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summer  2004
issue 10.1

Annie Liau M.D., a physician with MIT Medical's OB/GYN Service, uses those words to emphasize just how important it is for a woman to have regular Pap tests. "Pap tests help to screen for abnormal cells in the cervix [the opening of the uterus at the top of the vagina], she explains, " Abnormal pap tests alert us to look for and intercept these abnormal cells before they turn malignant.

Physician Dawn Anderson, M.D., also a member of MIT Medical's OB/Gyn Service, heartily agrees. "The Pap smear is one of the few screening tests that can detect abnormalities that could become cancerous, she says. "It's a great test. Indeed, according to the American College of Obstetricians and Gynecologists (ACOG), since it first came into use some 50 years ago, the Pap test has been responsible for a 70 percent decrease in the number of deaths caused by cervical cancer in this country. ACOG-and MIT Medical-recommends that women have a yearly Pap test beginning at age 21 or three years after first becoming sexually active, whichever comes first. "But after age 30, if a woman has no specific risk factors for cervical cancer, a Pap test every three years is sufficient, Anderson notes. However, adds Liau, such women should continue to have an annual gynecological visit and pelvic exam.

Simple and accurate

The Pap test (also called a Pap smear) is a fairly simple procedure that can be performed by OB/Gyn clinicians, internal medicine physicians, or nurse practitioners. Usually done as part of a woman's annual gynecological exam, the clinician inserts a small brush and scraper into the vagina to gently remove cells from both the inside and outside of the cervix. The procedure, while sometimes slightly uncomfortable, is not painful. The obtained sample is then examined under a microscope in a lab to see if any abnormal cells are present.

Since 2001, MIT Medical has been using a new liquid-based Pap test that provides improved accuracy and faster results. "It's more accurate than the older type of Pap test, because it samples more cells, is more likely to detect abnormal cells if present, and is less likely to produce a false-positive reading, Liau explains. "With the liquid base, cells are less likely to be obscured by blood or mucous, so they can be clearly seen and more easily evaluated.

Evaluating abnormal results

Most women with abnormal Pap test results do not have cancer, emphasize Liau and Anderson. Benign abnormalities are common, occurring as cervical cells go through a continuous process of growth and shedding. A careful analysis of abnormal Pap test results allows clinicians to determine exactly which women with abnormal results are at risk for cancer-needing more frequent, closer follow-up-and which are not.

Abnormal test results are first classified by severity. "If the cervical cells are classified as ASCUS-abnormal squamous cells of undetermined significance, with no clear evidence of pre-malignant change-we automatically test for the human papillomavirus, or HPV, Anderson explains. "HPV is known to cause cervical cancer, and knowing a patient has HPV allows us to monitor the condition and intervene if dysplasia [abnormal cell growth] occurs. The Pap test we use now allows us to test the original sample for high-risk strains of HPV without having the patient return to the office for a second Pap test and speculum exam.

If the HPV test is negative, patients are simply asked to return for another Pap test in a year. "However, Anderson continues, "if the HPV test is positive, or if the cell abnormalities are classified as LGSIL [ low-grade squamous intraepithelial lesion] or HSIL [ high-grade squamous intraepithelial lesion ], we follow up with a colposcopy, in which we examine the vagina and cervix using a special type of microscope. If the colposcopy uncovers areas of abnormal cells, the clinician will consider their location and size, along with the Pap smear findings, in deciding whether further tests, such as biopsies, are necessary.

"Most procedures and treatments can be performed as office procedures at MIT Medical , adds Liau.

An ounce of prevention.

Anderson reminds her patients that, in addition to getting routine Pap tests, they can make lifestyle changes to reduce the risk of cervical cancer. " HPV infection is a sexually transmitted disease, so condom use will reduce the likelihood of transmission, she notes. "We also recommend that women who smoke cigarettes try to stop, as studies have shown that smoking worsens HPV infection.

"We can take a number of steps to prevent cervical cancer, Anderson emphasizes. "Through regular Pap tests, we can detect most precancerous cells, so we can take action to prevent a malignancy from starting.

Annie Liau
"Pap tests save lives!" says Annie Liau M.D., a physician with MIT Medical's OB/GYN Service. "Pap tests can allow us to identify abnormal cells in the cervix and intercept these abnormal cells before they turn malignant."

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