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By the way, doctor: What can be done about inadequate cells on a Pap test?

By the way, doctor

What can be done about inadequate cells on a Pap test?

Q. I’m 48 years old, and 26 years ago I had a cone biopsy after an abnormal Pap test. Since then, all my Pap tests have been normal. But for the past three years, scar tissue has made it difficult for my gynecologist to get adequate cells. What do I do about Pap smears now?

A. A Pap test report of “inadequate cells” can mean either there aren’t enough cells to interpret the Pap, or endocervical cells are missing. If it’s insufficient cells, you can simply repeat the test in a few months. If it’s lack of endocervical cells, your clinician may take extra steps to get an adequate sample.

Endocervical cells are important because they reside in the part of the endocervical canal where changes that lead to cervical cancer occur. Scarring from a cone biopsy can narrow the canal and make it difficult to obtain endocervical cells. Narrowing is also caused by falling estrogen levels and is often seen in postmenopausal women.

Whether endocervical cells are needed for routine Pap test evaluation is debatable, but many clinicians think it’s important to examine them in women who have been treated following an abnormal Pap. In this case, vaginal estrogen may be prescribed to counter atrophy or inflammation, which can affect the availability of endocervical cells. The Pap test is then repeated in a few months. If this fails, the cervix can be dilated to retrieve the cells, but this is uncomfortable and may be unnecessary if a woman’s cervical cancer risk is low.

The protocol for Pap test screening depends on a woman’s risk for developing cervical cancer. Women over 30 and at average risk who have had three consecutive normal annual Pap tests only need to be screened every two to three years. Women should be screened annually if they have risk factors for cervical cancer, including exposure to diethylstilbestrol (DES), immune system problems, smoking, HIV infection, having new or multiple sexual partners, and infection with a high-risk human papilloma virus (HPV). These viruses are sexually transmitted and the major cause of cervical cancer. A Pap test can show the presence of HPV even if the number of endocervical cells retrieved is inadequate.

I’d recommend that your clinician check for HPV. If the test is negative and you don’t have other risk factors for cervical cancer, you can have routine Pap tests. As long as the cells aren’t atypical, you needn’t worry about inadequate endocervical cells. Be sure to tell your doctor about any change in your health or sexual behavior, such as a new sexual partner, that might change your cervical cancer risk.

— Celeste Robb-Nicholson, M.D. Editor in Chief, Harvard Women’s Health Watch

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Last updated:	August 21, 2006