Below we’ve answered questions pending from last issue.
Finding Abnormal Cells
The Pap Test
The Pap test finds certain cell changes before they lead to cancer or cause you to have symptoms.
These cell changes can almost always be treated so that you don’t get cancer of the cervix. Most changes in the cervix happen very slowly.
If the lab finds cell changes, the Pap test result is called “positive” or abnormal. If cells look healthy, the result is called “negative” or normal.
The Pap test is not always 100-percent accurate. If the test misses cell changes once, they can often be found the next time you have one. This is why it is very important that you have regular Pap tests. You should also go back to your health care provider for care if you get an abnormal result.
The Pap Test and DES
If you were born between 1940 and 1971, and your mother was given a synthetic form of the hormone estrogen called diethylstilbestrol (DES) when she was pregnant with you, be sure to tell your doctor. Your doctor will want to take additional cells to check for a rare type of cancer.
The HPV Test
Almost all cervical cancer begins as an infection with the virus called HPV. An HPV test, which is done much like a Pap test, can detect the virus in cervical cells.
Because health care providers know what causes most cervical cancers, it is important to get an HPV test if your health care provider recommends one.
How Is the HPV Test Done?
In an HPV test, a small number of cells is collected from the cervix, much like a Pap test. Sometimes this can be done at the same time as a Pap test. A lab then checks to see if HPV is present.
When Is an HPV Test Useful?
An HPV test can be useful in cervical cancer screening in two ways:
• For women of all ages, an HPV test can be useful as follow-up to a Pap test with an unclear result of ASC-US (see Table 1).
• If you are age 30 or older, an HPV test can be very useful if it is done together with a Pap test as a routine screening for cancer once every 3 years.
But if you are under age 30, getting an HPV and a Pap test together on a regular basis is not helpful. HPV tests can lead to unnecessary treatment, because HPV infection is very common in women under 30 and usually goes away on its own. This is why cervical cancer is very rare for women in this age group.
What Do My Pap Test Results Mean?
Your Pap test results could be normal, meaning only normal cells were found, or abnormal. The term “abnormal” could mean many different things:
• Your test was unclear
• Your test showed you have an HPV infection
• Your test showed precancer
• Your test showed cancer
See Table 1 for more information about what these results mean and what your health care provider might recommend you do next. If you have an abnormal result from your Pap test, it’s very important that you get follow-up care and any needed tests or treatment as suggested by your health care provider.
How you can help improve the chances that your Pap test results will be correct:
• Don’t have a Pap test when your menstrual period is heavy. The best time to schedule a Pap test is between 10 and 20 days after the start of your period.
• For about 2 days before a Pap test, do not:
• Douche
• Use any creams or medicine in your vagina unless your doctor tells you to do so. These may wash away cells or hide cells with changes.
Don’t have sexual intercourse for 1 or 2 days prior to your Pap test. This may cause unclear results.
Why Did I Get an Unclear Result?
The Pap test is a very good screening test. But no test is perfect, including the Pap test. There are a lot of reasons why you might get an unclear result.
• Not enough cells: The lab sample may not contain enough cells with changes. This can happen if the area of tissue with changes is very small or hard to reach. It can also happen if not enough cells are put on the slide for the lab.
• Cells are clumped together: The lab sample has too many cells clumped together or hidden by blood or mucus.
Any of these things can make changes hard to spot. Changes that are missed once are often found the next time. Having another Pap test can help get a clear result.
Is It All Right if I Don’t Get Tested Again Right Away?
Changes in the cervix happen very slowly. So a few months’ delay in getting another test usually does not mean the difference between getting cancer and not getting cancer.
More serious problems can develop when you do not have regular Pap tests or when you do not go back to your health care provider for care after an abnormal result.
Questions To Ask Your Health Care Provider
Getting a Second Opinion
If you have cervical cell changes, your health care provider may want to do a series of tests or treatments, or may refer you to another provider.
• Tests help your health care provider learn more about the changes in your cervix (see Table 2).
• Treatments remove or destroy cells with changes so that healthy cells can grow back (see Table 4).
You should always feel at ease asking your health care provider about the reason for a test or treatment and what you should expect during and after it.
Here are some questions you may want to ask:
• What do my test results mean?
• What care is best for me?
• Is this a test designed to help you learn more about the changes in my cervix? Or is it a treatment to cure the changes?
• What are the possible results? Will I need more care afterward?
• Are there any risks or side effects? How can I manage them?
• Do I need to do anything special to prepare for this test or treatment?
• Do I need to do anything special to care for myself afterward?
• Will this affect my ability to get or stay pregnant?
• Will my health insurance pay for the treatment you suggested?
Getting a Second Opinion
If you are concerned about your Pap test results and don’t feel right about your health care provider’s recommendations, you may want to get a second opinion. Changes in the cervix happen very slowly. Most of the time, they take several years to become cancer. Waiting a few months before follow-up care usually does not affect the success of the care you choose. You may want to use this time to:
• Ask your health care provider to have another pathologist review your test results.
• Ask another specialist or gynecologist to review your care plan. (A gynecologic oncologist, a doctor who specializes in female cancers, is someone you might want to see.)
Many women feel uncomfortable asking for a second opinion. They may feel that they are being a bother or that they will offend their health care provider, but it is very common for women to seek one. And doctors often expect patients to ask for one. A second opinion may help you feel more sure that you have made the best choices about your health.
If you have health insurance, many insurance companies will pay for a second opinion if you ask for one.
Most of the time, your health care provider will suggest the name of another specialist if you want a second opinion. You may choose to visit this second health care provider. Or you may get names of specialists from your local medical society, a nearby hospital or medical school, or your friends or family members.
The NCI Cancer Information Service (see Resources) can help you find qualified doctors and programs through cancer centers and other cancer programs.
Finding the Support You Need
It can be scary when you find out your Pap test is abnormal. Many women have found it helpful to:
• Ask friends or loved ones for support. They can go to the health care provider’s office with you while you are learning about choices in testing and treatment.
• Ask your health care provider to:
• Help you understand medical terms that are confusing
• Tell you how other people have handled the types of feelings that you are having
Contact the organizations listed in the Resource section.
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