"I'm not afraid of storms, for I'm learning to sail my ship."
~ Louisa May Alcott
HPV Virus
What is an Abnormal Pap Smear?
About 55 million Pap tests are performed each year in the United States. Of these, approximately 3.5 million (6%) are abnormal and require follow-up.
Occasionally, we will call you to let you know that your Pap smear result was not completely normal. This is not cause for worry, we will explain that we just want to follow you closer.
We are checking for several things:
- adequacy of sample
- normal squamo-columnar junction (transformation zone)
- the presence of high-risk HPV. The latter is only checked in the event of an atypical pap to further clarify, or in all women over age 30.
In the event you have an "abnormal pap" screening test, we will likely ask you to come in for a closer look at your cervix, for a more definitive evaluation: the colposcopy (or microscope of cervix and vagina.)
Abnormal results are classified into these main areas:
- ASCUS (atypical cells of uncertain significance): These changes may be due to infection with HPV but may also mean there are precancerous changes present, this is most common abnormal result - a "wastebasket" term.
- LGSIL (low-grade dysplasia): mild abnormality, caused by low-risk HPV, in general.
- HGSIL (high-grade dysplasia): This means precancer changes are likely to be present; the risk of cancer is greater if the result is HSIL.
- Carcinoma in situ (CIS): severely abnormal changes, are likely to progress to cancer.
- Atypical glandular cells (AGC): Cell changes are seen that suggest precancer of the upper part of the cervical canal or inside the uterus.
Dysplasia Regress% Persist% Progress CIN(%) Progress Invasive Ca(%)
CIN I 60 30 10 1
CINII 40 40 15 5
CINIII 33 55 N/A > 12
What does HPV have to do with Cervical Disease?
Some strains of HPV are associated with genital warts and others with the development of cervical cancer?
HPVs are a group of more than 150 viruses. Some types of HPV cause the common warts that grow on hands and feet. Over 30 types of HPV can be passed from one person to another through sexual contact. Some sexually transmitted HPVs cause wart-like growths on the genitals but do not lead to cancer. About 15 sexually transmitted HPVs are referred to as “high-risk” because they are more likely than other HPV types to lead to the development of cancer.HPV infection is the primary risk factor for cervical cancer. However, although HPV infection is very common (about 6 million new genital HPV infections occur each year in the United States), only a very small percentage of women with HPV infections develop cervical cancer.
Who is at risk for HPV infection?
Infection with sexually transmitted HPV types is more common in younger age groups, particularly among women in their late teens and twenties. Women who become sexually active at a young age, who have multiple sexual partners, and whose sexual partners have other partners are at increased risk of genital HPV infection. Women who are infected with HIV are also at higher risk for being infected with HPVs and for developing cervical abnormalities. Most HPV infections are transient, or temporary, but sometimes an infection can remain detectable for many years.
Does infection with a high-risk type HPV always lead to a precancerous condition or cancer?
No. Most HPV infections appear to go away on their own without causing any kind of abnormality. However, persistent infection with cancer-associated HPV types increases the risk that mild abnormalities will progress to more severe abnormalities or to cervical cancer. With regular follow-up care by trained clinicians, women with precancerous cervical abnormalities can have these abnormalities removed or treated before cancer develops.
Do women who have completed the HPV Vaccine series still need to have Paps/HPV testing?
Yes. Pap tests continue to be essential to detect cervical cancers and precancerous changes, even in women who have been vaccinated against HPVs, because current HPV vaccines do not protect against all HPV types that cause cervical cancer. Therefore, it is important for vaccinated women to continue to undergo cervical cancer screening in accord with recommendations for women who have not been vaccinated.
