Pap smear abnormalities (colposcopy)
Dr Moore is an accredited colposcopist, certified by the Australian Colposcopy Quality Improvement Program, and member of the Australian Society for Colposcopy and Cervical Pathology.
The Papanicolaou ("Pap") smear (or Pap test) is a screening test that aims to prevent cases of cervical cancer by detecting early "pre-cancerous" changes of the cervix to allow effective, curative treatment. Australia has one of the lowest rates of death from cervical cancer in the world, due largely to the organised National Cervical Screening Program. Pap smears are usually performed by General Practitioners, Gynaecologists, or specially trained nurses.
In Australia, all women who have ever been sexually active are advised to have a Pap smear every two years, even if they no longer have sex or have no unusual symptoms (such as unexpected bleeding, vaginal discharge, or pain). Women who have any of these symptoms should see their General Practitioner, even if a recent Pap smear was normal.
Importantly, the vast majority of abnormal Pap smears are not due to cancer, but rather to inflammation, infection, or a non-cancerous abnormality known as cervical intraepithelial neoplasia (CIN). Many of these require observation only, and your General Practitioner may recommend a repeat Pap smear after 4-6 months. Others, such as high-grade CIN, require referral to a Gynaecologist. A Pap smear is a screening test, meaning that it helps select women who may require a more thorough evaluation to make a diagnosis and determine treatment. This evaluation is accomplished by colposcopic examination, or colposcopy. Colposcopy involves using an illuminating microscope to examine the cervix more closely, allowing a small tissue sample (biopsy) to be taken. A biopsy allows a specially-trained Pathologist to make a more certain diagnosis of the cause of the abnormal Pap smear.
Almost all abnormal Pap smear results, and cervical cancers, are caused by the human papillomavirus (HPV).
There are over 160 types of HPV, and infection with HPV is very common; Professor Ian Frazer, developer of the HPV vaccine in Australia, aptly described HPV as "the common cold of sexual intercourse" - anyone who has ever had sex can contract HPV, and 80% of people will have had HPV at some time in their lives. HPV itself requires no specific treatment; in most cases, your immune system clears the virus in 8-14 months (importantly, persistence of HPV is highly associated with cigarette smoking). Rarely, the virus persists and can lead to CIN and cervical cancer, although progression to cancer is a very slow process (taking up to 10 years or more in most cases). The good news, however, is that the great majority of women with HPV will not develop cervical cancer.
Depending on the type of Pap smear and biopsy abnormality, you may require close observation only, or surgical treatment. Surgical treatments include diathermy ablation of the lesion, or excision by either a "loop excision" or cone biopsy. These are minor procedures, usually done as a "day case" under light general anaesthesia. Much less frequently, a hysterectomy (removal of the womb) may be indicated. Decisions regarding treatment are highly individualised and also depend on your age, plans for pregnancy, and your particular medical history. If you require treatment, Dr Moore will carefully explain the risks and benefits of all options, and the recommended course of action in your particular case.
Usually not. Depending on the abnormality that was found, the treatment(s) you may have had, and the findings after your treatment, it may be possible to return to routine (second-yearly) screening after a period of increased surveillance. After a follow-up colposcopy, most women will be able to return to the care of their General Practitioner for Pap smear and HPV testing as required.
The National Cervical Screening Program has an excellent FAQ resource page here.
Additionally, your General Practitioner will most likely be able to answer any questions you have, or may give you a referral to make an appointment with Dr Moore.
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David is a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, and undertook his specialist training in Queensland. He is highly skilled in the management of complex and high-risk pregnancies, and has special training in minimally-invasive surgery, endometriosis, pelvic floor and incontinence surgery. David has completed a Master of Reproductive Medicine and is skilled in the assessment and management of fertility problems, and can offer the full range of assisted reproductive treatments. He is a Senior Lecturer with The University of Queensland Medical School, and has published both medical journal and textbook contributions.
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