PATHOLOGY CLUB MEETING

The Pap Smear and Beyond

Wouldn’t it be great if...one simple medical procedure could significantly reduce cervical cancer deaths…

And, wouldn’t it be great if…this one simple procedure detected not only cervical cancer, but precancerous lesions and endocervical cancers…

And, wouldn’t it be great if…this one simple procedure also detected common infections of the female reproductive tract…

And you could get it all for only $14-$18…Interested?

What’s really great is that this one simple, inexpensive medical procedure—the Pap smear--does exist and it did contribute to the reduction of cervical cancer deaths in the US by 74% between 1955 and 1992. It can also detect other female reproductive cancers and infections, and it is that inexpensive.

This revelation and more from The Pap Smear and Beyond were presented by Kristen Atkins, MD, Assistant Professor of Pathology in Surgical pathology, at the Pathology Club meeting Tuesday, February 25. “The most important point of this talk,” said Dr. Atkins, “is that the Pap smear is not a diagnostic test. It is an effective screening test.” It is used to triage patients; those with positive screens are referred for further testing.

The procedure was named for George Papanicolaou, Professor of Anatomy at Cornell University who, along with Dr. Herbert Traut, a gynecological pathologist, validated the diagnostic potential of the vaginal smear. The latest technology, liquid-based cytology, allows better visualization of cells, making the test more effective than ever before. 

The procedure targets what’s called the cervical “transformation zone” where the majority of cervical cancers arise. “When looking at a biopsy, normal cervical cells,” said Dr. Atkins, “have relatively small nuclei in comparison to the volume of cytoplasm. They stack nicely and appear orderly.” Cells that are changing throughout a spectrum of low-to-high diagnostic grades, I-III, have increasingly larger nuclei, less cytoplasm, and appear much less orderly under a microscope.

Most women in the US will never develop cervical cancer--only 13,000 per year; but, most of those are preventable using the Pap smear to detect cellular changes. 

“The majority, 60%, of Grade I cellular changes will just go away if left alone,” said Dr. Atkins. About 30% will remain at low grade and only 10% will progress to Grade II. Even among Grade III cells, only 15% will progress to invasive cervical carcinomas. Patients referred for diagnostic procedures usually receive a colposcopy, and one of three types of biopsies. 

Colposcopy allows for better visualization of the cervix using an acetowhite test which turns changed (dysplastic) cells solid white. A simple biopsy requires a small 2m x 2m sample. Loop electrosurgical excision procedure (LEEP) removes a thin layer of dysplastic cells. Conization is a third biopsy technique which removes a large, cone-shaped wedge of the cervix for biopsy.

Interestingly, over 99 % of cervical cancers are caused by human papilloma virus (HPV), a very commonly occurring, sexually transmitted disease. The development of HPV vaccines is getting a lot of attention today. But this also means that cervical cancer is preventable and treatable if caught early enough. 

The Pathology Club is sponsored by the VCU Department of Pathology. Please join us at the VCU Pathology Club. Call Hattie Wyche at (804) 827-1079, or email: hmwyche@hsc.vcu.edu.