Pap smear is a screening test done to detect cervical cancer. The most recent recommendation is that your 1st Pap smear be done 3 years after your first sexual intercourse, but no later than 21 years of age. The most common abnormalities are discussed below. For complete information, visit the National Cancer Institute’s webpage concerning Pap smears.
Abnormal Pap Smears
ASCUS- Atypical Squamous Cells of Undetermined Significance is a low-grade abnormal pap smear. Sometimes having intercourse close to your Pap smear being done, an infection, or even menopause can cause your Pap smear to come back “abnormal”. We usually recommend that the first time you have an ASCUS Pap that it be repeated in 3-6 months. Two ASCUS results in a row will usually lead to a recommendation for colposcopy.
LSIL - Low-Grade Squamous Intraepithelial Lesion (sometimes referred to as CIN-I, which stands for Cervical Intraepithelial Neoplasia) is still considered a low-grade abnormality, but warrants further investigation. A repeat Pap smear in 3-4 months or a colposcopy is recommended. This type of abnormality is usually caused by the HPV virus. A vaccination against HPV is very close to being released, but it is meant as a preventative for those who are currently unaffected rather than a cure.
HSIL – High-Grade Squamous Intraepithelial Lesion (also known as CIN-2 or CIN-3) requires colposcopy with biopsy within 30 days which may demonstrate a need for LEEP (loop electosurgial excision procedure) or cryotherapy (freezing of the cervix). Follow-up Pap smears after the LEEP or cryotherapy are frequent to make sure new high-grade growth does not return. The schedule is usually to perform “Re-Paps” every 3-4 moths for a year then every six months for a year. The annual exam schedule can be resumed when all of these Pap smears have been normal (or no more than one ASCUS).
Risk Factors for Cervical Cancer
- Tobacco use
- Long-term HPV infection
- Multiple sex partners, especially partners who engage in risky behaviors
- Exposure to HPV, especially high risk strains
- Failure to receive treatment at an early stage, when cervical cancer may be curable
- Knowing a partner for less than 8 months before engaging in sexual intercourse
- Sexual activity before age 20