Pap smears

Abstract

The premalignant phase of cervical cancer is well recognized, easily detectable, and easily treated. Pap smears should be done annually in most womeN. but may be done less frequently in low risk women who have had three consecutive negative Pap smears. The evaluation of women with abnormal Pap smears should follow a careful stepwise approach. The Bethesda classification system is used for reporting cervical cytology. Because of the incidence of false-negative Pap smears, negative cytology should be repeated annually for three years before disease can be reliably excluded. Women with atypical smears are at risk for cervical dysplasia. Their evaluation should not be considered complete until they have had a negative colposcopy, three consecutive negative Pap smears, and/or a negative cervicography. Women with smears suspicious for squamous intraepithelial lesions should be evaluated with colposcopy and biopsy. If the colposcopy is satisfactory, women with low-grade disease may be followed closely with cytology and colposcopy. Women with high-grade disease may have transformation zone ablation with cryotherapy, laser vaporization. or electrosurgical loop excision. Women with an unsatisfactory colposcopy should have cervical conization. By using the protocols outlined above, significant disease can be recognized and treated, and unnecessary treatment can be avoided.