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Pap Test Results Often Confuse Women and Their Physicians

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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. continued...

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.

HPV is a sexually transmitted disease that has been rapidly increasing in the last 20 years. For many years gynecologists have known that HPV is associated with cervical cancer. Recent studies suggest that some strains of the virus are more likely to cause invasive cervical cancer than other strains of the virus, says Waxman.

For women with atypical cells, an HPV test can detect more than 90% of the cases that will progress to invasive cancer says Waxman. But he says that even HPV testing is not a simple matter because "most HPV infections are cleared, meaning that the virus does not go on to promote cancer." He says that most HPV infections last for "an average of eight months and young women are very likely to clear the infection." Waxman defines young woman as "younger than 30."

So if a young woman has atypical cells and tests positive for HPV, Waxman says he is likely to take a watchful waiting approach with her but if an older woman has the same clinical findings and has not recently changed sexual partners, he will "do a cone biopsy." A cone biopsy involves removing a small sample of tissue from the cervix.

In addition to HPV testing, some gynecologists are now using liquid-based testing methods such as ThinPrep for Pap tests.

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