ASK THE DOCTOR: Most abnormal Pap results are not cancer
By Dr. JIM MITTERANDO
The Patriot LedgerQ. I recently had an abnormal pap smear with atypical cells. My doctor recommended I have a colposcopy. I am nervous about this; I hear it is painful. What should I expect?
A. An abnormal Pap smear does not mean you have cervical cancer. A Pap smear is a screening test for cervical and uterine cancer. Abnormal results simply alert your doctor, nurse practitioner, or midwife to look more carefully for cervical cancer or precancerous changes to the cervix.
The most common abnormal Pap result, ASCUS (Atypical Squamous Cells of Undetermined Significance), is found in one in 20 women. Most atypical pap smears are not precancerous and most often are due to inflammation of the cervix caused by a virus called human papilloma virus (HPV). There are dozens of varieties of HPV; some are associated with a higher risk of cervical cancer.
Eighty percent of ASCUS Pap smears are normal. Of the remainder, 13 percent will have a low risk precancerous finding (called low grade dysplasia) and 7 percent will have a higher risk precancerous finding (high grade dysplasia).
If you have one ASCUS Pap, your doctor, nurse practitioner or midwife will either recommend a repeat Pap in four to six months or order an HPV test to determine if you carry one of the higher-risk HPV viruses. If one of these follow-ups is abnormal, then colposcopy is recommended.
Resembling a pair of binoculars, the colposcope examines the cervix under magnification. The exam is similar to a Pap smear in that a doctor inserts a speculum into your vagina so he or she can see your cervix. Then a vinegar solution is applied to the cervix and vagina with a cotton swab. The vinegar makes abnormal tissue turn white so your doctor can identify areas that need to be biopsied. A biopsy involves removing a small piece measuring less than 1/8 of an inch. The biopsy sample is sent to a laboratory where a pathologist will examine these samples under a micros cope.
It usually takes 30 minutes to complete a colposcopy and biopsy. The colposcopy causes no more discomfort than a Pap smear. Mild cramps can occur if you have a biopsy. To reduce discomfort take an over-the-counter pain reliever (Tylenol or Ibuprofen) one hour before the procedure. Ask your doctor first.
A cervical biopsy will not affect any future pregnancies. However, it is important to let your doctor know if you are or might be pregnant. This information will change the way your doctor does the procedure.
If your doctor takes a biopsy, he or she may put a thick, brownish-yellow paste on that area to stop any bleeding. When this paste mixes with blood, it forms a thick black discharge. It is normal to have this discharge for a couple of days. It is also normal to have a little spotting for at least two days after a colposcopy. Don’t use tampons or put anything in your vagina for one week after the procedure, or until your doctor tells you it is safe. Don’t have sexual intercourse for one week.
Call your doctor if you have any of the following problems after your colposcopy:
- Heavy vaginal bleeding (using more than one sanitary pad per hour).
- Lower abdominal pain.
- Fever, chills or a bad-smelling vaginal odor.
It usually takes one to two weeks for your doctor to get a report from the pathologist.
If the pathology report reveals no precancerous findings, then a Pap smear is repeated in six to 12 months.
If the report shows mild dysplasia, your risk of developing cervical cancer is low (less than one in 600). Since 50 percent resolve spontaneously, you have the option to monitor it with frequent Pap smears every six months or you can choose cryotherapy (freezing the tip of the cervix), which burns off the precancerous cells. Cryotherapy causes cramping during the procedure and profuse vaginal discharge for two weeks.
If the report reveals high-grade dysplasia, you have a 1 percent chance of developing cervical cancer. Your choices for treatment include cryotherapy or LEEP (loop electrosurgical excision procedure). LEEP uses a wire loop to pass electrical current, which cuts like a surgeon’s knife and removes the tip of the cervix. LEEP can affect future pregnancies.
Cervical cancer is not a common disease; women have a one in 300 chance of dying from it. Compare this to heart disease, which kills almost one in two women; lung cancer, one in 20, and breast cancer, one in 30. Despite this, Pap smears are recommended because they have reduced cervical cancer deaths by half.
One final note: Tobacco smoking increases the risk of abnormal Pap smears and cervical cancer. Quitting smoking will decrease your risk of cervical cancer and abnormal Pap smears.
Dr. Jim Mitterando is a family doctor at Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth.
Readers should send questions to: Ask the Doctor, The Patriot Ledger, P.O. Box 699159, Quincy, MA 02269-9159, or by E-mail to his attention at features@ledger.com.
Questions of general interest will be answered in this column. The information in this column is not intended to diagnose individual conditions, and individual replies are not possible. Readers should see their own doctors about specific problems..
Copyright 2003 The Patriot Ledger
Transmitted Tuesday, February 25, 2003