ABNORMAL PAP SMEAR RARELY CAUSE FOR ALARM, SAYS EMORY HEALTHCARE GYNECOLOGIST

August 15, 1997

Media Contacts: Traci Simmons, 404/727-8599, tgsimmo@emory.edu
Kathi Ovnic, 404/727-9371 - covnic@emory.edu
http://www.emory.edu/WHSC/

Relax. For the majority of women, abnormal Pap smears do not confirm a diagnosis of true cervical cancer, says gynecologist/obstetrician Charles D. Wootten, M.D., of The Emory Clinic Perimeter, EMORY HEALTHCARE. Pap tests do, however, indicate the presence of changes in cervical cells, which, if untreated, over time could become cancerous.

"We can say proudly that fewer women die of cervical cancer every year because of Pap testing," Dr. Wootten says. "Yet many women do not have the test performed."

Any abnormal cervical cells collected during a Pap smear are graded according to the Bethesda and CIN Systems. These systems attempt to define the severity of the abnormality. Abnormalities considered potentially precancerous are known as squamous intraepithelial lesions (SIL) or cervical intraepithelial neoplasia (CIN).

INFLAMMATION AND ATYPIA

Inflammation can be a cause of abnormal Pap smears. When inflammation exists, it may indicate presence of a mild infection or some type of irritation to cervical tissue which has caused the cells to be atypical. Most women who receive a result consistent with this condition are asked to repeat the Pap smear in two to six months. If results are again positive, a physician may either visually examine the cervix more thoroughly through the lenses of a colposcope or collect tissue samples through biopsy.

LOW GRADE SIL

Low grade squamous intraepithelial lesions (LGSIL) include the mildest forms of precancerous change of the cervical lining. This category includes human papilomavirus (HPV) infection and CIN1. CIN1 denotes a diagnosis of mild cervical dysplasia, the most mild form of precancerous change, and signifies that changes are limited to a minimal portion of the cervical lining. When this diagnosis is noted on a Pap smear, most physicians do recommend cervical colposcopy and biopsy for more complete diagnosis, Dr. Wootten says.

HIGH GRADE SIL

Test results graded as CIN2 suggest moderate dysplasia, meaning the abnormal cervical cells have taken up close to half the thickness of the cervical lining. This result also requires evaluation with colposcopy and biopsy.

Cells seen on a Pap smear suggestive of CIN3, or severe dysplasia, signify that the abnormalities of cervical cells encompass close to the entire layer of cervical lining. Involvement of the entire lining is considered severe dysplasia and is categorized as carcinoma in situ. In all such cases, colposcopy and biopsy are performed.

FURTHER DIAGNOSIS

Most abnormalities of the cervix that can be diagnosed by Pap smear show no symptoms. Some patients with cervical infections may notice discharge; however, most of dysplasia abnormalities produce no symptoms.

Some abnormalities require further biopsy and treatment after colposcopy. Treatments may include cryosurgery (which freezes abnormal tissue), electrocoagulation (employing electricity to destroy abnormal tissue), laser therapy or cone biopsy (which actually can be done by traditional surgical techniques, laser surgical techniques, laser surgical techniques). Most of these procedures are performed in the doctor's office under local anesthesia.

These therapies seek to completely diagnose the abnormal area of the cervix, and in most cases, rid the patient of abnormal cells. As the cervix heals, experts believe there is a good chance abnormal cells will not recur and that normal tissue will replace the zone of active growth. The cure rates for dysplasia approach 100 percent.

INVASIVE CERVICAL CANCER

Sometimes a diagnosis of invasive cancer is made by Pap smear alone. Since Pap smears are screening tests which do not give a full and complete diagnosis, when "cancer" is noted on a Pap smear, biopsies are recommended to confirm the diagnosis.

In the event cervical cancer is diagnosed, many therapies are available. Treatments include both surgery and radiation therapy; in most cases, if the cancer is caught at a very early stage, there is a promising chance for cure. The type of biopsy technique and cancer treatment chosen depend on diagnosis, patient preference, physician preference and cost.

SCREENING FREQUENCY

Some question remains about how often women should have Pap smears. Although the American Cancer Society and the American College of Obstetrics and Gynecology have guidelines for physicians, each woman should discuss with her physician her personal requirements for Pap smear screening. Women who are at higher risk for cervical cancer should be screened more frequently.

Risk factors for cervical cancer include infections with HPV or sexually transmitted organisms. Experts believe this virus is closely linked to the ability of cervical cells to become abnormal or precancerous. There are many types of this virus, some having a stronger link with cervical cancer than others. Women at risk for other sexually transmitted diseases are at increased risk for cervical cancer. Smoking is another risk factor.

Unlike many other cancers, cervical cancer does have known precursor indicators, namely the abnormal cells (cervical intraepithelial neoplasis) which appear on Pap smears and other diagnostic tests; thus, cervical cancer is one of the few types of cancers for which screening is available. The need for regular Pap smears following a schedule agreed upon between each individual patient and her physician is paramount.

In addition to screening for cervical cancer, regular visits to a gynecologist and regular pelvic exams also enable patients to be evaluated for other health problems, such as sexually transmitted diseases, contraceptive needs and other types of genital cancers, Dr. Wootten says.

More questions on Pap tests or cervical cancer? Visit these Internet Web sites: American Cancer Society (http://www.cancer.org) or National Cancer Institute patient info. (http://wwwicic.nci.nih.gov/patient.htm).

The Emory Clinic Perimeter is located at 875 Johnson Ferry Rd., Atlanta.

For more general information on The Robert W. Woodruff Health Sciences Center, call Health Sciences News and Information at 404-727-5686, or send e-mail to hsnews@emory.edu.