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Abnormal PAP Smears

Virtually all cancers of the cervix are caused by the human wart virus (HPV) (1) and no woman should die from that disease.

Cervical cells undergo a series of changes as they pass from normal toward cancerous (2), so all women would get yearly Pap smears in which a doctor inserts a stick into the vagina, scrapes the cervix and examines the cells under a microscope. Postmenopausal women need yearly Pap smears as 10% have abnormal tests (3). Women with mildly abnormal Pap smears should be treated with antibiotics and checked again in a few months. Most will clear up completely (4). Those with more severe changes may need to have the cells at the opening to the uterus removed in a simple surgical procedure or they can be cured with interferon injections and retinoic acid creams (5).

Most cases of treated abnormal Pap smears clear the virus (6). More than fifty percent of sexually active women are infected with venereal warts (7,8,9), but fewer than one woman in two hundred who has genital warts will go on to develop cervical cancer (10), those who retain the virus are the ones most likely to suffer cancer (11).

Doctors used to think that once you are infected with the virus, you keep it forever, now they know that most women eventually get rid of the virus in a few months with no treatment whatever (12). Women who continue to be infected with the human wart virus are at increased risk for cancer. Women who have low blood levels of antioxidant vitamins (13) are at increased risk for cervical cancer and 74 percent of women with cervical cancer smoke. (14).

1) FX Bosch, MM Manos, N Munoz, M Sherman, AM Jansen, J Peto, MH Schiffman, V Moreno, R Kurman, KV Shah, E Alihonou, S Bayo, HC Mokhtar, S Chicareon, A Daudt, E Delosrios, P Ghadirian, JN Kitinya, M Koulibaly, C Ngelangel, LMP Tintore, JL Riosdalenz, Sarjadi, A Schneider, L Tafur, AR Teyssie, PA Rolon, M Torroella, AV Tapia, HR Wabinga, W Zatonski, B Sylla, P Vizcaino, D Magnin, J Kaldor, C Greer, C Wheeler. Prevalence of human papillomavirus in cervical cancer: A worldwide perspective. Journal of the National Cancer Institute 87: 11(JUN 7 1995):796-802.

2) J Nuovo, J Melnikow, M Paliescheskey. Management of patients with atypical and low-grade Pap smear abnormalities. American Family Physician 52: 8 (DEC 1995):2243-2250.

3) D Gerbaldo, P Cristoforoni, M Leone, L Casciaro, P Baracchini, E Fulcheri. The incidental finding of abnormal cervical histology in postmenopausal patients. Maturitas 21: 2 (FEB 1995):115-120.

4) P Holowaty, AB Miller, T Rohan, T To. Natural history of dysplasia of the uterine cervix. Journal of the National Cancer Institute 91: 3(FEB 3 1999):252-258.

5) LS Massad, ME Turyk, P Bitterman, GD Wilbanks. Interferon-alpha and all-trans-retinoic acid reversibly inhibit the in vitro proliferation of cell lines derived from cervical cancers. Gynecologic Oncology 60: 3 (MAR 1996):428-434.

6) Bollen, L.J.M.; Tjongahung, S.P.; Vandervelden, J.; Mol, B.W.; Boer, K.; Tenkate, F.J.W.; Bleker, O.P.; Terschegget, J. Clearance of cervical human papillomavirus infection by treatment for cervical dysplasia","Sexually Transmitted Diseases. SEP 1997;24(8):456-460.

7) KL Kotloff, SS Wasserman, K Russ, S Shapiro, R Daniel, W Brown, A Frost, SO Tabara, K Shah. Detection of genital human papillomavirus and associated cytological abnormalities among college women. Sexually Transmitted Diseases 25: 5 (MAY 1998):243-250.

8) D Blackledge, R Russell. ''HPV effect'' in the female lower genital tract: A community study. Journal of Reproductive Medicine 43: 11 (NOV 1998):929-932.

9) KJ Mertz, GM Mcquillan, WC Levine, DH Candal, JC Bullard, RE Johnson, ME Stlouis, CM Black. Pilot study of the prevalence of chlamydial infection in a national household survey. Sexually Transmitted Diseases 25: 5 (MAY 1998):225-228.

10) Ho GYF, Bierman R, et al. Natural history of cervicovaginal papillovirus infection in young women. NEJM 1998(Feb 12);338(7):423-428.

11) GYF Ho, RD Burk, S Klein, AS Kadish, CJ Chang, P Palan, J Basu, R Tachezy, R Lewis, S Romney. Persistent genital human papillomavirus infection as a risk factor for persistent cervical dysplasia. Journal of the National Cancer Institute 87: 18(SEP 20 1995):1365-1371.

12) SA Hinchliffe, D Vanvelzen, H Korporaal, PL Kok, ME Boon. Transience of cervical HPV infection in sexually active, young women with normal cervicovaginal cytology. British Journal of Cancer 72: 4 (OCT 1995):943-945.

13) A Kwasniewska, A Tukendorf, M Semczuk. Content of alpha-tocopherol in blood serum of human Papillomavirus-infected women with cervical dysplasias. Nutrition and Cancer - an International Journal 28: 3(1997):248-251.

14) AO Olsen, J Dillner, A Skrondal, P Magnus. Combined effect of smoking and human papillomavirus type 16 infection in cervical carcinogenesis. Epidemiology 9: 3 (MAY 1998):346-349.

Checked 6/20/10

August 16th, 2013
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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