Management of Abnormal Cervical/Vaginal Pap Smears

, University of California, San Francisco


Medscape General Medicine. 1996;1(1) 

In This Article

Abstract and Introduction


The primary role of the Pap smear is to detect premalignant lesions. Unfortunately, it is unclear how best to manage patients with low-grade lesions or squamous atypia. There are simple approaches to common problems seen with Pap smears, such as infection, inflammation, and no endocervical cells on the smear.


Each year, approximately 16,000 cases of cervical cancer are diagnosed in the U.S.[1] Although the Papanicolaou (Pap) smear (exfoliative cytology of the vagina and cervix) allows detection of these cancers at earlier, more readily treatable stages,[2] the primary value of the Pap smear is to identify premalignant disease, the treatment of which prevents development of cancers. Based on extrapolation from the National Breast and Cervical Cancer Early Detection Program (1991-1993), there are about 55 million normal Pap smears (Fig. 1), 700,000 cases of high-grade squamous intraepithelial lesion (HSIL), 2.5 million cases of low-grade squamous intraepithelial lesion (LSIL), and 3.4 million cases of atypical squamous cells of uncertain significance (ASCUS) per year in the U.S.[3] Much of the controversy and clinical uncertainty about Pap smears arises from the large number of women who have smears categorized as LSIL or ASCUS, because it is not entirely clear how to follow up with or treat such patients. This article will examine the performance of the Pap smear in its various roles and describe common problems encountered in day-to-day clinical management of abnormal Pap smears.

Figure 1. A normal Pap smear.