A preliminary stage means that altered cells have been found on the cervix. A Pap3D1 means that slight cell changes have been detected, a Pap3D2 means that moderate cell changes are present. However, no cancer cells are present! The altered cells could have been caused by an infection with a virus or triggered by a specific virus, the human papilloma virus, or HPV for short.
Pap3D is the switch point at which it either goes in one direction or the other – i.e. Pap3D regresses and the woman becomes healthy again all by herself or whether it progresses and ends in disease.
No cervical cancer without HPV! HPV stands for “human papillomavirus”. There are hundreds of types of this virus. Low-risk types cause genital warts, for example. High-risk types of HPV are responsible for changes in the cervix, including cancer. The most common high-risk types are 16, 18, 31 and 33.
The most common transmission route for HPV is sexual intercourse. The virus can also be transmitted during oral sex. The virus is transmitted through mucosal contact, but – according to current knowledge – not through saliva, blood or semen!
If a smear is abnormal, an HPV test is carried out to determine whether it was caused by human papillomavirus. The types are also determined, often the high-risk types 16 and 18, but there are others. Unfortunately, determining the HPV type does not indicate whether the altered cells will regress on their own or not.
An HPV infection, even with so-called high-risk types, only very rarely leads to cancer, even with Pap3D! Whether a precancerous stage actually develops into cancer essentially depends on whether the immune system successfully fights against the virus.
An infection with HPV is a prerequisite for the development of cancer of the cervix. If the virus cannot be detected in the Pap3D, the development of cancer is practically ruled out. Nevertheless, check-ups with a gynecologist should not be neglected!
Various vaccines against HPV are available, but they only work optimally if they are administered before the first sexual intercourse. You can find more information here: https://www.krebsinformationsdienst.de/vorbeugung/risiken/hpv-impfung.php
When the cell smear is taken during the gynecologist's check-up, it is sent to a laboratory for assessment.
There, the smear is assessed under a microscope and divided into different categories.
| PAP | cytological findings |
|---|---|
| 0 | Insufficient cell smear |
| I | Inconspicuous findings, normal cell count |
| II | inflammatory or degenerative changes |
| III | Severe inflammatory or degenerative changes, HPV infection is possible |
| III D | mild to moderate cell dysplasia |
| IVa | severe cell dysplasia |
| IVb | Carcinoma in situ possible |
| V | Cervical cancer (cervical carcinoma) |
A PAP 1 is an inconspicuous and unsuspicious finding, a PAP 5 is already a cervical carcinoma, i.e. cancer. A Pap3D, on the other hand, is not cancer. There are altered cells (also known as "dysplasia") and it is important to wait and see how they develop. In addition to PAP 1, Pap3D and PAP 5, there are many other classifications.
A Pap3D - the "D" stands for dysplasia - is the switching point, so to speak, from which it either goes in one direction or the other: either the body heals itself or the altered cells increase and progress. The detection of the L1 capsid protein is like a compass that shows which way things will go.
Why is it called PAP at all?
PAP stands for the first three letters of the developer of the microscopic examination, Dr. Papanicolaou.
If not only a cell smear is taken with a brush, but also a tissue sample (biopsy), which reveals abnormal findings, this is classified as CIN. These are also precursors of cervical cancer.
A distinction is made between three stages:
CIN I describes a slight cell change in the cervix, similar to PAP 3D1.
CIN II describes a moderately severe cell change, similar to PAP 3D2.
CIN III describes a severe cell change. In this case, there is a high probability of a transition to cervical cancer. For this reason, conization is often recommended for CIN III.
Who pays the costs for the L1 certificate?
The gynecologist can request the L1 test from the laboratory by referral (you can see what should be on the referral on the example referral), the health insurance company covers the costs for the L1 test.
Ideally, the treatment should follow these steps
Your Pap smear showed PAP 3D and your HPV test is positive with high-risk type(s)?
* If the result for the biomarker p16/Ki67 is positive = dysplasia present, p16/Ki67 negative means: no dysplasia present. It is now known whether or not dysplasia – i.e. high-grade cell changes – has been identified in your case. However, this does not say anything about what will happen next for you – whether you will recover on your own or not. The prognosis marker L1 is also required for this.
** If the result of the prognostic marker L1 is positive = cure is very likely, an L1 negative result means: progression of the disease towards cervical cancer is very likely.
References to the studies on PAP3D:
- E. Y. Ki et al. 2019, Utility of human papillomavirus L1 capsid protein and HPV test as prognostic markers for cervical intraepithelial neoplasia 2+ in women with persistent ASCUS /LSIL cervical cytology, Int J Med Sci
- G. Mehlhorn et al. 2013, HPV L1 detection discriminates cervical precancer from transient HPV infection: a prospective international multicenter study. Nature-Modern Pathology
- H. Griesser et al. 2009, HPV vaccine protein L1 predicts disease outcome of high-risk HPV+ early dysplastic lesions. Am J Clin Pathol
- R. Hilfrich, J. Hariri, 2008. Prognostic relevance of HPV L1 capsid protein detection within mild to moderate dysplastic lesions of the cervix uteri in combination with a second biomarker p16. Anal Quant Cytol Histl
- H. Griesser et al. 2004. Correlation of immunochemical detection of HPV L1 capsid protein in pap smears with regression of high-risk HPV positive mild/moderate dysplasia. Anal Quant Cytol Histol
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If your gynecologist mentions that you have a PAP value or a CIN value during your annual cancer screening, you probably won’t be able to classify this exactly at first.
Imagine sitting in front of your gynecologist and finding out that your annual cancer screening has revealed a precancerous lesion.
Many women sit paralyzed in front of their gynecologist and only perceive these words as if through absorbent cotton. “We have found a precancerous lesion in you”. What does that mean …
