First of all, take heart - you’re unlikely to need a hysterectomy. And good for you for having your Pap smear! Pap smear testing for cancer of the cervix has saved thousands of women’s lives and is one of the great success stories in cancer screening. Deaths from cervical cancer have decreased by 50 to 80 percent in countries where routine Pap tests are available to women. Screening healthy women for cervical cancer does have a small downside, though:Many women will be found to have minor abnormalities on their Pap smears. These findings then require some type of follow-up or treatment, even though the risk of developing cancer from such minor abnormalities is quite small. Doctors and pathologists use a well-established system to assign a grade to the “precancerous” changes that can be seen on a Pap smear.The grade depends on just how abnormal the cells of the cervix look under the microscope. The higher the grade, the higher the chance that the precancerous abnormalities may someday develop into true cancer of the cervix. The grades range from “low-grade squamous intraepithelial lesion” (LSIL) or “atypical squamous cells of undetermined significance” (ASCUS) to so-called “high-grade squamous intraepithelial lesion” (HSIL) or “cervical intraepithelial neoplasia-3” (CIN-3). Two important things you should know: First, even the highest grade precancerous findings on a Pap test are associated with the development of a true, invasive cervical cancer in only about 10 to 20 percent of cases; and second, such a progression to invasive cervical cancer takes place over years, not weeks or months. This long time interval from the detection of precancerous findings to the development of cancer makes it possible to prevent the development of the cancer by eliminating the precancerous cells. What happens next for you? You should speak with your doctor about the specific type of precancerous changes that were seen on your Pap smear. You might also ask your doctor whether testing your cervical cells for the presence of a virus called human papillomavirus (HPV) would be helpful in determining your risk for developing invasive cervical cancer in the future. Depending on the precancerous grade of your Pap smear findings — and possibly on HPV results — your doctor may recommend a procedure, called a colposcopy, that involves taking a close look at your cervix with a special magnifying lens. It is possible that biopsies of the cervix will be needed. The goal of the further testing is to be sure there is no evidence of invasive cervical cancer present. The specific treatment for precancerous findings on a Pap test will depend on the results of the follow-up testing that is done. Be reassured that most young women with pre-cancerous findings on a Pap smear do not have true invasive cervical cancer and that the treatments employed to eliminate the precancerous cells do not require hysterectomy. Q2. Almost four years ago, a Pap smear came back as precancerous with HPV. I have had two kids since then, and a year ago my ob-gyn said that all my tests were normal. Does precancer really just go away? And now I am having some of the same problems a relative had when she had precancer and her cervix had to be taken out. Does precancer return? — Amanda, Louisiana Finding a “precancerous” spot on your cervix at the time of a Pap smear was a flag for your doctor that you needed further testing to determine whether there was a high chance that you had, or might develop, a true cancer (invasive cancer) of the cervix. Doctors and pathologists use a well-established system to assign a grade to the precancerous changes that can be seen on a Pap smear. The grade depends on just how abnormal the cervix cells look under the microscope. The higher the grade, the higher the chance that the precancerous abnormalities may someday develop into true cervical cancer. The grades range from “low-grade squamous intraepithelial lesion (LSIL)” or “atypical squamous cells of undetermined significance (ASCUS)” to so-called “high-grade squamous intraepithelial lesion (HSIL)” or “cervical intraepithelial neoplasia-3 (CIN-3).” Three important pieces of information: (1) even the highest grade precancerous findings on a Pap test are associated with the development of a true, invasive cervix cancer in only about 10–20 percent of cases — which means that 80–90 percent of the time, the precancerous changes seen resolve on their own; (2) when precancerous lesions do progress to invasive cervical cancer, the progression takes place over years, not weeks or months; and (3) the presence of certain strains of a virus known as human papilloma virus (HPV) increases the risk that a precancerous lesion may develop into a true cancer. Since you have already been tested for HPV, you could ask your doctor whether you were found to be positive for one of the known high-risk strains of the virus. (HPV serotypes 16 and 18 are the most common cervical-cancer associated strains, but there are some other rarer ones.) You should also ask your doctor about the results of your last Pap smear to confirm that it was truly read as completely normal. You will certainly need continued annual Pap smear screening even if your prior precancerous changes have completely resolved. Finally, since you report some new symptoms, you should see your doctor — precancer can return particularly in women with HPV — to report your symptoms and be examined carefully, most likely including a repeat Pap smear. Learn more in the Everyday Health Cervical Cancer Center.
