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Worried about an abnormal pap smear

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I am worried about an abnormal pap smear
Posted Wed, 27 Feb 2013 in X-ray, Lab tests and Scans
 
 
Answered by Dr. Timothy Raichle 38 minutes later
Can you type in the exact result that you are worried about and I would be happy to try and help you!
Above answer was peer-reviewed by
 
Follow-up: Worried about an abnormal pap smear 4 minutes later
-- My wife got the results (in Swedish) "light changes" and positive test for HPV.
-- She will be called back for a colposcopy
-- She is 40 and has done all previous paps regularly (3 year intervals), this is the first abnormal result
-- The nurse said on the phone "no changes, but virus", but letter said "light changes and virus"
-- She was in to check up some unrelated routine stuff with her gyn and when my wife mentioned the changes the gyn said (without a colposcope) that "well, to the naked eye the cervix looks undamaged". this is not the same dr who will do the colposcopy.

My wife takes this quite well it seems. Me, however, who has a history of health anxiety is on the border of panicking all the time. Keep thinking about worst case scenarios, googling the web for info, getting increasingly scared etc.
 
 
Answered by Dr. Timothy Raichle 1 hour later
Thank you for the followup.

Do not panic and limit your google searches - you are right, they will likely just increase your anxiety level.

The pap smear is a screen for PRE-cancerous changes of the cervix. These are changes at the cellular level that are not visible to the naked eye. Also, HPV is a common virus that most of us are exposed to if we have ever been sexually active. The changes that it causes can take years to develop into a problem on a pap smear. So, your wife had a positive screen - which means nothing except that there is a chance that a "pre-cancerous" change might be present. The way to determine this is by performing a colposcopy (microscope of the cervix) to see if any of these changes are visible. A biopsy of any of these changes can determine if they are mild (and can be observed over time for resolution) or if they are moderate / severe (and need treatment).

When they said "light" changes, they probably meant that there were mild abnormalities at most, and the presence of HPV only helps them to make the decision that she needs colposcopy. The chance of cancer being present is virtually zero.

I hope that this helps and good luck. Let me know if you have additional questions.
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Follow-up: Worried about an abnormal pap smear 11 minutes later
Thank you so much for this clarifying and reassuring answer. I want to ask a couple of more things for clarification. Not that you have been "unclear" as such, but getting this type of info from a professional is really comforting.

-- If something "seriously bad" would have been present a) could it possibly show as "light changes" on the pap, b) could it then also have been visible to the naked eye by a gyn inspecting the cervix without a microscope?

-- I guess, having health anxiety like me, it is the word pre-cancerous that triggers limitless worry, since I tend to focus my emotions on the later half of that word. If you have even "CIN3" (something I learned by googling...) is it still a long time before it would actually develop into actual illness?

-- My impression is, like you said, that if the HPV test would have been negative she would not have been scheduled for colposcopy. It is the light changes IN COMBINATION with the virus that makes them want to check. Could somehow the presence of HPV mean that something shown on the pap as "light changes" would actually be more severe on closer inspection?

-- If she ends up having a biopsy (another one of those anxiety triggering words) and IF it should show what you call "severe" changes, is the treatment of these still within everyday routine gynaecology and nothing acute or threatening?
 
 
Answered by Dr. Timothy Raichle 2 hours later
Here are the answers to your followup questions:

1. If something "seriously bad" would have been present could it possibly show as "light changes" on the pap.

Incredibly unlikely. Seriously bad would mean cancer. It is incredibly rare to go from normal pap smears to cancer AND nothing visible on the cervix.

2. Could it then also have been visible to the naked eye by a gyn inspecting the cervix without a microscope?

Cancer is usually "visible" as a definite abnormality. But the earliest forms of it are at the microscopic level. If it had been visible, this would be bad. If it is microscopic, even under the worst circumstances, it is curable.

3. If you have even "CIN3" is it still a long time before it would actually develop into actual illness.

To go from CIN3 to cancer takes years, if not decades.

4. It is the light changes IN COMBINATION with the virus that makes them want to check.

That is exactly correct. The presence of high risk HPV types makes the chance of finding precancerous changes more likely. Probably around 60%.

5. Could somehow the presence of HPV mean that something shown on the pap as "light changes" would actually be more severe on closer inspection?

That is unknown until they do the colposcopy and biopsies. That is the point of the colposcopy - that you cannot tell from the pap or visual inspection alone what is going on.

6. If she ends up having a biopsy and IF it should show what you call "severe" changes, is the treatment of these still within everyday routine gynaecology and nothing acute or threatening?

This is a common problem, and the procedure to remove the abnormal cells at the surface of the cervix is among the simplest procedures that a general OB/GYN performs in their office every week.

I hope that this helps and good luck to your wife! I am sure that everything is going to be fine.
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Follow-up: Worried about an abnormal pap smear 25 minutes later
Thank you so much for bearing with me and clarifying this.

Finally (I promise):

-- You write "To go from CIN3 to cancer takes years, if not decades". Wouldn't this mean that since she has had normal paps every three years, and that she only has light changes now, that any such scenario would be FAR into the future (and treatable through early screening) either way?

-- You write: "the presence of high risk HPV types makes the chance of finding precancerous changes more likely". But as she has only had a virus test (done together with the pap) we don't even know yet if she has a "high risk type", right?
 
 
Answered by Dr. Timothy Raichle 3 hours later
In answer to your first followup question: You are correct. Even if she was diagnosed with CIN3, and treated appropriately, her chance of developing cancer of the cervix approaches zero.

In answer to your second followup question: If someone has a pap smear abnormality, usually if HPV testing is done and is "positive" it means that she is positive for high-risk types. This would be a question for her doctor whether the high-risk types were the ones that she was postive for on the test.

Good luck!
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Follow-up: Worried about an abnormal pap smear 12 hours later
So, my wife had the colposcopy today.

1. Doctor said "well, even though your letter said light changes + hpv, your pap did not *actually* show any changes, just the hpv.

2. He did the colposcope examination. Did not seem alarmed. Applied whatever fluid it is that you use. Said: "well, there was a small are that looked a bit *white* so I took a test there". Wife: "does that mean that there are cell changes?". Dr. "Well... it MIGHT be". Test result due in a month or so. I guess this will show whether she has changes or not, and that nothing points to major or "dangerous" changes.

I am interpreting this like follows: If she has something, it will definitely be minor, and discovered early enough for it to be treated without risk of it turning into something problematic.

I hope this means that I can put my worry to rest feeling that she might not even have something, and IF she does it is under total control

What are your reflections on this?
 
 
Answered by Dr. Timothy Raichle 42 hours later
I am sorry about the delay in responding to your followup.

So the original pap smear was unconcerning / normal. It is not unusual with the new protocols for pap smears every 3 years to do HPV as well. It is possible that the pap smear was normal, and the HPV was positive, prompting the colposcopy.

During the colposcopic exam, they apply acetic acid, or vinegar. It turns abnormal cells white. It sounds like the doctors "colposcopic impression" was that of either mild changes or nothing. This impression usually correlates well with the final result.

So, you are right, if she has something, it will definitely be minor. Even if there are just mild changes (mild dysplasia) it is usually just followed with more frequent pap smears as these changes tend to go away on their own over time.

Finally, yes, you should put your worries to rest. Her doctor does not sound concerned, your wife does not sound too concerned, and this should all make you fell less stressed about it as well.

Good luck to both of you!
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