Pap Smear Classification

QUESTION: I have been required to return to my physician on several occasions
because my Pap smear is a "2". He keeps treating me and then taking another
smear. I am afraid I have cancer, because I don't understand what's going on.
Can you help?
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ANSWER: I believe I can, and the news is good. You most probably do not have
cancer. Since Dr. George Papanicolaou published his paper in 1941 describing
the value of vaginal smears to detect cancer of the uterus, the technique has
been used routinely to discover early abnormal changes of the cells of the
cervix (the entrance to the uterus). The cells are scraped from the cervix by
the physician, placed on a glass slide and then stained. When these cells are
examined under a microscope, the subtle changes from normal can be detected,
and graded against a classification of results which allow an interpretation
to be made. There are 5 such classifications from I to V (we use Roman
Numerals as did Dr. Papanicolaou). Class I means there are no suspicious
cells that reveal any changes and is interpreted as negative for cancer. In
Class II ( as in your case) there are some changes in the cells, which can be
caused by an inflammation, but are not considered to be changes that are due
to or lead to cancer. Usually when the inflammation is treated and has
cleared up, the cells return to normal. Class III is made up of cells that
show mild or moderate changes that are suspicious of cancer, but for which a
diagnosis can not be made with certainty. It is Class IV that is used to
indicate that a cancer has started in the cervix, and Class V which tells of
malignancy and invasive carcinoma, that has attacked the uterus.
There are varying recommendations as to the frequency that the test
should be taken, or repeated, and it is a test that must be performed
correctly to obtain results that are accurate. The best time to obtain cells
for examination is at day 14 of the menstrual cycle when the hormone effect of
estrogen is at its maximum. Any patient with a classification of Class III or
higher should have a biopsy of the cervix performed, since this is a more
reliable test, and affords a more dependable diagnostic interpretation. When
inflammatory changes are noted, the Pap report may note the presence of an
infecting bacteria, which can help the physician determine the treatment.
Most physicians agree that Class II smears should be repeated three months
after treatment. It looks like your doctor is following this appropriate
course.