The Pap Smear has been around since the 1940s, named after George Papanicolaou, it is a screening test for cervical cancer. In the 1940s – cervical cancer was the number one killer of women, through the development and use of this screening test, we have reduced the death rate for cervical cancer patients by 70%. Early detection has given us an edge in treating this condition.
Risk factors for cervical cancer include:
- Many sexual partners
- Early sexual activity
- Other sexually transmitted infections (chlamydia, gonorrhea, syphilis, HIV/AIDs)\
- A weak immune system
- Smoking
Cervical cancer screening now employs a liquid based cytology screening (ThinPrep) which has a higher accuracy then the Pap Smear method. Regular cervical screens helps physicians detect pre-cancerous lesions and treat appropriately. Through cervical screening we can identify the presence and strains of Human Papillomavirus (HPV). Certain strains of HPV are highly associated with cervical cancer and can be identified through additional testing.
The American College of Obstetricians and Gynecologists, ACOG, has recommended the following screening guidelines:
- Women ages 21-30 should be screened every 2-3 years.
- Women 30+ who have had 3 consecutive ‘Normal’ paps and have no history of dysplasia may be screened every 3-5 years
- Women with the following risk factors should be screened yearly:
- HIV/AIDs
- Immunosupressed patients
- Exposed to diethylstilbesterol (DES) in utero
- Previously treated for cervical intraepithelial neoplasia (CIN) 2 or CIN3 or cervical cancer
- Higher risk individuals should have both the cervical cytology and high risk HPV test
- Women 65 years and older can discontinue cervical cancer screening if they have had three or more negative cytology tests and no abnormal results in the past 10 years
An abnormal pap result can be a scary experience for a woman.
Abnormal results are grouped as follows:
- ASCUS or AGUS. Atypical cells were identified, the changes in these cells may be due to HPV and may lead to cancer
- LSIL (low-grade dysplasia) or HSIL (high-grade dysplasia). Changes noted in the cells may lead to cancer are present. The risk of cervical cancer is greater with HSIL.
- Carcinoma in situ (CIS). The abnormal changes noted are likely to lead to cervical cancer if left treated
- Atypical squamous cells (ASC). Abnormal changes have been found and may be HSIL
- Atypical glandular cells (AGC). Cell changes that may lead to cancer are seen in the upper part of the cervical canal or inside the uterus
An alternative grading method of grading the degree of degree of cervical dysplasia is also used. The term cervical intraepithelial neoplasia or CIN. CIN grading outlines how much of the lining of the cervix is affected by abnormal cells.
CIN Classifications
- CIN I: Mild dysplasia; abnormal cells can be found in 1/3 of the lining of the cervix
- CIN II: Moderate dysplasia; abnormal cells can be found in 2/3 of the lining of the cervix
- CIN III: Severe dysplasia; abnormal cells can be found in more than 2/3 of the lining of the cervix and up to the full thickness of the lining
Based on the level of dysplasia a treatment plan is recommended for the patient. Earlier stages of dysplasia are often treated by a ‘watch and wait’ approach by the standard medical system. Treatments for more advanced dysplasia aim to remove the abnormal cells through various procedures.
Through Naturopathic therapies, we can offer a conjunctive approach and treatment of abnormal pap results. Key aspects of treatment plans will be discussed in a future blog post!