Management of Abnormal Pap Smears

Pap Smears

Current guidelines for pap smear screening recommend this part of the pelvic examination begin at age 21. A pap smear is a screening tool for cervical cancer. In order to perform a pap smear, a speculum examination is required. This involves placing a small instrument internally to help the physician visualize the cervix. A thin plastic spatula or a small broom is then used to wipe across the cervix and collect cells. This type of examination is not necessary until age 21 regardless of sexual activity. This recommendation is based on our understanding of the human papilloma infection and of invasive cervical cancer. Pap smears should be performed every 2-3 years until age 29. After age 30 they will be performed at least every 3 years as long as they are normal. If co-screening for high risk HPV takes place and both are negative, these examinations can be spaced out to as far as 5 years. Timing of pap smears should be discussed with your physician and will be individualized based on your history. Screening should continue until age 65, and can then be discontinued with a history of normal pap smears. Pap smears may also be discontinued after hysterectomy if it was done for reasons other than cancer, and if the patient does not have a history of abnormal pap smears that required intervention, does not have a weakened immune system or have HIV, and was not exposed with DES while their mother was pregnant with them.

When an abnormality is noted on a pap smear, it is often necessary to do further evaluation in order to determine the next best course of action. This is done by colposcopy, an examination with a magnifying instrument called a colposcope. During the procedure biopsies are collected for evaluation by pathology to determine the extent of the abnormality.

Should a high grade abnormality be identified, it may be necessary to proceed with an excisional procedure to remove the abnormal cells. Often times this can be done in the office and is referred to as a LEEP (loop electrode excisional procedure).