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Screening for Cervical Cancer

The American Cancer Society recommends annual Pap smears for women who are sexually active or who have reached the age of 18.

After three consecutive satisfactory, normal smears, testing may be performed less frequently, but it should be performed at least every 2-3 years. If a woman has had SIL on any previous Pap smear, annual smears should be performed throughout her life. Cervical Cancer Screening Pap Smear-

Management of Minor Pap Smear Abnormalities

Satisfactory, but Limited by Few (or absent) Endocervical Cells

Endocervical cells are absent in up to 10% of Pap smears before menopause and up to 50% postmenopausally.

Management. Either repeat Pap annually or only recall women with previously abnormal Pap smears.

Unsatisfactory for Evaluation

Repeat Pap smear midcycle in 6-12 weeks.

If atrophic smear, treat with estrogen cream for 6-8 weeks, then repeat Pap smear.

Benign Cellular Changes

Infection--Candida. Most cases represent asymptomatic colonization. Treatment is offered for symptomatic cases. Repeat Pap at usual interval.

Infection--Trichomonas. If wet preparation is positive, treat with metronidazole (Flagyl), then continue annual Pap smears.

Infection--Predominance of Coccobacilli consistent with Shift in Vaginal Flora

This finding implies bacterial vaginosis, but it is a non-specific finding.

Diagnosis should be confirmed by findings of a homogeneous vaginal discharge, positive amine test, and clue cells on microscopic saline suspension.

Infection-Herpes Simplex Virus

Inflammation on Pap Smear

III. Management of Squamous Cell Abnormalities

A. Atypical Squamous Cells of Undetermined Significance (ASCUS)

1. ASCUS indicates cells with nuclear atypia, but not atypia caused by human papilloma virus (HPV).

2. A Pap smear should be obtained every 6 months for 2 years. Annual Pap smears may be instituted after 3 consecutive satisfactory, negative smears. A repeat ASCUS smear within 2-years requires colposcopic evaluation.

3. ASCUS associated with severe inflammation and an identifiable cause of infection can be managed by treating the infection and re-evaluating the patient in 4-6 months with a repeat Pap smear. If ASCUS persists, colposcopy should be performed.

4. ASCUS in a postmenopausal patient may be secondary to vaginal atrophy. The patient should be treated with intravaginal estrogen cream for four weeks, followed by a repeat Pap smear. Colposcopy should be performed if ASCUS persists.

5. ASCUS with a qualification favoring a neoplastic process (SIL) should be evaluated with colposcopy.

6. ASCUS in a noncompliant patient or in a patient with a history of SIL on a previous Pap smear should be evaluated with colposcopy.

B. Low-Grade Squamous Intraepithelial Lesions (LSIL)

1. LSIL includes HPV and CIN 1 (or mild dysplasia). Koilocytotic atypia is indicative of HPV.

2. A Pap smear should be repeated

IV. Management of Glandular Cell Abnormalities

V. Colposcopically Directed Biopsy

VI. Treatment Based on Biopsy Findings