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Making your Pap test results less confusing

Your guide to understanding SIL, CIN & ASC-US

ladies exercise_smallMaybe you have had a Pap test and your doctor said that you have cervical dysplasia (also called CIN) ASC-US or SIL. Just hearing those words can be scary. Here’s some information to help make your Pap test results less confusing.

Pap test results are grouped into several categories depending on what the doctor sees when looking at the specimen under the microscope. If changes in cells from the cervix are found following a Pap test, it can mean that cancer – or a maybe a pre-cancer – is present.

The term ASC-US (atypical cells of uncertain significance) is used when the cells look abnormal, but it’s not possible to determine the reason why under the microscope.  It may be caused by an infection, irritation or a pre-cancer, for example. Usually ASC-US cells are not pre-cancer, but more testing needs to be done just to be sure. Which additional tests are needed will depend on the results of the tests already done.

Dysplasia and CIN (cervical intraepithelial neoplasia) are terms that describe changes in the cervix cells.

They are often given a grade of mild, moderate or severe:

  • Mild dysplasia (CIN1) may go away on its own without treatment
  • Moderate (CIN2) and Severe (CIN3) mean there are serious changes in the cells

SIL (squamous intraepithelial lesion) is a term used when the cells on the surface of the cervix appear abnormal under the microscope.

  • High grade SIL (HSIL) means the cells look very abnormal
  • Low-grade SIL (LSIL) means the cells look slightly abnormal

After a laboratory doctor, or pathologist, examines the cells under the microscope and assigns a category, your own doctor will discuss next steps with you, based on these categories. Sometimes, abnormal Pap results are tested further to see if the cells are positive for certain types of HPV (human papillomavirus) that can cause cancer. Other times, abnormal Pap results are followed up by having a procedure called a colposcopy.

Usually done in the doctor’s office, a colposcopy is a quick procedure where the cervix and vagina are examined by using a special lens to see if there are any areas that appear irregular or abnormal. If an abnormality is found, a biopsy is taken and sent to the lab where a pathologist determines if pre-cancer or cancer is present.

It’s good to know that having an abnormal Pap test is quite common, and does not mean you have cervical cancer. A Pap test may be repeated several months later , often showing things have returned to normal without any treatment.

If you have had an abnormal Pap test, ask your doctor to explain what the results mean for your situation, ask what tests or treatments are needed (if any), and how often you should come back for a follow up appointment. What’s key is that you follow up with your doctor to be sure that irregular areas go away on their own or are quickly treated to prevent a serious medical condition from developing.

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One thought on “Making your Pap test results less confusing

  1. There would be a lot less confusion if women were offered evidence based screening. Most women cannot benefit from pap testing, but are exposed to high risk with testing from false positives, excess biopsy and over-treatment. Damage to the cervix can lead to premature babies, miscarriages, c-sections etc.
    Using the HPV AND the pap test on all women over 30 simply causes confusion and generates the most over-investigation. The HPV test should stand alone as the primary test.

    The Dutch have a new program on the way, that puts women first. It’ll save more lives and take most women out of pap testing and harms way. They’ll scrap their 7 pap test program, 5 yearly from 30 to 60, and offer instead 5 hrHPV primary tests at ages 30,35,40,50 and 60 and ONLY the roughly 5% who are HPV+ and at risk of cervix cancer will be offered a 5 yearly pap test. (until they clear the virus)
    Those women who are HPV- and confidently monogamous or no longer sexually active might choose to stop all further testing.
    Dutch women are already using the Dutch-invented HPV self-test device, the Delphi Screener, also, available in Singapore and being rolled out in many other countries.

    Pap testing has been horribly over-used and used recklessly and inappropriately (without informed consent and in many cases, with no consent at all. i.e. medical coercion – no birth control pills UNLESS…) to create a hugely profitable industry in the over-treatment of CIN. There was never a need to worry and harm so many in an attempt to help so few. Since the 1960s the Finns have had a 7 pap test program (5 yearly from 30 to 60) and they have the lowest rates of cervical cancer in the world and refer FAR fewer women for colposcopy/biopsy etc. Over-screening simply sends up risk for zero additional benefit. (to women)
    So this is not new evidence.

    Testing women who’ve never been sexually active is unethical, risk for no benefit. testing those with no cervix after a hysterectomy for benign reasons is also, unethical.
    Cervical cancer has always been a rare cancer in the developed world, (0.65% is the lifetime risk) and it was in natural decline before screening started. Women’s healthcare is the poorer for this insane obsession with the cervix and focus on one rare cancer. There are far better ways (and that has always been the case) to deal with this rare cancer.
    (Lifetime risk of referral for colpocopy/biopsy in Australia is a whopping 77%, the States would be the same, and probably, higher with the testing of women never sexually active etc.
    The American well-woman exam is not evidence based and carries risk, even unnecessary surgery. The routine pelvic, breast, rectal, recto-vaginal or visual inspections of the genitals are not backed by evidence and are not recommended….they are FAR more likely to harm you.
    Mammograms, before agreeing to 2 yearly testing from 50 read the Nordic Cochrane Institute’s summary on the risks and benefits of mammograms, it’s at their website. The evidence is very concerning, about 50% of screen detected breast cancers are over-diagnosed, the fall in the death rate is mostly about better treatments, not screening. Also, any benefit from screening is wiped out by women who die from heart attacks and lung cancer after treatments.
    All cancer screening carries risk, legally and ethically, it requires our informed consent and yes, we can say NO. We need to make sure any routine/screening tests or exams are in OUR best interests.
    HPV Today, Edition 24, sets out the new Dutch program
    Delphi Bioscience can provide info on HPV self-testing.

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