causes of cervical and vaginal cancer. Some have also been identified as genital warts. It has been approximated that nearly 60% of women carry this virus on their cervix, genital area or skin without being aware of it. A communicable virus, it is generally cleared by the immune system; but this may not take place and a small percentage of women carrying this virus may develop CIN.
Under the Bethesda System an abnormal pap smear result is described using the term Squamous Intraepithelial Lesion (SIL); squamous being the type of cells that form the tissue covering the cervix. The results are then classified as follows:
Normal: Absence of pre-cancer or cancer
Atypical squamous cells of undetermined significance (ASC–US): The most common result, it confirms changes in cervical cells which most often are found to be linked to the HPV infection but may also be a pre-cancer condition
Squamous intraepithelial lesion (SIL): Can be low grade (LSIL) or high grade (HSIL). LSIL is very common and clears out without treatment. HSIL denotes more serious changes. Carcinoma in situ (CIS) is a severe form of HSIL. It is the result most likely to progress to cancer.
Atypical squamous cells, cannot exclude HSIL (ASC–H): Changes that may be HSIL have been detected. Further testing is required
Atypical glandular cells (AGC): Abnormal changes that imply pre-cancer of the upper part of the cervix
Cancer: Abnormal cells have proliferated deeper into the cervix
This includes repeat pap tests (allows CIN 1 to clear out over time), HPV tests, Colposcopy (allows further examination of cervix), Biopsy, Endocervical Sampling (tissue sample from cervical canal), Endometrium Sampling (sample of uterine lining).
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