ACOG Guidelines for an Abnormal Pap
The American College of Obstetricians and Gynecologists (ACOG) recommends that women should begin having Pap tests for women three years after they start sexual activity, no matter what their age. The majority of Pap smears is the United States are done using Brush Cytology Screening, which consists of gently scraping cells and fluid from the cervix. These cells are then viewed for anomalies or cancer.The ACOG guidelines recommend a yearly Pap smear for anyone younger than 30 until the woman has had three negative Pap tests. At that point, the recommendation is for testing every three years until the age of 25. For women over age 25, a Pap smear should be done annually to monitor possible exposure to HPV.
Women who have had a hysterectomy do not need Pap tests if the reason for the surgery was non-cancerous and they do not have any other factors that would warrant testing, such as HIV or cancer in another area of the body. The ACOG has not set an upper age limit as to when a woman can stop getting a Pap smear.
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Timing Effects Results
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To avoid a false positive test result, don't schedule a Pap smear when you are menstruating. Three day prior to getting a Pap smear, a woman must avoid douching, using spermicidal contraceptives and vaginal medications, unless directed by a physician. Refrain from sexual intercourse for two days prior to the test, because this will affect the results. The best time to get a Pap smear is 10 to 20 days after the first day of your last period. If menstruating on the day of the test please reschedule.
Abnormal Pap Tests
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The majority of laboratories use common terms for reporting test results. Negative indicates the test was clear of abnormalities and nothing further needs to be done. A positive result indicates that there were cell abnormalities in the sample. A doctor will need to address any positive result.
What Happens Next
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If you have a positive or abnormal Pap screening, your doctor likely will order a retest. If the test shows an abnormality of the cells, the doctor might recommend that you return in three to six months for a retest. Abnormal cells sometimes appear because of changing hormone levels and often go away on their own. When a woman is near or past menopause, the doctor might prescribe estrogen prior to retesting to ensure that the cell abnormalities were caused by hormonal changes.
After retesting and another positive result, your physician might schedule a more extensive test called a colposcopy. This entails coating the cervix area with a vinegar solution, which will turn abnormal cells white. Then, using a magnifying microscope, the docotr will review the whitened areas and retrieve a biopsy sample for testing, using a sharp scoop-like tool called a curette.
Treatment
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If the biopsy shows cells that have a chance of becoming cancer or that are cancerous, your physician will recommend treatment. Prior to getting any recommended treatment, women of childbearing years should discuss with their doctors any possible fertility issues resulting from the various treatment procedures. Some procedures can cause uterine and cervical scarring that might affect future pregnancies.
Treatment options include Loop Electrosurgical Excision Procedure (LEEP), a surgery that uses an electrical wire as a knife. Cryotherapy uses freezing to destroy abnormal tissue. Laser therapy removes tissue by using an intense, narrow beam of light. Conization removes a cone-shaped piece of tissue and is a more intensive procedure to remove cancerous cells.
Don't Panic
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It's important to find cervical cancer early, when cure rates are as high as 90 percent; as the disease progresses, it becomes harder to cure. And remember: An abnormal Pap test does not always mean cancer. In fact, most abnormal Pap tests result from hormonal changes, and the cells cure themselves. The ACOG recommends that women with abnormal Pap smears have yearly follow-up Pap smears and pelvic exams.
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