PAP Test (Part Two)

What does the test result mean?

• Normal: Negative (NILM- Negative for Intraepithelial Lesion or Malignancy): no abnormal cells are present.
• Unsatisfactory: the material sample is insufficient, or there is interference from other substances.
• Benign: non-cancerous cells, but the test shows infection, irritation, or repair of normal cells.
• Atypical Squamous Cells of Undetermined Significance: abnormal changes in the cells that cover most of the outer part of the cervix (squamous cells--ASCUS) or in the cells that line the inner part of the cervix (glandular cells--AGCUS) for which the causes are undetermined; an ASCUS result is followed up with DNA testing to identify the presence of a high-risk HPV infection.
• Low-grade changes (LSIL): changes often due to HPV infection, which in some cases may be a risk for cervical cancer; this test result can be followed up with DNA testing to identify the presence of a high-risk HPV infection.
• High-grade changes (HSIL): the cells are sufficiently atypical that they could result in cancer.
• Squamous cell carcinoma or adenocarcinoma: terms used to identify some types of cancer, in these cases, cancer is visible and requires immediate attention.

Is there anything else I need to know?

The Pap test is generally used as a screening test. A certain percentage of abnormalities in women may go unnoticed with a single PAP Test; this is why it's important for women to regularly perform PAP Tests.

An important limitation of the test is related to the sample collection. The PAP Test presents a small sample of cells present in the cervix and vaginal area. Even for the most experienced doctor, sample collection can occasionally be inadequate and a repeated Pap test may be required.

When the Pap test is carried out routinely, it is a great help in detecting and treating conditions that precede cancer, as well as in preventing the development of cervical cancer. Furthermore, the test helps to detect cervical cancer in its early stages, when it is most curable. The PAP test is also used to monitor any anomalies or unusual findings. In many cases, these findings are part of the body's repair process and often go away on their own, without any further treatment.

If you shower, bathe in a tub, or use vaginal cream 48 - 72 hours before the examination, the result may be "unsatisfactory." Other factors that may affect the results include menstrual bleeding, infection, medication use, or having sexual intercourse within 24 hours before the examination. In these cases, a repeated Pap test may be necessary, but this does not mean there is a significant problem.

What are the risk factors for cervical cancer?

The most important risk factor for cervical cancer is infection by the human papillomavirus (HPV). Tests are available to detect this type of infection and are often performed in conjunction with a Pap test.

Also, a vaccine is available to help prevent HPV infection which is most effective if given to women before they become sexually active.

The increase in risk is also related to the age at which sexual activity begins (the earlier, the higher the risk), multiple sexual partners, infrequently performing PAP tests, smoking, and the presence of other sexually transmitted diseases such as herpes or HIV.

Does an abnormal PAP Test always mean cancer?

A single "abnormal" Pap test does not indicate that cancer is present. The membranes covering the cervix can undergo continuous changes and repairs. While treatment may not be necessary, the situation should be closely monitored. This may require a repeated Pap test every 3-6 months until the situation is resolved.

If I have cervical cancer, what are my treatment options?

Cervical cancer is a slow, progressive disease and may take years to advance beyond the cervix. This is because regular gynecological examinations offer the best opportunities for preventing cancer development, allowing for the detection and removal of precancerous tissues.

Minimal invasive surgery of the cervix (the terms your doctor might use are LEEP, conization, or cryotherapy) which removes precancerous or very early-stage cancerous tissues, is the standard treatment.

In more advanced cervical cancer, a hysterectomy (removal of the womb) may be performed. If cancer spreads to other tissues (metastasizes), radiation therapy and, in some cases, additional surgery may be necessary.