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Thursday, February 28, 2013

Your Gyno Cannot Report What She Is Not Informed About: Pap Smear Secrets


It’s not so surprising when you think about it. There is more information on your pap smears than is actually reported out. In one case cells seen in younger patients are considered so normal, they just aren’t reported, but they are after 40. It’s one of the reasons you may have to learn about a pap test problem you may have never heard of! Women over the age of 40 may receive an unexpected phone call regarding their pap smear: they are told they have a test that isn’t a sign of cervical cancer, but that they need to come and discuss the finding of uterine lining cells, or endometrial cells, on their pap smear. They are likely to be told they need additional testing, and that occasionally this may mean a cancer or pre-cancer of the uterus itself. Women who have had menstrual periods know that they do shed the actual lining tissue at the time of the menstrual bleeding. A little known fact is that over 1/10 pap smears have these lining cells present. Women will shed these cells a bit more frequently in the first two weeks of the menstrual cycle prior to ovulation, and they are shed more commonly in cases of prolonged or irregular bleeding, if there is a polyp or thickening of the lining of the uterus, or they will be shed more frequently if there is a uterine cancer. By over the age of 40, the lining begins to naturally thin, and these cells are just not seen as often. In fact, instead of over 1/10 of these showing these cells, only less than half a percent of specimens will have these cells. In younger women, they aren’t very often a signal of a medical problem, so you may have had these, but they are not revealed in your pathology report and you and your gyno wouldn’t be notified of these tests. If you are age 40 or older, and the cells are seen, then your report will reflect that those cells were seen. Over the age of 40 who have these cells up to 16% of women will have a medical condition that needs to be treated, and almost 80% of the women who have this will have irregular periods. The recommendations of what to do have changed over time and the current recommendations are to work with your gyno and only undergo special testing if you have reasons to. The most concern is based on whether you are actually before or after menopause, and whether you have been on hormonal therapy, or have risk factors for uterine cancer. The best form of testing is a sample of the uterus, with a endometrial biopsy, or perhaps a d and c.

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