Pap Smear Abnormalities Treatment

Portrait of gynecologist in white lab coat and sterile gloves using vaginal speculum during pelvic exam

Pap Smear Abnormalities

Precancerous changes of the outer (squamous) cells of the cervix have the potential to turn into cancer if left untreated. In the cervix these precancerous changes are called ‘Cervical Intraepithelial Neoplasia’ or CIN for short.
There are different grades of CIN according to how severe the changes are, from CIN1 minor change referred to as Low Grade Squamous Intraepithelial Lesions (LSIL) to CIN 2 and CIN 3 referred to as High Grade Squamous Intraepithelial Lesions (HSIL).
The risk of CIN1 developing into cancer is very small, however we know that CIN2 and CIN3 may develop into cancer in some cases, if left untreated.

There is a rare abnormality called ‘Cervical Glandular Intraepithelial Neoplasia’ and this is the same sort of precancerous change involving the inner glandular cells of the cervix.
ASCUS (Atypical Squamous Cells of Undetermined Significance) is the diagnosis made when the doctor is unable to distinguish on a Pap smear how abnormal the cells are. The abnormal cells may have features of CIN 1, 2 or 3 or they may be caused by an infection in the vagina, but these features are not specific enough to make a particular diagnosis. In such cases, further testing such as colposcopy is indicated.

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What are different types of abnormal cells?

Women who have a high-risk of HPV shall have a colposcopy examination to assess changes in the cells of the cervix more closely. Pap smear only tests superficial cells of the cervix and misses about 30% of abnormal cells. Colposcope will highlight the abnormal cells, which will be taken for biopsy and tested for precancerous changes.
Women with CIN 1 or Low-Grade Intraepithelial Lesions (LSIL) will be observed every six months with Pap smear and possibly colposcopy. CIN 1 or LSIL changes are considered to be minor. The vast majority of CIN 1 (LSIL) lesions disappear without any treatment within 18 to 24 months. However, occasionally (in about 5%) of cases they may progress to CIN2 or CIN3 or High-Grade Intraepithelial
Lesions (HSIL) and 1% of CIN 1 lesions progress to cancer.
Women with CIN 2 or 3 or HSIL require a procedure to remove these abnormal cells. The procedure is called LLETZ. It is a minor procedure performed in the operating room under general or local anaesthesia. Please refer to the patients’ information on LLETZ for details. 5% of CIN 2 and 12% of CIN3 lesions progress into cervical cancer within 5 to 20 years. Smoking and
immune deficiency is strongly associated with such progression.

Do I have cancer?

No, you don’t have cancer. CIN lesions are precancerous changes. A screening program for cervical cancer with Pap smear aims at identifying precancerous cells and treating them before cancer develops.

Do I have an STI?

Yes, HPV is STI. However, Eighty percent of sexually active people will acquire HPV sometime in their life, more commonly at a younger age when they become sexually active. The immune system clears HPV.

Do I have to tell my sexual partner I have HPV?

You don’t have to tell your partner about HPV as there are interventions or treatment needed for your partner.

Condoms do not protect against HPV virus because it is transmitted through skin-to-skin contact, hence, it is so common.

Can I do anything to prevent the HPV virus?

Nowadays, girls (and in some countries boys) are being vaccinated against the HPV virus. The vaccine has the most advantage when it’s been given before any sexual activity. The vaccine can be used for people who have already had sex. When the vaccine is given to sexually active individuals, it will have no impact on HPV infection they have already acquired, but it will protect against HPV infection they may get from future sexual partners.

In South Africa, we currently use vaccine (Gardasil) against 4 HPV viruses, which are responsible for 80% of cervical cancer. Therefore, the vaccine does not protect against all HPV types and regular screening with pap smears / HPV test remains particularly important.

Healthy lifestyle and strong immune system are paramount for prevention of progression of HPV infection. People with a weak immune system due to chronic illness, HIV, on medications suppressing immune system are at particular risk to quick progression of precancerous changes in the cells of the cervix to cervical cancer.
Smoking increases the risk of HPV infection and cervical cancer. So, if you are a smoker, seek help to stop smoking immediately. This is the best thing you can do for yourself.

Pap Smear Abnormalities