What is a cytological study PAP test (Pap test). Women Health. What is a PAP test? When, to whom and why a smear is prescribed for cytology

In fact, Papanicolaou cytological examination is one of the staining methods for microscopic examination and is based on the different reaction of cell structures to acidic and basic dyes.
But the undoubted merit of George Papanicolaou is that he was the first to use this staining method and substantiate its importance for the diagnosis of precancerous and cancerous diseases of the cervix. The first description of the method appeared in 1928, and in 1943 the method officially became used for the cytological diagnosis of cervical cancer worldwide. Currently, the Pap test (named after the scientist) is the main diagnostic method for this common deadly disease in women.

How is the Pap test (Pap test) performed?

After taking the material, it is sent to the laboratory, where it is first stained with basic hematoxylin or orange dyes, and then with an acid dye
more often eosin. As a result of staining, it is easy to determine changes in the nuclei, cytoplasm of cells. First, the nature of the pathological process is determined - inflammatory,
reactive, malignant, then, according to the composition and changes (degrees of severity of signs of atypia) of cellular elements, a differential diagnosis of malignant and benign processes is carried out.

How is the PAP test (Par test) evaluated?

Since 1954, a five-class classification has been used, which was developed by D. Papanikolaou. This classification is still used in some laboratories in Russia, but in world practice it is not used and represents
only of historical interest.

What systems are used to evaluate the Pap test

WHO classification

In 1968, the World Health Organization proposed a new descriptive system for scoring the test based on morphological criteria. Class 2 according to the Papanicolaou classification was divided into three forms of atypia, class 3 was described in three forms of dysplasia - mild, moderate and severe, class 4 was described as cancer in situ and 5 as invasive cancer.

CIN classification

In 1978, Richart proposed a histological classification and introduced the term CIN (cervical intraepithelial neoplasia) - cervical intraepithelial neoplasia, the degrees of which corresponded to the degrees of dysplasia of the WHO classification.

Bethesda system classification

In 1988, the US National Cancer Institute proposed a new,
cytological, Papanicolaou test evaluation system - Bethesda system, which is still used in world medicine. All changes were divided into 2 types - ASCUS (atypical squamous cells of undetermined significance) squamous cell atypia of uncertain significance and SIL (Squamous Intraepitelial Lesions) squamous intraepithelial lesions , which in turn were divided into 2 categories - low severity (LSIL - Low-Grade Squamous Intraepithelial Lesions) and high severity - (HSIL - High-Grade Squamous Intraepithelial Lesions)

What are benign cell changes

In some processes, benign changes in the cells of the epithelium of the cervix occur. These changes are evaluated by the Pap test as inflammatory atypia, atypia caused by papillomavirus, or as mixed atypia or atypia of uncertain significance.

Causes of benign changes

• Pregnancy
• Exposure to chemicals (drugs)
• Infection caused by actinomycetes
• Atrophic vaginitis
• Radiation damage (with radiation therapy)
• Intrauterine contraceptive (spiral)

What are atypical squamous cells

What is cervical dysplasia

Dysplasia (or cervical intraepithelial neoplasia - cervical intraepithelial neoplasia - CIN) of the cervix is ​​a pathological process that begins in the transitional metaplastic epithelium and is expressed in the appearance of atypical cells against the background of increased proliferation of basal and parabasal cells. Dysplasia can progress to squamous cell carcinoma (cervical cancer ) or spontaneously regress or regress after treatment.

What is ASCUS

What is Low Grade SIL

What is High Grade SIL

What are atypical glandular cells

With the help of the Pap test, atypical cells of the glandular epithelium can be determined.

What to do with an abnormal Pap test (Pap test)

For LSIL-type cytological features (low-grade cervical intraepithelial lesions or features of HPV and CIN I), the International Agency for Research on Cancer recommends:

This is a test that evaluates the structure of the cells of the cervix. It got its name in honor of the Greek physician Papanikolaou, who first introduced it into medical practice in the 50s of our century. In Russia, this study is also called the Pap test or its other name is "cervical cytology" (from the word "cyto" - cell). The Pap test helps to identify various changes in the structure of the cells of the cervix, which can lead to the development of cancer. Detection of these changes and their appropriate treatment prevents the development of cancer.

Thus, the main goal of performing cytology is the prevention (ie prevention) of cancer. For example, in the United States, where the Pap test is mandatory for preventive examinations by a gynecologist, the incidence and mortality from cervical cancer has decreased by 70% over the past 40 years.

Can a Pap Test Detect Cervical Cancer?

Yes. But the main role of the test is to detect cell changes that usually precede the onset of cancer. These changes are also called precancerous changes. It usually takes several years from the onset of abnormalities in the structure of cells to the onset of cancer. And if a Pap test is regularly performed in this time interval, which will reveal these disorders, then with the help of early treatment it is possible to prevent the development of cancer or to detect it at a very early stage. To confirm and clarify the diagnosis of cancer found in the cytology of the cervix, other additional studies are carried out.

Does the Pap test detect or prevent cancer in other organs?

No. This test allows you to evaluate the structure of only the cells of the cervix and no other organs. The cervix is ​​a narrow tube located in the lower part of the uterus, which opens into the vagina with its outer end. Outside, it is covered with a thin pink epithelium, which in appearance resembles the tissue in your mouth. This epithelium consists of 4 layers of cells of different structure and is called "stratified squamous epithelium".

From the inside, the neck is covered with epithelium, consisting of one row of cylindrical cells. Therefore, this epithelium is called "column epithelium". It has a bright red color. Cytology of the cervix examines the structure of cells located both outside and inside.

How is cervical cytology performed?

A Pap test is done during a gynecological exam. The doctor will ask you to undress and lie down on the gynecological chair. In order to see the cervix, the doctor will insert a special instrument called a speculum into the vagina. After removing the discharge from the vagina, using a small brush and a wooden spatula, the doctor makes a scraping for examination from the outer and inner surface of the cervix. This is a completely painless procedure that lasts 5-10 seconds.

Cells are applied to special glasses, sent to the laboratory, where they are examined under a microscope by a cytologist. The cytologist determines whether the sent material contains cells with a modified structure or not, and informs the gynecologist about this (usually in the form of a written opinion). Since the doctor scrapes them off during cell sampling, some women, after cytology, may have extremely slight, spotting bloody discharge from the genital tract over the next 1-2 days.

Do I need to prepare for a Pap test in any way?

Yes. To take cytology, come in the first few days after the end of menstruation. 2 days before the Pap test, it is not recommended to use any medications for vaginal use, spermicidal contraceptives, vaginal lubricants, moisturizers. All this can affect the true picture of the structure of the cells of the cervix.

It is not recommended to conduct a study in the presence of symptoms such as itching and which may indicate a possible infection. In this case, it is better to consult a doctor to find out the cause of these symptoms.

How often should cytology be performed?

The first Pap test should be performed immediately after the onset of sexual activity. Then once a year, during your annual preventive visits to the gynecologist, regardless of whether you are sexually active or not. If you have good Pap test results for 3 years in a row (i.e. you do not show changes in the structure of the cells of the cervix), then a Pap test is performed once every 2-3 years until the age of 65. After age 65, the Pap test may be discontinued, provided that all previous results were good.

Of course, the frequency of a Pap test can vary. Your doctor may recommend that you do this test more frequently if you have a history of cervical abnormalities and/or risk factors for cancer, such as:

• more than one sexual partner or a partner who has other sexual partners besides you
• early onset of sexual activity (before 18 years of age)
• past or current sexually transmitted diseases (), especially such as genital herpes and papillomas on the genitals
• HIV infection
• smoking

How accurate is the Pap test?

Like any medical test, the Pap test is not always 100% accurate. Those. sometimes pathological changes are described in the conclusion of the cytology of the cervix, but in fact they are absent. Such a result is called a false positive. Or vice versa, the conclusion of the Pap test is good, while in reality there are violations in the structure of the cells. Such a result is called a false negative.

The most common cause of false-positive cervical cytology results is the presence of inflammation in the vagina or cervix. In this situation, if the doctor sees an abnormal Pap test + signs of inflammation, then it is usually recommended to conduct a course of anti-inflammatory treatment and repeat the Pap test after it has ended.

Reasons for a false negative Pap test may include:

• too few cells on the slide for examination
• infection in the vagina and cervix
• blood in the test
• use of vaginal medications, lubricants 1-2 days before the test

Proper preparation, regular testing (as recommended by your gynecologist) helps to minimize the frequency of inaccurate Pap test results.

BUT what if the Pap test shows abnormal cells?

In this case, the doctor recommends an additional examination. This may be as simple as repeating the Pap test some time after the first result. Sometimes a special study is prescribed - colposcopy. - this is a study when the cervix is ​​examined by a gynecologist under strong magnification (usually 7-15 times) using an instrument called a colposcope (similar to a large microscope). During such an examination, the doctor can see the area where the pathological changes found in the Pap test are located.

In addition, during a colposcopy, the doctor decides whether you need to clarify the diagnosis. Depending on the result of the Pap test and colposcopy (with or without a biopsy), your doctor may recommend that you either simply follow up with periodic cervical cytology or have any abnormal cells removed.

The basis for the early diagnosis of cervical cancer is a Pap smear ( Pap test). A smear is a scraping of uterine tissue and examination of cells under a microscope. Like all human organs, the uterus is made up of different layers of cells. The outer surface consists of epithelium, they are constantly replaced by new ones. During the process of maturation and replacement, cells move along the surface, where they are sometimes deposited and can be taken for analysis. The widespread use of a simple cytological study has reduced the incidence of cervical cancer by 2 times. The Pap test is also informative in some other cases. For example, when examining any secretions (urine, feces, sputum, etc.), it is possible to recognize cancer of the bladder, stomach, and lungs. However, most often the Pap test is used in gynecology.

Georgios Papnikolaou, the founder of medical cytology, discovered that malignant tumor cells enter the vaginal secretion. Accordingly, the study of this secret for pathological cells has become the basis for the early diagnosis of tumors.

The Pap test is mandatory for all women during a gynecological examination, starting at the age of 21, annually. Thanks to the introduction of this test into the work of gynecologists, the incidence of cancer among women has been reduced by 60-70%. To obtain the material, the doctor conducts a scraping of the epithelium from the surface of the cervix and cervical canal. The analysis is best done on the 10-20th day of the cycle. In the lab, samples are stained for better examination. The type of cells, their size, number and structural features, etc. are evaluated. The result is usually ready in 1-3 days. The smear may be positive or negative. With a negative result, there are no atypical cells, the cells have the same size and shape. A positive result reveals cells that are different in shape and size, their location is not normal. The results of the smear indicate what changes were found:

ASC US- abnormal cells of the surface epithelium, their appearance is associated with dysplasia, papillomavirus, chlamydia and other infections, mucosal atrophy during menopause. It is recommended to be tested for the human papillomavirus (HPV), which is one of the main causes of cervical cancer.

LSIL- Squamous cell lesions of low severity. Causes may be dysplasia, papilloma virus. The risk of cancer is low. It is recommended to conduct an HPV test, colposcopy.

ASC-H- Abnormal epithelial cells. Causes of cell detection: precancerous changes, the initial form of cancer. An extended colposcopy is recommended.

HSIL- high-grade squamous cell lesions. These lesions can develop into cancer cells. Causes - high-grade dysplasia, cervical cancer. Colposcopy or biopsy recommended .

AGC- Abnormal glandular cells. Causes: high-grade dysplasia, endometrial cancer, cervical cancer. HPV analysis, colposcopy, endometrial scraping are recommended.

AIS- squamous cell carcinoma, cells typical of cervical cancer. Causes - cervical cancer, high-grade dysplasia. Recommended diagnostic curettage, diagnostic excision (removal of the mucosal area).

Benign glandular changes- wandering connective tissue cells. Their detection may be evidence of endometrial cancer, precancerous changes. For women who have not reached menopause and do not have other adverse symptoms, benign glandular cells are considered a normal option. Diagnostic curettage is recommended.

Despite all the informativeness and high significance of the PAP test, its results depend on the quality of the material sampling and some other factors. Therefore, the results may be erroneous.

False positive Pap test- the result indicates the presence of dysplasia, although the woman is healthy. Such a result may be due to past inflammatory or infectious diseases of the genital organs, erosion, hormonal disorders. A repeat Pap test and colposcopy are recommended.

False negative Pap test- indicates the absence of the disease, although it is present. The reason may be incorrect sampling of material for analysis, laboratory error. It is recommended to carry out a colposcopy in addition to the Pap test.

Possible pathologies in the conclusion of the Pap test:

- inflammatory process - the inflammation caused by the infection should be treated, after which a second PAP test is prescribed. If the papilloma virus is detected during the examination, then the patient undergoes long-term treatment under the constant supervision of the attending physician.

- atypical epithelial cells - moderate changes, deviations from the norm, but not yet cancerous cells. Most often, atypical cells disappear on their own. If dysplasia is detected, treatment is carried out.

- pathology of the epithelium of a high level - a serious pathology of cells, but not yet cancer. Only in 1-2% of cases of such a conclusion, cancer is detected during a biopsy. Further examination, colposcopy, biopsy is required.

Epithelial neoplasia is a serious form of pathology of epithelial cells. A thorough examination and immediate treatment is required.

- cancer in situ - the development of cancer cells in a limited area, without moving to other areas.

Thus, the Pap test helps to identify not only cancerous and precancerous conditions. During the analysis, inflammation, infection, atrophy of the cervix can be detected. Modern cytological examination is one of the most effective methods for diagnosing neoplasms.

A gynecological Pap smear is a simple, painless test used to diagnose endometrial and cervical cancer. It is based on the work of George Papanicolaou, who discovered that malignant tumor cells slough off into vaginal secretions.

Research principle

Every year, 500 thousand women fall ill with cervical cancer in the world. Over the past 30 years, the incidence has decreased by more than 2 times. This is largely due to the widespread use of screening cytology.

The basis of early detection of cervical cancer in large populations over the past 60 years is the Pap smear.

What is a Pap test (also known as Pap smear)?

This is an exfoliative cytological procedure with staining of the obtained material. In other words, a Pap smear is a scraping of the tissues of the surface layer of the cervix and examination of the resulting cells under a microscope after treatment with special dyes. The method is also used to detect cancer of the bladder, stomach and lungs. Any body secretions (urine, feces, sputum, prostate secretion), as well as biopsy material, are suitable for it.

However, most often the Pap smear is used to diagnose the initial stages. The material is taken from the transition zone of the cervix, where the columnar epithelium of the cervical canal borders on the squamous stratified epithelium lying on the vaginal part of the cervix. The resulting sample is placed on a glass slide, stained, and examined under a microscope to detect abnormal or malignant cells.

What does it show?

It detects precancerous and malignant changes (cancer) of the cervix. After a few minutes, the analysis can reveal or its neck at a stage when the tumor is not accompanied by external changes and damage to surrounding tissues. At this time, the malignant neoplasm is successfully cured. Therefore, a Pap test is recommended for all women over the age of 21.

The liquid-based cytology Pap test aids in the detection of . At the same time, an additional study is carried out to identify the DNA of the virus. This pathogen is a major risk factor for cervical cancer. When using the method of liquid cytology, the material is placed not on a glass slide, but in a test tube with a liquid preservative.

A smear for the human papillomavirus is prescribed in case of doubt in the results of a cytological examination. Both traditional analysis and liquid cytology have equal diagnostic efficiency. Both of these methods can be used in practice.

HPV testing is not performed in women under the age of 30 due to the high prevalence of this infection in this age group. In addition, often the infection is transient, that is, it can disappear.

Although the interpretation of the results largely depends on the qualifications and experience of the doctor, there are objective ways to improve the accuracy of the diagnosis. So, special computer programs are being developed. Some clinics retest some swabs for quality control.

Much depends on the correct preparation of the woman for the study.

Test preparation

The analysis is carried out during a scheduled examination by a gynecologist. The doctor should be informed about the contraceptives and other hormonal drugs taken.

Special preparation for the Pap test:

• refrain from vaginal intercourse for 48 hours before the study;
• at the same time, do not use vaginal tampons, do not douche, do not use drugs or contraceptives inserted into the vagina;
• it is desirable to pre-cure, if any.

Pap test, in other words Pap smear

On what day of the cycle should I take the test?

There are no special restrictions. The only condition is the absence of menstrual or other uterine bleeding. However, the analysis can be taken even during menstruation, but its accuracy is reduced.

If a woman has bleeding or cervicitis (inflammation of the cervix), this is not a contraindication for the study. These symptoms may be caused by precancer or malignancy, which can be detected during screening.

Indications

For the timely diagnosis of malignant tumors, a simple method that has no contraindications is needed. Pap test of the cervix is ​​a screening test that allows you to regularly examine most women.

Table. When is the best time to do a Pap test?

Some women have a higher than average risk of developing cancer. They may need more frequent testing.

At-risk groups:

• women infected with HPV or HIV;
• survivors and venereal diseases;
• immunocompromised patients;
• early onset of sexual life;
• multiple sexual partners;
• had;
• smoking or drug use.

A Pap test during pregnancy is mandatory to exclude infections and precancerous diseases. It does not carry any danger to the expectant mother and baby.

How is it carried out?

For the analysis are used:

• gynecological chair and lamp;
• metal or plastic vaginal dilator;
• examination gloves;
• cervical spatula and a special brush;
• test tube or glass slide.

How is a Pap smear performed?

The patient is located on the gynecological chair. Her coccyx should be on the edge of the chair to ensure a good view when the dilator is inserted.

A dilator is placed in the vagina. It is previously recommended to warm it in warm water for the comfort of a woman. In some clinics, if necessary, a small amount of a special lubricant is used to facilitate the insertion of the dilator.

The surface of the cervix should be completely open and well examined by a doctor. It is necessary to visualize the squamous epithelium, the transition zone and the external pharynx. The transition zone is the area where the squamous epithelium is transformed into glandular. HPV affects this area. Therefore, the selection of cells is carried out in this zone. In addition, material is taken from the surface of the neck and from the area of ​​the external pharynx.

If necessary, the neck is cleaned of secretions with a soft swab. Taking the material is taken with a spatula or a special brush, turning them around its axis.

Depending on the equipment used, the resulting material is either placed in a special solution, which is in a test tube, or on a glass slide, which is then applied with a fixative and placed in an alcohol solution.

The study is completed within a few minutes. It is painless. After the analysis, within 5 days it is better to refuse sexual intercourse, the use of tampons and douching.

Can I take a bath after a Pap test?

Complications and restrictions

Adverse effects after a Pap smear are very rare. A woman should be warned of the possibility of weak spotting. This is fine. Another complication is the addition of an infection. However, its probability is very low, since the procedure does not damage the blood vessels and sterile instruments are used.

Although the Pap smear is one of the best screening methods, it has its limitations. The sensitivity of a single Pap test in detecting cervical dysplasia averages 58%. This means that the existing disease will be found in only half of the women who actually have it. Approximately 30% of women with newly diagnosed cervical cancer had a negative test result.

Higher sensitivity has HPV testing. In the group of women over 30 years old, it allows diagnosing dysplasia in 95% of cases. However, in younger women, such an analysis becomes less informative.

results

If the interpretation of the results of the Pap test showed the presence of abnormal cells, the patient is assigned a colposcopy. This study helps to detect precancerous and malignant changes using a biopsy - taking a piece of tissue for microscopic analysis. If a precancerous disease is detected and treated in time, this will save the patient from cancer.

How many days is the analysis done?

The result is ready in 1-3 days, when using automatic analyzing systems, the time to obtain the result is reduced. In some public clinics, the waiting time for the result increases to 1-2 weeks.

There are 5 classes of smears:

1. Normal, no abnormal cells.
2. Cellular change associated with inflammatory disease of the vagina or cervix.
3. Single cells with altered cytoplasm or nucleus.
4. individual malignant cells.
5. Atypical cells in large numbers.

The Bethesda classification system is also used. In accordance with it, a low and a high degree of change are distinguished. Low includes koilocytosis and CIN grade I. High includes CIN II, III and carcinoma in situ. This corresponds to grades 3-5 smears.

As a result of the analysis, you can see the following designations:

• NILM - the norm, corresponds to class 1 smear.
• ASCUS - atypical cells of uncertain significance. They can be caused by dysplasia, HPV infection, chlamydia, mucosal atrophy during menopause. HPV testing and a repeat Pap test in a year are required.
• ASC-H is an atypical squamous epithelium that occurs in CIN grade II-III or early cancer. The tumor occurs in 1% of women with this result. An extended colposcopy is scheduled.
• LSIL - a small number of altered cells, indicates mild dysplasia or HPV infection. HPV testing is necessary, and if a virus is detected, a colposcopy. A repeat Pap smear is performed after one year.
• HSIL - pronounced changes corresponding to CIN II-III degree or cancer in situ. Without treatment within 5 years, cancer will occur in 7% of these patients. A colposcopy with biopsy or diagnostic excision is prescribed.
• AGC - altered glandular cells that occur with dysplasia and cancer of the cervix and body of the uterus. An HPV study, colposcopy, curettage of the cervical canal are prescribed. If a woman is over 35 and has irregular uterine bleeding, a separate diagnostic curettage is performed.
• AIS is carcinoma in situ, an early stage of a malignant tumor. Shown colposcopy, diagnostic excision, separate diagnostic curettage.
• High-grade SIL - squamous cell carcinoma.
• Adenocarcinoma is a tumor that develops from the glandular epithelium of the cervical canal.

Benign glandular changes are considered a normal variant in women with a normal menstrual cycle. If there is irregular bleeding, or the patient is in menopause, diagnostic curettage of the endometrium is indicated to rule out uterine cancer.

With any variant of the Pap test, a consultation with a gynecologist is necessary.

Doctors regularly take a Pap smear (PAP test) from female patients during routine check-ups to check for abnormal cell changes in the cervix. If left untreated, these changes can lead to cervical cancer. Negative (normal) test results indicate the absence of abnormal cells. This means that you do not need to undergo additional examinations before the next scheduled examination. Positive (abnormal) results indicate a potential problem.

Steps

Part 1

Keep calm. Many women are very worried when they receive a positive test result, but at this stage there is no reason to panic. In most cases, positive results do not indicate cervical cancer. You will have to follow the instructions of the doctor and, possibly, undergo additional examination to determine why suspicious changes were found in the smear at the cellular level in the cervix.

Read information about HPV. Most often, abnormal smear results are caused by the human papillomavirus (HPV). This virus is sexually transmitted and is so common that most sexually active people will experience this problem sooner or later.

• There are many different types of HPV, some of which can lead to cervical cancer. For many people, this virus will never develop and will go away on its own. Having HPV does not mean you have or will ever have cervical cancer.

1. Be aware of other possible causes of abnormal smear results. When taking birth control pills, a smear test may turn out to be a false positive. Some women may experience cellular changes in the cervix that are not caused by HPV. Hormonal imbalances, fungal infections, vaginal sex, use of tampons, douche, or vaginal cream within 48 hours before a pap test may cause incorrect results.

2. Decipher your test results. There are a number of "positive" or "abnormal" indicators, and some are more important than others. The next step depends on the specific results of the cytological smear.

   • Atypical squamous cells of indeterminate significance (ASC-US) are cervical cells that look abnormal, but are not necessarily cancerous or precancerous.
   • Squamous intraepithelial lesions are cells that may be precancerous. Their presence is called cervical dysplasia (CIN), which has several degrees: CIN 1 (weak), CIN 2 (moderate) and CIN 3 (severe).
   • Atypical glandular cells are glandular cells (cells that produce mucus in the uterus and cervix) that are abnormal but are not necessarily cancerous or precancerous.
   • Squamous cell cancers may indicate that the cancer is already present in the cervix or vagina. These cells, along with adenocarcinoma, are one of the most potentially dangerous Pap smear findings.
   • Adenocarcinoma means that the cancer may already be present in the glandular cells. Along with squamous cell carcinoma, this is one of the most potentially dangerous smear results. It may indicate the presence of cancer of the uterus (endometrial carcinoma), so your doctor may refer you for an endometrial biopsy.

3. Ask about colposcopy. Your doctor may also suggest a colposcopy, a procedure that uses a magnifying device called a colposcope to examine your cervix in more detail. If your doctor sees any potential problems, they may also refer you for a cervical biopsy for further investigation.

   • If you think you may be pregnant, tell your doctor before your colposcopy. The risk of miscarriage is small, but bleeding is possible after the procedure.
   • Do not insert anything into your vagina (avoid tampons, do not shower, do not take medications, avoid sexual contact) for at least 24 hours before the colposcopy.

Part 3

1. Find out if you need any treatment. In most cases, doctors simply recommend regular checkups and Pap smears to keep things under control. However, you may also need additional testing.

   • Keep in mind that a Pap smear will reveal the presence of certain abnormal cells, but the doctor will not be able to make a diagnosis based on it alone. If he sees a potential problem, he will refer you for a colposcopy or biopsy to find out the cause.

2. Choose the treatment that's right for you. If a doctor recommends removal of precancerous cells, there are several treatment options available. These procedures may seem intimidating and painful to you, but keep in mind that they are performed under anesthesia so that you can feel comfortable.

   • Loop-assisted electrosurgical excision procedure (LEEP) is a process in which a physician cuts out abnormal tissue with a small, electrically energized wire. This procedure is performed in the doctor's office under local anesthesia and takes only a few minutes. This is the most common treatment.
   • Cryotherapy is another procedure performed in a doctor's office using a cold probe to freeze abnormal cells. This procedure is very fast and does not require anesthesia.
   • Conization is a procedure in which a doctor removes abnormal cells with a scalpel. This procedure requires general anesthesia, so you will have to go to the hospital.
   • Laser therapy is a procedure in which a doctor uses a laser to remove abnormal cells. Like conization, this method is performed in a hospital under general anesthesia.

• Get regular check-ups, take a smear, including a Pap smear. This process may seem uncomfortable, especially if you have abnormal test results, but this procedure is the best defense against cervical cancer.
• The most common cause of cervical cancer is the human papillomavirus (HPV). This virus is widespread, but often asymptomatic, so don't assume that you won't be affected by HPV or cervical cancer if you don't feel any discomfort. Regular examination is very important.
• Quit smoking. Besides HPV, smoking is another risk factor for cervical cancer.
• Women younger than 27 should consider HPV vaccination. The HPV vaccine will not cure the virus or change the result of a smear test, but it can protect you from future HPV infections and cervical cancer that it causes. The HPV vaccine is a very controversial topic, so consult your doctor and make an informed decision.
• It's perfectly normal to feel worried and upset when you get abnormal test results. Talk to a partner, friend, or relative. Talk about your feelings and concerns. If you let your emotions out, you may feel better.