A
Pap test, or Pap smear, is part of a woman's routine
physical exam. It is the best way to prevent
cervical cancer, because it can find cells on your
cervix that could turn into cancer. The cervix is the
lower part of the uterus that opens into the vagina.
When your
doctor says that your Pap test was 'abnormal,' it means that the test found
some cells on your cervix that do not look normal. It does not mean that you
have cancer. In fact, the chances that you have cancer are very small.
What causes an abnormal Pap test?
Most of the
time, abnormal cell changes on the cervix are caused by certain types of
human papillomavirus, or HPV. HPV is a
sexually transmitted disease. Usually these cell
changes go away on their own. But certain types of HPV have been linked to
cervical cancer. That's why it's important for women to have regular Pap tests.
It takes many years for cell changes in the cervix to turn into cancer.
Sometimes cell changes in the cervix are due to other types of infection,
such as infections caused by bacteria or yeast. These types of cell changes can
be treated. In women who have been through menopause, a Pap test may find cell
changes that are just the result of getting older.
What increases your risk for an abnormal Pap test?
High-risk sex raises your chances of getting HPV and having an abnormal
Pap test. High-risk sex includes having sex without condoms and having more
than one sex partner (or having a sex partner who has other partners).
HPV can stay in your body for many years without your knowing it. So even
if you now have just one partner and practice safe sex, you could still have an
abnormal Pap test if you were exposed to HPV in the past.
Smoking
or having an
impaired immune system also may raise your chances of
having cell changes in your cervix.
Do abnormal cell changes cause symptoms?
The cell
changes themselves don't cause symptoms. HPV, which causes most abnormal Pap
tests, usually doesn't cause symptoms either. This is why regular Pap tests are
so important.
If a different sexually transmitted disease or
infection is the cause of your abnormal Pap test, you may have symptoms,
including:
A discharge from the vagina that isn't normal
for you, such as a change in the amount, color, odor, or texture.
Pain, burning, or itching in your pelvic or genital area when you
urinate or have sex.
Sores, lumps, blisters, rashes, or warts on
or around your genitals.
What will you need to do if you have an abnormal Pap test?
You will need more tests to find out if you have an
infection or to find out how severe the cell changes are. These tests may
include:
Colposcopy, a
test to look at the vagina and cervix through a lighted magnifying tool.
An HPV test. Like a Pap test, an HPV test is done on a sample of
cells taken from the cervix.
Another Pap test in 4 to 6
months.
A colposcopy is usually done before any treatment is
given. During a colposcopy, the doctor also takes a small sample of tissue from
the cervix so that it can be looked at under a microscope. This is called a
biopsy.
Treatment, if any, will depend on whether your abnormal
cell changes are mild, moderate, or severe. In moderate to severe cases, you
may have treatment to destroy or remove the abnormal cells.
Most
abnormal Pap tests are caused by
human papillomavirus (HPV) infections. Other types of
infection-such as those caused by bacteria, fungi (yeast), or protozoa
(Trichomonas)-sometimes lead to minor changes on a Pap
test called atypical squamous cells of undetermined significance (ASC-US). The most common cause is HPV infection.
Natural cervical cell changes (atrophic vaginitis) related to
menopause can also cause an abnormal Pap test.
The cervix contains two kinds of cells:
rectangular-shaped columnar cells on the surface of the cervix and in the
cervical canal; and flat, scalelike squamous cells on the surface of the
cervix.
Columnar cells are constantly changing into squamous cells
in an area of the cervix called the
transformation zone.
Because cells in this
area of the cervix are always dividing, they are at risk for abnormal changes.
Most abnormal cell changes found during a Pap test are from the transformation
zone.
Symptoms
Because
cervical cell changes that can cause an
abnormal Pap test rarely cause symptoms, regular Pap
test screening to monitor cell changes is important.
Human papillomavirus (HPV) infection, which is the
most common cause of abnormal cervical cell changes, usually does not cause any
symptoms.
Abnormal vaginal bleeding or a significant
unexplained change in your
menstrual cycle.
Bleeding when something
comes in contact with the cervix (such as during sexual intercourse or
insertion of a diaphragm).
Abnormal vaginal discharge containing
mucus that may be tinged with blood.
Pain during intercourse.
What Happens
Abnormal Pap test results can be caused by infection,
which leads to cell changes in the
transformation zone of the
cervix. Pap test results often return to normal when
the cells have returned to healthy growth or after an infection has been
treated or has resolved on its own.
In some cases, untreated
cervical cell changes that cause abnormal Pap tests may progress to
precancerous or cancerous stages. Certain high-risk types of the
human papillomavirus (HPV) have been linked to the
development of
cervical cancer. But changes in cervical cells usually
progress slowly and take many years to become cancer cells. Treatment can
remove or destroy these cells before they become cancerous.
The
American Cancer Society has reported the following statistics.1
In women ages 13 to 21, minor cervical cell
changes go away on their own about 90% of the time.
In women older
than 21, minor cervical cell changes go away on their own about 50% to 80% of
the time.
Regular Pap test screening can detect cervical cell changes
early.
Minor cell changes often go away without
treatment.
Early detection of precancerous cell changes or cervical
cancer usually makes a complete cure possible.
If a high-risk type
of HPV is diagnosed, more frequent Pap tests or other testing (such as
colposcopy or
cervical biopsy) may be needed for further
evaluation.
Cervical polyps are unrelated to cervical cancer, but
may be found and removed at the time of a pelvic exam and Pap test.
What Increases Your Risk
Most cervical cell changes
that cause an
abnormal Pap test are the result of sexual
transmission of HPV disease. High-risk sexual behaviors by you or your partner
at some time, possibly even many years ago, may lead to HPV infection.
High-risk sexual behaviors increase your risk of infections and
sexually transmitted diseases (STDs).
High-risk sexual behaviors include:
Starting sexual intercourse at an early age
(before age 18).
Having sex without using a condom, which increases
your risk of being infected with:
If you have had one abnormal Pap test result, you may be at
higher risk for having another abnormal Pap test in the future.
When To Call a Doctor
Most problems that cause
abnormal Pap tests do not cause symptoms, so you won't
know you have cervical cell changes. Regular Pap testing is needed to detect
early cervical cell changes.
Call your doctor if:
You have unexpected bleeding between menstrual
periods, especially if you are not using any hormonal contraceptives, such as
birth control pills.
You have bleeding after douching or sexual
intercourse.
If you think you may have
symptoms of a sexually transmitted disease (STD), call
your doctor for an appointment. Avoid sexual intercourse
until you have been treated for your symptoms and can no longer infect your
partner.
If your sex partner has symptoms of an STD, both of you
should be evaluated by a doctor. If you have been diagnosed with an STD, such
as genital warts, your
sex partner(s) may want to be evaluated.
Watchful Waiting
When Pap test results show minor changes,
watchful waiting may be done before any further
evaluation is recommended because these changes often go away without any
treatment. Watchful waiting usually involves repeat Pap tests as often as
recommended by your doctor for the type of abnormal cell change present.
One study showed that regular condom use during this time improves the
chance that abnormal cells will go away by themselves.2
If you have had an abnormal Pap test, be certain
to complete any additional testing or treatment that your doctor recommends.
You and your doctor can decide how often Pap test screening should continue or
whether other tests are needed.
Who To See
Your family doctor or any of the following health
professionals can manage an abnormal Pap test:
You will have a
Pap test as part of your routine gynecologic exam. A
Pap test is used to identify abnormal cell changes on your
cervix and to screen for
cervical cancer. Pap test screening is the most
effective way to detect early abnormal cervical cell changes.
Women over 30 years old may have a screening test for HPV infection at
the same time they have their Pap test.3
Pap test screening schedule
The recommended
Pap test screening schedule is based on your age and risk factors.1, 4 Testing should start 3 years from
the time you begin to have sexual intercourse, but no later than age 21. Women
should have Pap tests every 1 to 3 years. Studies show that healthy women who
have normal Pap tests for 3 years in a row are unlikely to develop moderate to
severe cervical cell changes within 3 years. Discuss this with your doctor to
determine whether you can safely extend your Pap test screening to every 2 to 3
years.5
Women who have gone through
menopause have an increased risk of
false-positive Pap test results. For this reason,
postmenopausal women with previous normal Pap tests may be advised to have Pap
tests less frequently than every year.6
Women who have had a hysterectomy that included removal of the cervix do
not need any more Pap tests if both of the following are true:
The hysterectomy was done for a problem other than
cancer.
Regularly scheduled Pap tests have shown that the woman has
not had precancerous cell changes in the cervix or vagina in at least 10
years.
Abnormal Pap test result
An
abnormal Pap test classifies cells according to their
degree of abnormality using
the Bethesda system (TBS). Further evaluation decisions are guided by the
kinds of changes seen in the cells.
Following an abnormal Pap test
result, additional tests may be needed to determine whether an infection is
present or to determine the severity of cervical cell changes. These additional
tests include:
Colposcopy. A colposcopy uses a magnifying instrument
called a colposcope to look at the vagina and the cervix. Cell
abnormalities (dysplasia) that might be missed by the naked eye can
be seen with the colposcope.
Cervical biopsy. A cervical biopsy removes a small piece of the cervix so the
tissue can be examined under a microscope.
Cone biopsy. This is an extensive form of a cervical
biopsy. It is called a cone biopsy because a cone-shaped wedge of tissue is
removed from the cervix and examined under a microscope. A cone biopsy may also
serve as treatment by removing the abnormal cervical cells.
Human papillomavirus (HPV) DNA test. HPV testing is
done to identify high-risk types of HPV infection. If your abnormal Pap test is
caused by HPV, knowing whether you have a high-risk type of HPV can help guide
your evaluation and treatment decisions.
Some new testing methods,
such as
computer-automated review of Pap tests and
liquid-based collection, are being used in many areas
of the United States. Liquid-based collection methods allow testing for HPV at
the same time as a Pap test, but these methods are not available everywhere and
may be more costly.
The terms used to report Pap test results vary
depending on which classification system is used. The Bethesda system (TBS) is
used by most labs in North America. Other classification systems are used
around the world.
Even though most
abnormal Pap tests are caused by an
HPV infection that will go away or an inflammation
that can be treated, you will need a follow-up evaluation to make sure your
abnormal cell changes have resolved. Your need for treatment will vary
depending on whether your abnormal cell changes are mild, moderate, or severe.
Abnormal Pap test results may show minor cell changes (most common), moderate
to severe cell changes (less common), or
cervical cancer (rare). Depending upon the cause and
severity of the cervical cell changes,
treatment may be necessary.
Human papillomavirus (HPV) infection is the most
common cause of an abnormal Pap test. There are many types of HPV. High-risk
types can cause cell changes that could develop into cancer.
Evaluation of minor cell changes (ASC-US and LSIL)
An abnormal Pap test result is not uncommon because HPV infection is
very common. Most cell changes seen in abnormal Pap test results will not
progress to cervical cancer. If your abnormal Pap test shows
minor cell changes, you may have several choices of what to do next.
If your Pap test shows that a vaginal infection or a treatable
sexually transmitted disease (STD) is present, you can
be treated with medicine.
Evaluation of ASC-US.If you have had a Pap test only and your test
results show atypical squamous cells of undetermined significance (ASC-US), you
can:
Choose
watchful waiting, which includes repeat Pap tests
every 4 to 6 months. Watchful waiting will not be harmful if the abnormal
tissue is not visible on the cervix or a type that is not likely to progress to
cancer and you do not have an
impaired immune system. Regular use of condoms during
this time will increase the chance that abnormal cells will go away on their
own.2
Have a
test for high-risk human papillomavirus (HPV) types.
The natural course of most types of HPV is to resolve on their own within 18
months. HPV in women younger than 30 usually goes away on its own. HPV in women
older than 30 is more likely to persist. Minor cell changes not related to
high-risk HPV may not be significant and often go away. Even if you have a
high-risk HPV type, more severe cell changes may never develop because
high-risk HPV infections can also go away on their own. But if testing shows a
high-risk HPV, your doctor will probably recommend a
colposcopy and possibly
cervical biopsy to look at the abnormal cells. If you
do not test positive for a high-risk HPV, you can return to a normal screening
schedule.7
Have a
colposcopy so your doctor can look at the abnormal
cells. A
cervical biopsy may be done at the same time to
confirm the colposcopy findings. Women with HIV infection will most likely be
evaluated with colposcopy and then treated for any abnormal cervical
cells.
Women over 30 can have a Pap test and an HPV test at the
same time. If you have had a Pap test and an HPV test as
part of your regular exam, you will have two results to consider. The following
are recommendations for these test results.
Normal Pap and
negative for high-risk HPV: Return to routine Pap test
screening schedule every 3 years.
Normal Pap
and positive for high-risk HPV: Repeat Pap and HPV in 6
to 12 months. If both repeat tests are normal, return to routine Pap screening
schedule. If either of the repeat tests is abnormal,
colposcopy is recommended.
Pap result of
atypical squamous cells of undetermined significance (ASC-US) and negative for high-risk HPV: Repeat
Pap test in 12 months.
Pap result of ASC-US
or more severe changes and positive for high-risk HPV:
Have a colposcopy.
HPV testing or colposcopy may be included in a watchful
waiting period of time because they are diagnostic tests, not treatments.
Watchful waiting is usually recommended only for women who will follow through
with repeat Pap tests every 4 to 6 months.
Evaluation of LSIL.If the results of your Pap test show the
minor cell changes called low-grade squamous intraepithelial lesions (LSIL), your doctor may recommend a
colposcopy to evaluate the cell changes. Some women,
especially those who have already gone through menopause, may be treated for
atrophy with estrogen cream and then have a repeat Pap test. Colposcopy is
needed only if the repeat test shows cell changes.
Adolescent
girls with a Pap test that shows ASC-US or LSIL will usually have a repeat Pap
test at 6 to 12 months. This is because girls this age are extremely unlikely
to develop cervical cancer, and HPV is likely to go away on its own. But if
either of the follow-up tests are abnormal, colposcopy is usually the next
recommended test.8
It is very unlikely
that minor cervical cell changes would progress to cancer in a short period of
watchful waiting. Atypical squamous cells of undetermined significance (ASC-US) cell changes usually remain the same or return
to normal after the first abnormal result. Low-grade squamous intraepithelial
lesions (LSIL) cell changes may be more likely to progress to
more severe cell changes over time, but most LSIL cell changes return to normal
or are not identified as more severe cell changes.1
Minor changes found by a repeat Pap test and
confirmed by colposcopy or biopsy can remain under observation (watchful
waiting) or be treated to destroy or remove the abnormal tissue.
Treatment for moderate to severe cell changes (HSIL)
Treatment decisions for an abnormal Pap test that shows
moderate to severe cell changes are based on the Pap
test results, colposcopy, and cervical biopsy. A larger tissue sample may be
removed by a
cone biopsy. In some cases, this procedure may serve
as treatment so you are cured. Follow-up to evaluate and treat moderate to
severe cervical cell changes is recommended sooner than for minor cell changes.
If not treated, about 40% of women with untreated high-grade squamous
intraepithelial lesions (HSIL) will progress to invasive cancer over a period
of 10 years.9
For moderate or severe precancerous cell
changes confirmed by biopsy, treatment will focus on destroying or removing the
abnormal tissue. Treatment choices include
LEEP, a surgery that uses a thin wire loop to remove
the abnormal tissue;
cryotherapy, which destroys tissue by freezing it;
laser therapy, which destroys tissue with a laser
beam; or
cone biopsy (conization), in which a cone-shaped piece
of abnormal tissue is removed from the cervix.
A
Pap test may be done during pregnancy if a woman is due for her regular
screening test. A
pregnant woman with an abnormal Pap test is monitored
closely throughout her pregnancy. Monitoring may include evaluation by
colposcopy. The goal of evaluation is to rule out
cervical cancer, a rare diagnosis. Treatment for abnormalities other than
cancer is done after delivery.
Prevention
You cannot prevent an
abnormal Pap test, but you can reduce your risk
factors.
Have regular Pap test screening
The Pap test is
the most effective screening test to prevent the development of
cervical cancer. Pap tests done at regular intervals
almost always detect cervical cell changes before the changes become cancerous.
Regular screening for and treatment of cervical cell abnormalities can prevent
the abnormal cell changes from developing into cancer.
Women who smoke are at higher risk
for developing cervical cell changes that cause an abnormal Pap test. The
reason for this is not fully understood. Quitting smoking may decrease this
risk. Not smoking has many other health benefits. For example, nonsmokers have
a lower risk of other cancers and heart disease. For more information, see the
topic
Quitting Smoking.
Reduce your risk of a sexually transmitted disease (STD)
Sexually transmitted diseases (STDs), especially
HPV infection, often cause abnormal Pap tests and can
lead to other serious health problems. Preventing an STD is easier than
treating an infection after it occurs.
Talk with your partner about STDs before
beginning a sexual relationship. Find out whether he or she is at risk for an
STD. Remember that it is quite possible to be infected with an STD without
knowing it. Some STDs, such as
HIV, can take up to 6 months before they are detected
in the blood. Consider HIV testing if you or your partner are at risk for
HIV.
Be responsible.
Avoid sexual contact if you have symptoms
of an STD or are being treated for an STD.
Avoid all intimate
sexual contact with anyone who has symptoms of an STD or who may have been
exposed to an STD.
Use
male or
female condoms to reduce the risk of getting an STD.
Using male condoms when you have sex has been shown to reduce your risk of
getting HPV.10 Female condoms may help also, although
there has been less study of this type of protection.
Abstaining from sexual intercourse is the only way to
completely prevent any exposure to STDs.
Your risk for an STD increases if you have several sex
partners at the same time or if your sex partner has more than one
partner.
The U.S. Food and Drug Administration (FDA) has approved
a
vaccine (Gardasil)(What is a PDF document?)
that protects against four types of HPV, which together
cause most cases of cervical cancer and genital warts. Three shots are given
over 6 months. Gardasil is recommended for girls 11 to 12 years old. The
immunization is also recommended for females 13 to 26 years old who did not
receive it when they were younger. It can be given to girls as young as 9 years
old. Clinical studies showed that the vaccine is safe and works well to prevent
cervical cancer and genital warts for girls and women who have not already been
infected with these HPV types.11 For more information,
see the topic
Immunizations.
For more information on
getting your daughter vaccinated, see:
All
abnormal Pap tests require follow-up. In some cases,
you may need further testing or treatment. In other cases, your doctor may
recommend a period of
watchful waiting that includes repeat Pap
tests.
Be certain to complete any additional testing
that your doctor recommends. This includes repeat Pap tests as well as any
other tests.
If a vaginal infection or a treatable
sexually transmitted disease (STD) caused your
abnormal test results, you will probably need medicine. Take all the medicine
as directed by your doctor. If you skip doses or do not take all your medicine,
the problem may come back.
To reduce your risk of cervical problems:
Have regular Pap tests. Regular Pap tests
almost always detect cervical cell changes before the changes become cancerous.
Regular screening for and treatment of cervical cell abnormalities can prevent
cancer. You and your doctor can decide how often you need to be
tested.
Reduce your risk of exposure to sexually transmitted
diseases by practicing safer sex. Use condoms until you are certain that
neither you nor your partner has an STD. To prevent STDs, condoms must be put
on before beginning any sexual contact.
Quit smoking. Women who smoke are at higher risk of developing
cervical cell changes that cause an abnormal Pap test. The reason for this is
not fully understood.
Medications
Medicines may cure a bacterial, fungal,
or protozoal infection and allow
minor cell changes called atypical squamous cells of undetermined significance
(ASC-US) that have caused an
abnormal Pap test to return to normal. HPV infection
cannot be treated with medicine. The infection or inflammation changes of
cervical cells are monitored in the following sequence:
The
Pap test is repeated at regular intervals as recommended by your doctor. If the
repeat Pap test results are normal after the treatment of an infection, you can
return to your normal Pap test screening schedule.
If the Pap test
remains abnormal after treatment, you and your doctor may choose
watchful waiting. Or a
colposcopy may be done to diagnose the cause of the
abnormal test. Regular Pap testing allows you to monitor minor cervical cell
changes.
Estrogen cream. Women near
menopause may have abnormal Pap test results because
of normal body changes during menopause, such as cervical cell atrophy and
estrogen loss. These minor cell changes may improve with the use of estrogen
cream.
Surgery
If you have had an
abnormal Pap test, surgery may be an option. Surgical
treatment may be recommended if:
The cervical biopsy shows that you have or may have
cervical cancer.
Surgery may be done to destroy or remove the abnormal cells
on your cervix, or confirm or rule out the possibility that you have cervical
cancer.
Abnormal tissue that can be seen through the magnifying
viewing instrument (colposcope) can often be destroyed or removed with
cryotherapy, a cone biopsy, a carbon dioxide (CO2) laser, or the loop
electrosurgical excision procedure (LEEP).
Abnormal cervical cells
that are detected by a Pap test but cannot be seen by colposcopy may be high in
the cervix (cervical canal). Before treatment is recommended, the location and
type of cell change must be confirmed by a cervical biopsy. Depending on the
results of the colposcopy and cervical biopsy, a
cone biopsy may be done as the next step.
Surgery Choices
Surgical choices for abnormal cervical cell changes
include the following:
Procedures that remove abnormal tissue
Cone biopsy (conization) removes a cone-shaped wedge of abnormal cells high in the
cervical canal. A small amount of normal tissue around the cone-shaped wedge of
abnormal tissue is also removed so that a margin free of abnormal cells is left
in the cervix.
Loop electrosurgical excision procedure (LEEP) uses a thin, low-voltage electrified wire loop to cut out
abnormal cervical cells. It can also be used to remove a cone-shaped wedge of
tissue like a cone biopsy.
Procedures that destroy abnormal tissue
Cryotherapy
destroys abnormal cervical cells by freezing them.
Carbon dioxide laser uses a laser beam to destroy
(vaporize) abnormal cervical cells. It can also be used to remove a cone-shaped
wedge of tissue like a cone biopsy.
If the results of a Pap test, colposcopy, and
cervical or cone biopsy indicate invasive cervical cancer, then surgery,
radiation, chemotherapy, or a combination of treatments will be needed to
destroy or remove the cancerous tissue. A diagnosis of cervical cancer will
probably be treated under the care of a
medical oncologist who specialized in women's cancer
(gynecologic oncologist).
Treatment options for cervical cancer
that are not discussed in detail in this topic include:
Total
hysterectomy, to surgically remove the cervix, uterus,
and other affected pelvic organs.
Radiation therapy, to destroy cancer cells and shrink tumors with the use of
high-dose X-rays.
Chemotherapy, to destroy cancer cells
with the use of medicine.
Minor cell changes may not need
to be treated with surgery. When deciding on treatment for minor cell changes,
consider the following:
Infections may be cured with medicines for
the specific cause of the infection.
Minor cell changes often go
away without treatment. Your doctor may suggest a period of
watchful waiting before further evaluation or a biopsy
is recommended. Surgery may be needed if the cell changes are confirmed by
biopsy to be progressing to more severe cell changes. Surgery may also be done
if follow-up evaluation is not possible or immediate treatment is
wanted.
Cell changes caused by
human papillomavirus (HPV) infection may not progress
beyond mild changes. The natural course of most types of HPV is for the cells
to change back to normal within 18 months without treatment. Cervical cell
changes caused by HPV may be treated because of their degree of abnormality,
but treatment does not eliminate the virus. You may still have HPV inside your
body's cells.
Treatment choices for moderate to severe cell changes are
more likely to include surgery to specifically destroy or remove the abnormal
tissue.
Other Treatment
Removal of the uterus (hysterectomy) may be a treatment choice for some women
who have had an
abnormal Pap test if both of the following are
true:
They are done having children.
They have other gynecological problems, such as heavy irregular bleeding that
does not improve with medicine, that would also be treated with a
hysterectomy.
Other Places To Get Help
Organizations
American College of Obstetricians and Gynecologists
(ACOG)
409 12th Street SW
P.O. Box 96920
Washington, DC 20090-6920
Phone:
(202) 638-5577
E-mail:
resources@acog.org
Web Address:
www.acog.org
American College of Obstetricians and Gynecologists
(ACOG) is a nonprofit organization of professionals who provide health care for
women, including teens. The ACOG Resource Center publishes manuals and patient
education materials. The Web publications section of the site has patient
education pamphlets on many women's health topics, including reproductive
health, breast-feeding, violence, and quitting smoking.
Association of Reproductive Health Professionals (ARHP)
2401 Pennsylvania Avenue, N.W.
Suite 350
Washington, DC 20037-1718
Phone:
(202) 466-3825
This organization of health professionals
provides education and information on reproductive health matters, such
as sexual health, sexually transmitted diseases (STDs), family planning, contraception,
and infertility.
Centers for Disease Control and Prevention (CDC):
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB
Prevention
1600 Clifton Road
Atlanta, GA 30333
Phone:
1-800-CDC-INFO (1-800-232-4636) (404) 639-3534
TDD:
1-888-232-6348
E-mail:
cdcinfo@cdc.gov
Web Address:
www.cdc.gov/nchstp/od/nchstp.html
The National Center for HIV/AIDS, Viral Hepatitis, STD,
and TB Prevention is a branch of the Centers for Disease Control and Prevention
(CDC). Their Web site provides information and updates on sexually transmitted
diseases (STDs), human immunodeficiency virus (HIV), and tuberculosis (TB). You
can also find fact sheets on these health topics.
National Women's Health Network
514 10th Street NW
Suite 400
Washington, DC 20004
Phone:
(202) 347-1140
Fax:
(202) 347-1168
E-mail:
nwhn@nwhn.org
Web Address:
www.womenshealthnetwork.org/
This nonprofit advocacy group includes consumers, health
centers, and organizations. The National Women's Health Network monitors
federal health policy and operates an information clearinghouse.
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Hogewoning CJA, et al. (2003). Condom use promotes
regression of cervical intraepithelial neoplasia and clearance of human
papillomavirus: A randomized clinical trial. International Journal of Cancer, 107(5): 811-816.
American College of Obstetricians and Gynecologists
(2005, reaffirmed 2007). Human papillomavirus. ACOG Practice Bulletin No. 61.
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American College of Obstetricians and Gynecologists
(2003, reaffirmed 2007). Cervical cytology screening. ACOG Practice Bulletin
No. 45. Obstetrics and Gynecology, 102(2):
417-427.
Sawaya GF, et al. (2003). Risk of cervical cancer
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Sawaya GF, et al. (2000). The positive predictive value
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Runowicz CD (2007). Approach to the patient with an
abnormal Pap smear. In DC Dale, DD Federman, eds., ACP Medicine, section 16, chap. 1. New York: WebMD.
American College of Obstetricians and Gynecologists
(2008). Management of abnormal cervical cytology and histology. ACOG Practice
Bulletin No. 99. Obstetrics and Gynecology, 112(6):
1419-1444.
Sawaya GF, et al. (2001). Current approaches to
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