Episode Transcript
Announcer: Covering all aspects of women's health. This is The 7 Domains of Women's Health with Dr. Kirtly Jones on The Scope.
Dr. Jones: So you just got a call from your doctor or probably your doctor's nurse, who told you that your pap smear was slightly abnormal or was abnormal and you need to come back in. Well, should you hang it up and write your will or is it going to be okay?
What Is a Pap Smear?
Well, here's the scoop on that. The Pap smear is a screening test to pick up pre-cancerous abnormalities in the cervix before they become cancer. So the vast majority of abnormal pap smears that you might get a call about are actually not cancer. They are pre-cancerous conditions that we want to investigate a little bit further and can treat these little local areas in the cervix before they become cancer.
Abnormal Pap Smear Causes
So if you go back in, what might happen? Well, your pap smear may have been abnormal because for some reason the fluid got screwed up or they didn't collect enough cells. So sometimes you get a call not because there's anything wrong, but because there wasn't enough to look at. Okay. So that's not a scary thing, but your nurse should explain that you. "No problem. We just didn't get enough cells on your pap smear to look at."
So what's the chance that if the Pap smear said you have some abnormalities on your cervix that you really do have something, abnormalities on your cervix? So we mentioned that a pap smear is a screening test. It's not a diagnostic test.
How good is it as a screening test? How true is it? That's a difficult question, but I would say that if you have mild dysplasia on your pap smear, the chances of us not finding anything on a colposcopy may be as high as 50 percent to 60 percent. On the other hand, if you have severe dysplasia or high-grade dysplasia on your pap smear, the chances that we're going to find something is more like 90 percent.
So a few little mild changes, which will trigger the callback, may not mean that you have anything. So if you have a low-grade lesion, that may not mean that you really have anything to worry about. If you have a high-grade lesion, that doesn't mean cancer, but it does mean that you really need to have it looked at and probably treated because a high-grade lesion on a pap usually means there's something there to treat.
Colposcopy: An Examination of the Cervix
If there's an abnormality, or what we call dysplasia or cervical intraepithelial neoplasia . . .There are a bunch of scary words. Usually, what happens is you go in, and the doctor puts a speculum in that device to look at your cervix. And then he or she rolls up this little instrument that looks like binoculars on a stick.
So they use these very special binoculars to magnify the cervix so they can look for areas that might be a little bit abnormal. This is called colposcopy. The "colpos" is the upper vagina and "scopy" means to look. So they are going to look at your cervix with these kinds of binos.
They may put some vinegar. So if you smell like a pickle, that's because they're using just ordinary vinegar to clean off your cervix. And vinegar makes the areas that might be abnormal turn white. So then they can look at the cervix, paint it with a little vinegar, look for areas that might be a little bit abnormal, and then they will take a tiny bit of tissue. Now, you think, "Oh, my god. They're going to operate on my cervix." Well, the amount of tissue they take is about the size of a hangnail.
So they take a tiny little biopsy, and they send that to pathology. And they say, "Is this something to worry about or not?" And if it's not something to worry about, then people come back, and they may have a few more pap smears than every three years. Maybe they're going to have a few extra in the next couple of years.
Treatment for Abnormal Cervix Cells
If it is dysplasia that is moderate or severe, that isn't cancer yet, but then we can actually treat the cervix. Usually, we use freezing or sometimes we use a little laser, but freezing is very cheap and very common. And we make a little cold blister. So we make a little blister, and the abnormal cells just come off. And then new, healthy cells grow in.
Well, the treatment can get rid of abnormal cells about 98 percent of the time so that's really good news. Now, we know that new, healthy cells can get infected by the virus. So it turns out that almost all cervical dysplasias and cancers are caused by the HPV virus.
So now you have all these pretty new cells covering your cervix. Well, they can get infected, too. So first, you want to make sure that you're in that 98 percent cure rate. So they'll probably ask you to get pap smears more frequently, maybe twice a year for a couple of years. If they all stay normal then you are back on to your every other, every third year screening. If, for some reason, you're at high risk, meaning you have a high-risk virus or you have a high-risk lifestyle where you might get more viruses, then you probably need to be screened a little more often.
So the treatment is about 98 percent effective at getting rid of the dysplasia that you have, and new, healthy cells will grow in. But as long you've got the virus or are exposed to new viruses, it's possible that you could get these changes come back. So once a woman's been treated for dysplasia, she's very likely to be cured, but she has risk factors for getting it again. Not that it wasn't cured the first time, but getting it all over again.
Think of it as sun exposure on your face. So you're a little bit older, and you've got this little area on your face that the dermatologist wants to burn off. You can burn off that one, but it's very likely that a year or so from now you'll get another someplace else. So it's not unlike that with cervical cancer as well.
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updated: July 26, 2018
originally published: May 11, 2015