Pap Smear (cont.)
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- Pap smear facts
- What is a Pap smear?
- Who should have a Pap smear?
- Which women are at increased risk for having an abnormal Pap smear?
- How is a Pap smear done?
- What are the risks of having a Pap smear?
- How is a Pap smear read (analyzed)?
- What information is included on a Pap smear report?
- Why is a woman's menstrual status important for the Pap smear?
- Why is a woman's past Pap smear history pertinent?
- When might a Pap smear not be adequate for interpretation?
- How is the final Pap smear diagnosis made?
- What are the possible recommendations for follow-up after a Pap smear?
- What treatments are available if a Pap smear is abnormal?
- What is the follow-up after treatment for an abnormal Pap smear?
- What is the current status of human papilloma virus (HPV) testing?
- When should women start and stop having Pap smears, and how often should Pap smears be performed?
- What is the current status of the newer Pap smear technologies?
- With Pap smears so available, why are women still dying of cervical cancer?
- Historical note: Dr. Pap
- Find a local Obstetrician-Gynecologist in your town
What is the follow-up after treatment for an abnormal Pap smear?
Follow-up is crucial after treatment for an abnormal Pap test. Women who have undergone any one of the above-described treatment procedures require special follow-up schedules. They must be evaluated and checked until the physician is fully convinced that routine Pap smears can be resumed.
What is the current status of human papilloma virus (HPV) typing?
HPV is a sexually transmitted virus that may be spread from one person to another even when the genital sores are not visible. Many sexually active people are carriers of HPV, very often without even knowing they are carriers. It is estimated that up to 60% of sexually active women harbor this virus on their cervix or in their vaginal area. It is not unusual for a woman to be unaware that she has HPV - only to find out that her Pap smear shows evidence of HPV.
HPV is not curable, although the cellular damage it causes is generally treatable and a vaccine against the four most commonly found HPV types is available. A woman with HPV needs careful and regular long-term medical follow-up to watch for any resulting HPV-associated pre-cancerous cellular changes.
There are over 70 different strains of HPV virus. Based on the observation that certain strains of HPV (for example, types 16 and 18) are more likely to be associated with cervical cancer, some people have advocated testing HPV infected women in order to identify their specific strain of HPV. Following an abnormal Pap smear, this information would then be used to help select the specific treatment strategy. In other words, a physician would more aggressively treat a woman with an abnormal Pap smear if she tests positive for an HPV type that is more likely to be associated with the development of cervical cancer.
However, even the so-called "low-risk" HPV strains can still be associated with cervical cancer at some time in the future and not all of the high-risk HPV strain abnormalities will necessarily result in cervical cancer. Furthermore, the HPV typing is expensive. The main use of HPV testing in screening for cervical cancer is for determination of treatment and follow-up recommendations for women with Pap smears interpreted as atypical squamous cells of undetermined significance (ASC-US) . Those with positive tests for high risk HPV types and an ASC-US smear are referred for further evaluation.
HPV testing along with Pap screening (a combined test) was approved for primary screening for cervical cancer by the U.S. Food and Drug Administration (FDA) in 2003. This combined testing has been used as an alternative screening test for low risk women aged 30 and over at intervals of three years or greater.
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