Abnormal Pap Test

Q:  I am a 43-year-old premenopausal woman. I recently had my second pap smear in six months that came back with "inflammation." My doctor suggested that I could either wait another three months for another pap smear or see a gynecologist for a cervical biopsy. His voice seemed to be concerned, but when I asked what causes this, I was told that they really do not know.

Because I let a few years slip by without getting a pap smear, I have chosen to get the cervical biopsy and am waiting for my appointment. Also, I have been with the same partner all of my life.

I am feeling very anxious and worried about this, since I have never had an abnormal result in the past. Is this a pre-cancerous condition? Could you shed some light on this subject?

A:  Pap smears are done to look for abnormal cells in the cervix that can lead to cervical cancer. Specially trained technologists grade the pap smear all the way from normal to cancer using a system of classification called the Bethesda system, which was introduced in 1992. A pathologist, who is a physician and specializes in tissue diagnoses, reviews all abnormal paps and also screens 10% of "normal" paps.

Infection and inflammation are two of the "benign" cellular changes commonly seen. These can be the result of yeast, viral or bacterial infections, use of an intrauterine device (IUD), delivery of a child or tissue thinning from estrogen deficiency. Inflammation does not usually require a biopsy, but the pap smear can be repeated after four to six months when the underlying condition is treated.

According to Dr. Gary Keeney, a pathologist who is director of the cytology laboratory at the Mayo Clinic, the pap smear diagnosis that is of concern is ASCUS, which stands for "atypical squamous cells of uncertain significance." This change may still be a benign reaction or represent early precancerous changes. About 20% to 25% of patients who are biopsied turn out to have low-grade precancerous changes which are easily treated and which often spontaneously regress on their own if left untreated.

Depending on a patient's risk for cervical cancer, colposcopy may be performed immediately or after repeated abnormal paps. This technique, which was developed and refined by Adolf Stafl, MD, former Professor of Obstetrics and Gynecology at the Medical College of Wisconsin, uses a magnifying instrument to directly visualize the cervix. Special solutions can be applied to the cervix to help identify abnormal areas. Suspicious areas can then be biopsied.

Since you have had only one sexual partner, you are at low risk for cervical cancer. If the pap smear was only "inflammation" and not ASCUS, you could have it repeated again without going to biopsy.

"Dear Doctor" is a compilation of patient questions answered by doctors from the Medical College of Wisconsin.