Abnormal PAP smears and observation

Last Modified: September 11, 2005

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Question

Dear OncoLink "Ask The Experts,"
I have had abnormal pap smears for 4 years now. I have had colposcopies and biopsies several times - however these show up little or no abnormalities, until recently when a minor abnormality was visible. My gynecologist advises that he 'keep an eye' on me - however I feel that I am going around in circles with no solutions. Is this situation common, or is there further treatment/ tests that I can request?

Answer

Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:

Examples of minor abnormalities found on Pap tests that are then confirmed by colposcopic biopsies include changes caused by the HPV virus and mild dysplasia (also called CIN 1). The good news is that in the majority of women, these changes resolve spontaneously over the next 1-2 years, and rarely require any intervention. In these cases, doctors typically just recommend close clinical follow-up, with Pap tests every 4-6 months. Patients who have persistent mild dysplasia or changes of the HPV virus lasting longer than 2 years may discuss the possibility of an excisional biopsy (such as LEEP) with their physicians. Patients with the diagnosis of moderate or severe dysplasia (also called CIN 2 or CIN 3) that is found on Pap, and confirmed by colposcopic biopsies, should undergo therapy for these abnormalities. Common treatments include excisional biopsies such as LEEP or cold knife cone, or ablative therapies such as cryotherapy or laser.

Patients with other Pap abnormalities, such as atypical squamous cells of undetermined significance (ASCUS), may also be followed with repeat Pap test in 6 months. If a second Pap test is abnormal, colposcopy is warranted. Alternatively, patients with ASCUS on Pap may have a secondary test for high-risk HPV subtypes performed (usually done on the same cells that were collected at the time of the Pap test). If the cells show evidence of high-risk HPV types, colposcopy should be performed. If no high-risk HPV is present, a Pap may be performed in one year.