FamilyCare of Kent

400 West Gowe St, Suite 400     Kent, WA 98032     253.859.CARE (2273)     Fax: 253.850.8894

Your Pap Smear is Normal

Your Pap smear is satisfactory or normal when the cytotechnologist and the cytopathology laboratory that examines it returns a diagnosis of "negative."

Negative means that an adequate number of cells were obtained from the cervix and endocervix for examination, and no atypical cells suggesting precancerous or cancerous disease were noted; no further Pap tests for cervical precancer or cancer are necessary at this time.

If you are sexually active, your clinician will probably suggest that you return for a routine Pap smear in one to three years, depending upon various risk factors, and the number of previous satisfactory negative (normal) annual Pap smear examinations you have had in the past.

You should also know that a normal report may have an error margin of 5 to 10 percent depending upon whether or not the Pap smear was obtained, prepared, and analyzed under optimal or ideal conditions. You may want to review the brochure, "Why You Need a Pap Smear¾With instructions for Pap test preparation."

Your Pap Smear is Unsatisfactory or Less Than Satisfactory

An inadequate specimen does not mean that something is wrong, it just means that the laboratory cannot be certain that there is nothing wrong.

Sometimes the Pap smear submitted to the laboratory is inadequate for evaluation, because it contains too few cells for accurate evaluation or the sample was not representative of the area from which most cervical disease occurs or there was excessive blood or inflammation on the slide. Under these circumstances, the laboratory will recommend a repeat Pap smear, and your clinician will ask you to return for another sample before your routine periodic examination.

Your Pap Smear Is Atypical or Abnormal

A Pap smear discloses many different diseases, from common cervical and vaginal infections to precancer or cancer.

If any atypical or abnormal cells appear in the specimen, the examining laboratory may return a "positive," atypical, or abnormal report indicating possible cervical disease or a condition that requires further evaluation.

Not all abnormal Pap smears represent a precancerous or cancerous condition. Abnormal but non-cancerous cells in the Pap smear are more frequently reported if the specimen is obtained within 10 days of the start of menstruation, shortly after childbirth, after miscarriage, following surgery or treatment involving the cervical area, or the result of noncancerous and inflammatory conditions, such as a yeast or bacterial infection. Use of an intrauterine device (IUD) and certain drugs can also cause cells to appear abnormal, as can hormone deficiency in menopause. For these reasons, it is extremely important that you return to your clinician for further discussion, evaluation, and care, if your Pap smear shows atypical or abnormal cells.

For most women, an abnormal Pap smear report raises the fear of cancer, even though this is only one possibility out of many. For this reason, in order to make your return visit easier, write down any questions you want to ask your clinician during your appointment and have a more experienced friend or family member accompany you.

Be sure to follow your clinician’s instructions prior to the Pap test. You will find complete information in our brochure, "Why You Need a Pap Smear¾With instructions for Pap test preparation."

Colposcopy

Your clinician may recommend a colposcopic examination, a common procedure that takes about 30 minutes.

A colposcope is a low-power magnifying instrument that allows close inspection of the vaginal opening, vagina, and cervix. While the Pap smear collects cells from the surface of the cervix, it does not identify the exact location or precisely predict the severity of tissue abnormality. Your clinician uses the colposcope to see the source of the abnormal cells and the extent of abnormal tissue present.

First, your clinician will place a speculum in your vagina, like the one used during the Pap test. Then the walls of the vagina are spread apart, and the cervix is carefully examined using a colposcope. A mild vinegar solution, which may cause a mild burning sensation, is applied to the cervix to make abnormal areas easier to see. Any abnormal appearing areas are often biopsied, the removal of a small tissue sample, for study under a microscope. A sample may also be taken from the endocervical canal, just beyond the opening of the cervix. You may feel a slight twinge during the biopsy but little more. Then the entire vaginal area is carefully viewed, while the speculum is rotated and slowly withdrawn.

If biopsies are taken, they will be sent to the laboratory and examined by a pathologist to determine the precise nature of the abnormality. Your clinician will schedule another appointment to discuss the results and treatment with you, after s/he has received the pathology report.

Explanation of Clinical Terms

When your clinician discusses your Pap smear with you, s/he may use some of the following clinical terms.

• Actinomyces: a bacteria, sometimes found in women with an intrauterine device (IUD)
• Atrophic vaginitis: vaginal inflammation caused by decreased estrogen
• Atypia or atypical cells: cells that do not appear normal; a sign of possible infectious disease or other abnormality
• Benign lesion or reactive change: an abnormal area often related to infection, inflammation, or irritation
• Candida (yeast or Monilia): a common fungus; causes itching and vaginal discharge
• Carcinoma: cancer; a malignant growth of cells
• Carcinoma in situ (CIS): early cancer; limited to the top layer of the cervix; does not invade; 100% cure rate, if completely removed
• Cervical Intraepithelial Neoplasia (CIN): precancerous changes in the top layer of cells; term being replaced by SIL
• Dysplasia: abnormal cells that may be precancerous; may regress to normal or progress to cancer
• Endocervix: the neck of the womb, beyond the opening of the cervix
• Epithelium: surface layer of tissues
• Gardnerella (Bacterial Vaginosis): a bacteria
• Genital warts (condyloma): abnormal growths of epithelium resulting from HPV
• Herpes virus: a common virus, sometimes causing genital ulcers and pain
• HPV (human papillomavirus): a sexually transmitted virus; increases the risk of cervical precancer and cancer in some women
• Invasive cancer: cancer that has spread from the surface cells to deeper tissues
• Neoplasia: cell/tissue abnormality; new growth
• Precancer: abnormal cells or tissue which may become cancer if not treated; dysplasia
• Squamous Intraepithelial Lesion (SIL): cell abnormality seen before development of cancer; replaces CIN
• Trichomonas vaginalis: a common infection causing a frothy vaginal discharge in women and a urinary discharge in men.

Classification of Pap Smear Results and Possible Recommendations

The cytopathology laboratory will grade the cellular changes on your Pap smear from "normal" to "cancer" with many variations between.

Some of the following may be terms your clinician will use. The typical or standard follow-up procedures are also described.

• Within normal limits; negative. This means there is no sign of infection, irritation, inflammation, cell repair, atypical cells, precancerous changes, or cancer. No treatment is required. A repeat Pap smear in one year or later is recommended, depending on your risk history for developing cervical precancer, and how many satisfactory negative (normal) annual Pap smears you have received in the past.
• Benign cellular changes. Treatment for the specific infection, irritation, or inflammation is often recommended, if symptoms are present. Infections which may require treatment are actinomyces, atrophic vaginitis, Candida, Gardnerella, herpes, or Trichomonas vaginalis. The recommendations for a repeat Pap smear are the same as for "normal".
• Atypical cells of undetermined significance. Dysplasia or HPV or inflammation is possible, but the Pap smear is not diagnostic or definite, and the laboratory cannot be sure. Your clinician may want to repeat the Pap smear and/or perform colposcopy with or without biopsy.
• Low-grade Squamous Inraepithelial Lesion (SIL)-HPV. Your clinician may want to repeat the Pap smear and/or perform colposcopy and biopsy.
• Low-grade SIL (Mild Dysplasia). Your clinician may want to repeat the Pap smear and/or perform colposcopy and biopsy.
• High-grade SIL (Moderate Dysplasia). Your clinician may want to perform colposcopy and biopsy.
• High-grade SIL (Severe Dysplasia). Your clinician may want to perform colposcopy and biopsy.
• Carcinoma in situ (CIS). Your clinician may want to perform colposcopy and biopsy.
• Invasive carcinoma. Your clinician will discuss with you the diagnostic procedures.
• Inadequate/non-representative/less than optimal/unsatisfactory. Your clinician may want to repeat the Pap smear before routine or annual examination, depending upon your risk for developing cervical precancer.

Take Charge of Your Health

It is important for you to follow-up on abnormal Pap test results.

The Pap smear is highly effective in providing early warning signs before cancer develops, when the disease can still be treated successfully and simply. However, further medical evaluation, including colposcopy and biopsy, is necessary before treatment can begin. By discussing with your clinician whether to immediately treat or to watch and wait; for example, with repeat Pap smears and, possibly, colposcopy every six months, you can eliminate uncertainty and reduce emotional distress.

It is important to talk about your feelings in an accepting, noncritical situation with someone-your partner, your clinician, and/or a more experienced friend.

This brochure was prepared as an expression of our dedication to high quality Pap smear testing and our concern for your health and well-being.

Used with permission from:

ACCUPATH Laboratory Services, Inc.
10740 Meridian Ave. N., Suite G3
Seattle, WA 98133-9010
206/365-5177
800/222-8727
Fax: 206/362-0943

Ó 1993 R. Hasselbrack, M.D., M.S., F.C.A.P.