Pap Smear Results | Prevention

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Pap Smear Results

Written by Allen Lawrence, M.D.

Understanding Your Pap Smear Results

There is no question that one of the most difficult experiences a woman goes through is having a Pap Smear done. Year after year we have heard women saying, "you know I really hate this, if I didn't have to do it I wouldn't." Maybe you have said this or thought this same feeling many times. While we can't make the procedure itself easier, we can make the rest of the process more meaningful and then the results and findings more valuable.

Now that you have had the Pap Smear done and the results have been returned to us we would like to give you feedback as to its results and there meaning.

You can ask your doctor for a copy of your test results. By law (and this differs from state to state) they must make it available to you. Generally, somewhere near to top of the form there is specific information regarding your name and other information that the laboratory requires to be submitted when the test is sent to them.

One of these pieces of information is the date of your Last Menstrual Period. This is often abbreviated as LMP. This should have been attained from you when the test was performed as it helps the pathologist interpret the information and the stage your cervical and endometrial cells should be in at the time of the test.

Cytology and Hormonal Status

This defines the test that is being done by the laboratory. When the test is originally done, samples are generally taken from three sites. 1) Secretions from the vagina, usually from the pool of secretions in its most dependent part. 2) A scraping from the face of the cervix (the part of the uterus within the vagina) and 3) A scraping from the canal within the cervix, the endocervical canal. It is important to get a sufficient number of cervical cells from the face of the cervix and from the endocervical canal to look for and determine if there are any abnormal cells. Once the sample is obtained, it is smeared on a glass slide in tree sections and sent to the pathology lab or evaluation and diagnoses.

Cytologic Interpretation

This is the important information. The first finding is the PAP CLASS directly below it is a verbal description of the findings.

Class I: The review of the cells has found all normal or benign (harmless) cells. This is the most common classification. It represents a healthy cervix or at least one that sheds no abnormal cells.

Class II: Means that atypical or abnormal, but still benign, cells have been found on examination. It usually represents an infection or an inflammation of some type.

Class III: This means that abnormal cells have been found. This classification suggests dysplasia, that is, the cells are abnormal, but cannot be definitely classified as malignant. These cells must be considered suspicious for cancer of the cervix.

Class IV: These are definitely abnormal cells. They are usually classified as Carcinoma In-Situ of the cervix. In-Situ Carcinoma of the cervix is the earliest form of cellular changes that can be definitely called cancer. This malignancy is localized and has not spread. It generally has not crossed the basement membrane.It can generally be treated with a simple surgical procedure or laser treatment.

Class V: This represents definite cancer of the cervix and may indicate that this cancer may have spread to other areas of the body. This is serious and requires radical surgery.

The next comments below the class are descriptive of what was seen on the slide such as whether the sampling was good, whether there was blood, whether there were normal bacteria or abnormal bacteria which can cause infection; or whether yeast or trichomonas organisms were found. If abnormal organisms such as bacteria, trichomonas, yeast are found, than these organisms will need to be treated. Usually a note and instructions including a prescription will be enclosed with your report indicating specific organism and the specific treatment necessary.

Often the report may include terms such as squamous metaplasia: changes in cells caused by infection, inflammation or irritation. This is a benign (harmless) condition which you need not to be concerned about. It will frequently be associated with mild or moderate inflammation. Often the report will state that there is either normal flora or mixed bacteria the statement refers to the kinds of bacteria that are seen on the smear. These types are usually the normal types of bacteria seen within the vagina on the pap smear.

Hormone Pattern: Every woman that has one or more (two) ovaries or is using hormonal supplementation (birth control pills, estrogen with or without progesterone by tablet, injection, patch, suppository or vaginal cream) will have changes in the lining of their vagina and cervix caused by these hormones. For the most part, we are only concerned about women where there is an excessive estrogen effect caused by these hormones or by their own internal hormones. We are not concerned when the hormonal effect is in the normal range in otherwise normal women. Therefore when the pathologist sates that estrogen effect is normal for age this can be considered a normal finding unless it is too high or low for the real age of the woman.

The exact hormonal pattern will vary from day to day depending on where the woman, where she is in her cycle or whether she uses external hormones. For most women with no problems relating to hormone production or external use, this information is unimportant.

Finally, there is most usually a comment regarding whether or not endocervical cells are present or not. The presence of endocervical cells lets us know that these cells from within the canal of the cervix were seen. This is good for it means that since cells from within the cervix are present one can relay on the pap smear sample to have been good and that finding NO CANCER is reliable both for the outer face of the cervix as well as from within the cervical canal.

Is the Pap Smear Reliable?

The Pap Smear when taken correctly is generally reliable but there are flaws in the process. Cancers can be early or so small as to be missed even when well done and read by a well trained Pap Smear Technician. It has always been my feeling that Pap Smears should be taken more frequently than less frequently, to avoid missing positive findings for long periods of time.

Women under 25, once per year is usually sufficient.

Women over 25, I recommend exams every six months. The risk of breast cancer starts to rise after 25 this in itself should be followed regularly every six months.

Women using birth control pills every six months to watch for risks of the pill as well.

Women with an IUD (Intrauterine Contraceptive Devise) should have examinations every six months.

Women with specific problems, for example: endometriosis, pelvic pain, fibroid tumors, breast lumps or history of: abnormal pap smears, vaginal warts, herpes, multiple high risk sexual contacts, or women with family history of DES exposure, breast cancer or other high risk factors should be seen every six months.