Texas Tech University Health Sciences Center at the Permian Basin

Following a Pap smear, most women routinely receive a message from their doctor’s office saying the test results were normal. But what if the message says something else — what if your Pap smear shows some abnormalities?

Don’t panic, advises Jenatta Freeman, M.D., instructor physician at Texas Tech University Health Sciences Center at the Permian Basin.

“Often patients are under the impression that they may have cancer,” Dr. Freeman says. “We emphasize that most patients have a pre-cancerous change, not a cancer.”

As with many other conditions, this pre-cancerous change, known as dysplasia, is very treatable — provided it’s caught early enough. “Follow-up is crucial,” she says.

At the Texas Tech colposcopy clinic, Dr. Freeman and resident doctors look at the vagina and cervix through a powerful magnifying machine called a colposcope. The tissue is examined by applying a mild vinegar solution that changes the abnormal tissue to a white color so it is visible with the colposcope. The grade or level of dysplasia is determined. The dysplasia is graded as 1, 2 or 3 or mild, moderate or severe. The higher the grade, the more likely it will lead to cancer.

A small piece of the abnormal tissue is pinched off (biopsed) with an instrument and sent for further evaluation. Most patients only have mild discomfort for a second from this, she says. “We try very hard to ensure patients do not experience severe discomfort.”

If the Pap test, colposcopy and biopsy results indicate a severe lesion, there are several treatment options to remove the abnormal tissue. When the staff removes a larger area of tissue, they apply local anesthesia to decrease discomfort. “I tell patients it’s like taking a bad spot off an apple by coring it out,” Dr. Freeman says.

Unfortunately, many women do not follow up on an abnormal Pap smear notification. Dr. Freeman says her office has a no-show rate of 50% following an abnormal Pap smear.

“Some women may not understand the urgency of a follow-up appointment,” she says. “Around 15% to 20% of women have a higher grade lesion than what was indicated on the original Pap smear following testing. For these women, early treatment could save their lives.”

Other women may be in denial, fearing changes that could come about in their lives following a diagnosis of cervical cancer, Dr. Freeman says. Again, she stresses that cervical cancer is less commonly seen in women who have yearly exams.

Still others may fear pain from the testing procedure. “We know this is an emotional and frightening experience for women so we try to be very gentle and understanding.”

And, for some, lack of ability to pay is a factor. “Most insurance companies pay for the testing,” Dr. Freeman says. “At Texas Tech, a woman may qualify for some programs if she hasn’t had a Pap smear in a long time. And it is likely that a payment schedule can be worked out.”

HPV, the human papilloma virus, is a major cause of cervical cancer. Cervical cancer strikes nearly half a million women each year worldwide, killing a quarter of a million, according to the National Cancer Institute (www.cancer.gov).

Since the introduction of the Pap smear, the United States has seen a large decrease in the number of lives lost due to cervical cancer. Still, more than 10,000 women are diagnosed per year in the United States, leading to around 4000 deaths. It is important that all women understand the relationship between HPV and cervical cancer.

The Gardasil vaccine, recently approved by the FDA, protects women from the two most common types of HPV associated with cervical cancer, types 16 and 18. In addition, it prevents types 6 and 11, which lead to genital warts — a very emotionally and physically debilitating condition.

“According to statistics, 70% to 80% of the sexually active population has been exposed to HPV. All women have to realize that if she or her partner has had more than one sexual relationship, chances that she has contracted or will contract HPV are really high,” Dr. Freeman says.

Educating women concerning diagnosis and treatment options is vital.

“If we can convince women to protect themselves from cervical cancer and continue to schedule regular Pap smears and follow-up exams, we can decrease the number of cervical cancer deaths even further, both in the U.S. and worldwide,” Dr. Freeman says.

Texas Tech Physicians of the Permian Basin is located at 701 W. 5th St. For information or to schedule an appointment, call (432) 335-5233 or the Tanglewood office at (432) 368-3170.