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What Do Cellular Abnormalities In A PAP Smear Test Indicate?
Question: 4 months after having CIN3 carcinoma in situ removed from my cervix my pap smear came back clear. but now i had my 8 month check up and it is showing abnormal cells again but it doesn't test positive for hpv. does that mean that the abnormal cells won't multiply? basically, is that good news that it's negative for hpv or is irrelevant?
Brief Answer:
The HPV test is more reliable than cytology and your PAP was done too early
Detailed Answer:
Hello, and I hope I can help answer your question today.
I am basing my recommendations on the standard of care for treatment of cervical dysphasia used in the U.S. You can look up the algorithm at www.accp.org
All the current research shows that the LEEP procedure is curative in 90 percent of cases and that the recommended follow up after a LEEP is a PAP and HPV test in one year. Doing a repeat PAP too early may increase the rate of false positives.
If the follow up PAP smear at 1 year comes back HPV negative, it is just recommended that you repeat another one in a year.
It takes 5-7 years to develop cancer from severe dysplasia or CIN 3 so there is time to wait and see what happens over time. Most women will clear HPV (if they have a normal immune system) within 2 years of treatment.
I encourage you to read more about HPV and dysplasia on the ASCCP (American Society of Colposcopy and Cervical Pathology) they have the most current standards used in the United States where I practice.
So in summary the fact that your HPV test is negative at one year and by U.S. standards I would recommend you just have another PAP smear and HPV test in one year.
Please do not hesitate to contact me further if you need any other assistance.
Best wishes, Dr. Brown
The HPV test is more reliable than cytology and your PAP was done too early
Detailed Answer:
Hello, and I hope I can help answer your question today.
I am basing my recommendations on the standard of care for treatment of cervical dysphasia used in the U.S. You can look up the algorithm at www.accp.org
All the current research shows that the LEEP procedure is curative in 90 percent of cases and that the recommended follow up after a LEEP is a PAP and HPV test in one year. Doing a repeat PAP too early may increase the rate of false positives.
If the follow up PAP smear at 1 year comes back HPV negative, it is just recommended that you repeat another one in a year.
It takes 5-7 years to develop cancer from severe dysplasia or CIN 3 so there is time to wait and see what happens over time. Most women will clear HPV (if they have a normal immune system) within 2 years of treatment.
I encourage you to read more about HPV and dysplasia on the ASCCP (American Society of Colposcopy and Cervical Pathology) they have the most current standards used in the United States where I practice.
So in summary the fact that your HPV test is negative at one year and by U.S. standards I would recommend you just have another PAP smear and HPV test in one year.
Please do not hesitate to contact me further if you need any other assistance.
Best wishes, Dr. Brown
Above answer was peer-reviewed by :
Dr. Yogesh D
but my doctor said i needed to get a pap every 4 months indefinitely because i went from 10 years in a row of a clear pap to this last year with a severe CIN and my whole cervix was covered according to her.
anyhow today she called me to tell me that my cells came back abnormal. she told me that she wants to do another biopsy and then refer me to a specialist. she had mentioned that if the abnormal cells came back (which they did) she would send me to a specialist to find out a second opinion of removing my whole cervix.
in what cases would one need to remove her whole uterus? what problems could arise? i am done having children. please let me know. thanks.
anyhow today she called me to tell me that my cells came back abnormal. she told me that she wants to do another biopsy and then refer me to a specialist. she had mentioned that if the abnormal cells came back (which they did) she would send me to a specialist to find out a second opinion of removing my whole cervix.
in what cases would one need to remove her whole uterus? what problems could arise? i am done having children. please let me know. thanks.
Brief Answer:
Repeating PAP smears every 4 months is no longer recommended
Detailed Answer:
I am not sure in which country you are located, but at least in the U.S. we have learned a lot more about the biology of HPV and your treatment. Having another colposcopy at 1 year if they still say you have abnormal cells isn't unreasonable but unless you are found to still have CIN3 on biopsy there is no reason you should need a repeat procedure of any kind. The chances of actually having residual CIN3 if you tested HPV negative is very low. It may be beneficial for you to see the specialist your doctor recommended as he/she is not using the current U.S. standards. I again encourage you to go to asccp.org and click on management guidelines and then treatment algorithms. It is written in medical language but has pretty clear diagrams that may help you understand these guidelines.
If you are located outside the United States, you may have been given different information, but I just advise you that unless you have biopsy proven CIN 3 left in your cervix, you do not need any additional procedures and you are NOT at risk of cancer within at least a year from your most recent colposcopy.
I am sorry that this is confusing for you. Many physicians (especially non-GYN doctors) do not understand the biology of HPV and the updated recommendations for follow up after a LEEP procedure.
I encourage you to seek additonal opinions about your situation from doctors but please try to read about what I'm talking about. There are also patient education materials on the ASCCP website.
If you do still have CIN 3 on your cervix on a repeat biopsy, it is true that you could choose to have more tissue removed from your cervix (how much depends on how big your cervix is and how big the patch of cells is) or to have your whole uterus removed, which would effectively eliminate your lifetime risk of cervical cancer. But again, from what I understand you had a recent negative HPV test, and even if the healing process on your cervix may have made your PAP look abnormal, I doubt you will still have CIN3 on your biopsy.
Regarding the timing of your abnormal PAP, it is extremely unlikely you had a reactivation of an old HPV infection 10 years later unless you have a compromised immune system, like from cancer chemotherapy, HIV, or certain medications used to treat autoimmune diseases. It is most likely you acquired a new infection somewhere between three months to two years before your abnormal PAP.
I know this is a lot of information that you haven't heard before, but please take a look at the ASCCP website they have a lot of educational materials that may help explain the basis for my recommendations.
Sincerely, Dr. Brown
Repeating PAP smears every 4 months is no longer recommended
Detailed Answer:
I am not sure in which country you are located, but at least in the U.S. we have learned a lot more about the biology of HPV and your treatment. Having another colposcopy at 1 year if they still say you have abnormal cells isn't unreasonable but unless you are found to still have CIN3 on biopsy there is no reason you should need a repeat procedure of any kind. The chances of actually having residual CIN3 if you tested HPV negative is very low. It may be beneficial for you to see the specialist your doctor recommended as he/she is not using the current U.S. standards. I again encourage you to go to asccp.org and click on management guidelines and then treatment algorithms. It is written in medical language but has pretty clear diagrams that may help you understand these guidelines.
If you are located outside the United States, you may have been given different information, but I just advise you that unless you have biopsy proven CIN 3 left in your cervix, you do not need any additional procedures and you are NOT at risk of cancer within at least a year from your most recent colposcopy.
I am sorry that this is confusing for you. Many physicians (especially non-GYN doctors) do not understand the biology of HPV and the updated recommendations for follow up after a LEEP procedure.
I encourage you to seek additonal opinions about your situation from doctors but please try to read about what I'm talking about. There are also patient education materials on the ASCCP website.
If you do still have CIN 3 on your cervix on a repeat biopsy, it is true that you could choose to have more tissue removed from your cervix (how much depends on how big your cervix is and how big the patch of cells is) or to have your whole uterus removed, which would effectively eliminate your lifetime risk of cervical cancer. But again, from what I understand you had a recent negative HPV test, and even if the healing process on your cervix may have made your PAP look abnormal, I doubt you will still have CIN3 on your biopsy.
Regarding the timing of your abnormal PAP, it is extremely unlikely you had a reactivation of an old HPV infection 10 years later unless you have a compromised immune system, like from cancer chemotherapy, HIV, or certain medications used to treat autoimmune diseases. It is most likely you acquired a new infection somewhere between three months to two years before your abnormal PAP.
I know this is a lot of information that you haven't heard before, but please take a look at the ASCCP website they have a lot of educational materials that may help explain the basis for my recommendations.
Sincerely, Dr. Brown
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Above answer was peer-reviewed by :
Dr. Sonia Raina
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