Like many tests in medicine, the pap smear is done to find an abnormality that you really hope not to find. George N. Papanicolaou, in 1928, studied the cellular changes in the vaginas of guinea pigs and found he could predict which animal would develop a genital tract cancer. In the 1950s this was found to be an effective screening method in women and since then it has greatly increased the number of curable cervical cancers found. A pap smear is only a screening method, it can not be used to direct therapy and only tells use we must look closer at the cervix for a pre-cancerous area called dysplasia or cervical intra-epithelial neoplasia (CIN).

The way we look closer is with the colposcope. It is a microscope used by the Gynecologist, in his office to magnify the cervix. The surface blood vessels of the cervix are examined for areas with known patterns of abnormality. These areas are sampled (biopsied) and this tissue is examined by a pathologist for the severity of the problem. Dysplasia can be mild (CIN I) moderate (CIN II) or severe (CIN III).

It is probably a combination of several things. Lately, human papilloma virus (HPV) is getting a lot of attention as the culprit. It is passed from one person to another with intercourse. HPV causes venereal warts, which can be invisible to the naked eye on the male. This would explain why the partners of some men seem to be more prone to get cervical abnormalities and why cervical cancer is virtually non-existent in virgins. Also, women who begin their sexual activity at an early age increase their risk of cervical disease. The cervix appears to be more susceptible to dysplasia in the developing teenager. If they become sexually active, teens should get yearly pap smears, as well as counseling on birth control. It is beginning to look like cervical dysplasia may be just another sexually transmitted disease. Also, resent studies, now show that nicotine is concentrated in the mucus of the cervix and this may be why women who smoke are at increased risk for cervical cancer, as well as lung cancer!

How is a cervical dysplasia treated?

Therapy can be based on the biopsies that are obtained with the colposcope. For mild dysplasia (CIN I) observation is reasonable in young women who desire future fertility. Over 50% of these low grade abnormalities resolve on their own. Treatment can be freezing the abnormal areas on the cervix, using an electric loop to remove the area (which can both be done in the office), or by using a laser to burn the areas away in the operating room.

If the lesion can not be completely evaluated, or is too severe to safely diagnose with the colposcope, a larger sampling, called a "cone biopsy" is required. This removes the entire area of the cervix that is subject to this pre-cancerous change. This supplies more tissue for examination and evaluation, and, at the same time, can cure the problem completely by removing all the dysplasia. A cone biopsy is done as out patient surgery.

In closing, the pap smear is great preventive medicine, but you must have it done for it to prevent anything.