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Pap Test Results Often Confuse Women and Their Physicians

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May 4, 2001(Chicago) -- This year about 12,900 American women will be diagnosed with invasive cervical cancer. Unfortunately, half of these women never had a Pap test, the simple screening test that experts say is responsible for a 74% decline in the number of cervical cancer deaths in the last 50 years.

But even with the dramatic decline in cervical cancer mortality, over 4,000 women are expected to die from the disease this year according to the American Cancer Society. Alan G. Waxman, MD, says that the traditional Pap test does miss some cancers and sometimes Pap tests raise more questions than they answer.

For more on cervical cancer and other health conditions, go to WebMD's Women's Health: Common Conditions board moderated by Jane Harrison-Hohner, RN, RNP.

Waxman, an associate professor at the University of New Mexico Health Sciences Center, tells WebMD that experts from the National Institutes of Health are convening this week in Bethesda, Md. to refine classifications of Pap test results. Many gynecologists hope they will issue new information that may help unravel some of the confusion surrounding ambiguous Pap test results.

Meanwhile, Waxman, who conducted a seminar on cervical cancer screening at the American College of Obstetricians and Gynecologists Annual Clinical Meeting held here this week, says that one of the most confusing Pap test results for both women and their doctors is atypical squamous cells of undetermined significance, also known by doctors as ASCUS.

Doctors don't know if these atypical cells are precancerous or not. But Waxman says that there is no simple answer to the question because not all cells that are labeled ASCUS are alike.

Waxmen says that the experts in Bethesda are working on a way to describe atypical cells that are likely to progress to cancer and those that are "likely to clear on their own." The ability of these cells to appear and then disappear is particularly frustrating to women who may be told that their Pap test results "showed some abnormal cells" so they are asked to return for a second Pap test or a colposcopy, a procedure in which a the cervix is visually examined and sometimes tissue is removed for laboratory analysis.

Colposcopy is the "gold standard for identifying cervical cancer," says Neal M. Lonky, MD, MPH, director of medical education and research in obstetrics/gynecology and infertility at Kaiser Permanente in Anaheim, Calif. "You know there are some cancers that are never detected by Pap test. You can see the lesions on the cervix but a Pap test won't find them," Lonky tells WebMD.

Waxman says that visual examination may be the best approach for some women, especially women who have repeated findings of atypical cells on Pap tests. "I think that when this keeps happening it is time to examine the cervix with colposcopy," he says.

But Waxman says that sometimes the confusion over atypical cells can be sorted out by testing for the human papillomavirus known as HPV.

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