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Introduction
At one time, cervical cancer was the number one cancer-related killer among American women. Now it is considered one of the most preventable cancers because of a simple test. Nearly all of the 16,000 newly-diagnosed cases this year will be treatable, if detected early enough with a Pap test.

The Virus and Cervical Cancer Connection
Cells inside the cervix are constantly being replaced and this process of cell division progresses normally until something triggers a change. These disruptions in normal cell division are nearly always caused by the human papilloma virus (HPV), also known as genital warts. The virus, introduced into the cervix during sexual intercourse, has the unique ability to infect the dividing cells of the cervix. Once inside the cell, HPV inserts itself into the DNA of the cervical cells and alters their ability to produce new cells. Over the course of many years, the cells tend to become cancerous. This process takes a long time, and an annual Pap test can detect some of these changes early on. Tests have been developed to detect the virus in tissue of the cervix, and they are now being used in conjunction with the Pap test to identify women at risk for cervical cancer.

What Is a Pap Test?
A Pap test, sometimes called a Pap smear, involves obtaining cells from the cervix, placing them on a glass slide, and later examining them under the microscope to visualize any abnormal cells. It is a quick and relatively painless process. Women often describe it as the feeling as an "internal pinch" when the brush touches the cervix. After the procedure, the sample is sent to the lab for analysis.

Even in the best labs, the Pap test is only 80% accurate. But with a regular schedule of Pap testing, the chance of missing an abnormality is very remote. Still, many doctors have switched to a newer type of Pap test called the ThinPrep Pap test. This test is slightly more accurate than the traditional Pap, yielding a 6-65% increase in detection of abnormal cells. In addition, HPV DNA testing can only be done in conjunction with the ThinPrep Pap technology.

If Pap test results suggest an abnormality, or if the results are unclear for any reason, there are a number of additional tests that can be performed. Colposcopy, loop electrical excision procedure (LEEP), and cone biopsy, are additional diagnostic tests that may be performed.

What Do The Test Results Mean?
After your Pap test is examined at the lab, your physician will receive a report describing the results of your test-satisfactory or unsatisfactory. On the report, there will be comments about the type of cells and a recommendation for follow-up care.

The following language may appear on the report:

Normal: The cells appear normal and a follow-up Pap should be done the following year.
Unsatisfactory: Essentially, an unsatisfactory Pap test is a "do over." It means that there was a problem with the preparation or staining of the slide, or there was an interpretation error, or there were not enough cells retrieved for proper evaluation.
Inflammation: This means that there are no changes in the cervical cells that would indicate cancer, but there are inflammatory changes in the cells' environment.
Benign changes: These are changes within the cervical cells themselves. These cells are not malignant cells, but they may have the tendency to progress at some point in the future. This result should have follow-up testing-generally a recheck in one year.
Atypical squamous (glandular) cells of undetermined significance (ASCUS or ASGUS): This diagnosis is the most confusing to patients. Basically it means that the person at the lab who evaluated the slide felt that some of the cells were slightly abnormal but not abnormal enough to warrant more aggressive evaluation. In women receiving the traditional Pap test, this result is commonly associated with mild infections in the vagina or changes during the postpartum (after delivery of a baby) or menopause. Many doctors use HPV DNA testing to help determine which patients in this group require further testing.
Low-grade squamous intraepithelial lesion (LGSIL): This result requires further testing by means of a colposcopy, which is a procedure that allows us to both look carefully at the cervix and uterine wall, and retrieve cells for biopsy. This finding represents the mildest cervical change, though 15% of these abnormalities will progress to cancer in time. Many physicians recommend treating these lesions by destroying the abnormal cells. Sixty percent of these lesions will disappear on their own without treatment, and there are some doctors who prefer to follow patients in this group with repeated Pap tests and colposcopy instead of treatment.
High-grade squamous intraepithelial lesion (HGSIL): This result also requires further testing by colposcopy and represents a pre-malignant condition, which must be treated aggressively by destroying the abnormal cells. Failure to treat will lead to cancer in many patients.
Cervical Cancer: This is a rare diagnosis, and the patient should be referred to a gynecological oncologist for management and treatment.

Treatment
Cervical treatment involves destroying any abnormal cells and the allowing the cervix to regenerate healthy cells.

Cryosurgery has been used successfully for many years. It involves freezing the cervix and destroying the entire junction between the two types of cells in the cervix. It is a quick, office-based procedure and causes minimal discomfort. In general, a few Advil or Tylenol in advance of the procedure will suffice as pain medication. After the procedure, patients experience watery discharge for up to two weeks.

Though more time consuming and uncomfortable, laser treatment still has a role in treatment in certain circumstances. This method involves the use of high energy to vaporize an area of abnormal cells. Sometimes local anesthesia is used to make the procedure more comfortable. Patients will experience watery discharge for up to two weeks.

Electrocautery uses electrical energy to burn away abnormal cervical tissue. It is a quick procedure, which typically requires local anesthesia. As with all these procedures, a watery discharge should be expected for up to two weeks.

The cone biopsy is both a diagnostic tool and therapeutic treatment. It allows the doctor to look at the entire cervix and remove cells for biopsy. If the cone biopsy results show that all abnormal cells have been removed, it will have successfully treated as well as diagnosed the problem.

Follow-Up
Following treatment, a Pap test is usually performed every three months for a full year to make sure that any recurrence of abnormal cells is promptly found. In the second year after treatment, the interval between tests may be extended to six months. Thereafter, if all subsequent results are normal, annual Pap smears are recommended.

Conclusion
The Pap test is an excellent screening tool to help prevent and detect cervical cancer, and as with all areas of medicine, new technology will continue to improve our ability to detect abnormalities on the Pap test. When caught early, most cervical cancers are treatable. But it's up to each of us to take charge of our own health.