If your gynaecologist tells you 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. What do these terms actually mean and how do they differ? I’ll explain a few things here so that you know what your gynaecologist is trying to tell you in future!
PAP, CIN, high-risk, low-risk, HPV, so many abbreviations and terms. Do they sometimes confuse you too? No wonder, because many women are totally overwhelmed when their gynaecologist tells them that a precancerous stage has been found and that they should monitor it first. Have you ever felt the same way?
During a cancer screening examination, a smear is taken from the cervix, sent to the laboratory and examined there. The doctors in the laboratory then classify the examined cells accordingly: there are different categories ranging from normal cell images to altered cell images. There is PAP I (i.e. PAP 1), which stands for an inconspicuous, normal finding, through to Pap V (i.e. PAP 5), where unfortunately tumor cells are already detectable in the smear. There are many other PAP values in between.
One PAP value that many women hear from their doctor is PAP IIID (pronounced PAP 3D). Did you know that around 750,000 women in Germany are told by their gynecologist every year that they have a pre-cancerous stage – i.e. a PAP 3D? As scary as that sounds, fortunately in most cases it is not. For most women, a PAP 3D heals on its own without any action having to be taken. You can find more information on this in my other blog post.
A PAP 3D (or PAP IIID) is a fork in the road, so to speak: from then on, it either goes in one direction or the other. This means: either the PAP 3D regresses or it continues to develop – until the precancerous stage has actually become cancer.
Even cervical cancer does not develop overnight. You should therefore do the following:
1. please always go for regular check-ups! Having an annual check-up with your gynaecologist can detect abnormalities at an early stage.
2. if you have PAP IIID, you should have a laboratory test done, which will give you a decisive indication of whether your body can heal itself or not. This is the so-called “L1 capsid protein detection”. If you have this L1 – which is detected by the test – your chances of healing without any intervention are really good.
3. even if you don’t have the L1 capsid protein, you still know that self-healing is unlikely to happen. Because this protein is your ticket to self-healing, so to speak. But even then, don’t panic. You know now and can take appropriate measures to prevent the worst from happening.
As already mentioned at the beginning, the PAP values indicate how the cell material taken during the smear test is assessed. From PAP 1 (PAP I, everything is fine) to PAP 5 (PAP V, which is already cancer). And the PAP3D, where the D stands for dysplasia. This means that the cells or tissue show changes. The PAP values are therefore determined by the cell smear using a small brush. Sometimes you also hear that it is a PAP 3D1 or a PAP 3D2. The numbers indicate whether it is a slight cell change (in the case of a PAP 3D1) or a moderate cell change (in the case of a PAP 3D2).
If an abnormal finding, i.e. a precancerous stage, is suspected, the doctor removes some tissue from the uterine orifice or cervix. This is called a biopsy. This is followed by a microscopic examination of the tissue. A specialist doctor, a pathologist, looks at the cells taken and divides them into categories – CIN I, CIN II and CIN III (i.e. CIN 1, CIN 2 and CIN 3). The smaller the number after the CIN, the less altered the cells taken during the biopsy are, i.e. CIN 1 indicates a slight alteration, CIN II a moderate alteration and CIN III a severe alteration.
A PAP 3D 1 or 2 therefore often corresponds to a CIN I or a CIN II. In the case of a CIN III, where the cells found show a severe change, it can be assumed with a high degree of probability that a transition to cervical cancer must be expected. For this reason, a CIN III (PAP IV or PAP V – i.e. PAP 4 or PAP 5) should be tested.
A study* has found that in 60 percent of women with CIN I, the abnormal cells disappear on their own, in 30 percent they are permanent and in only 10 percent do they continue to develop, i.e. get worse.
In the case of CIN II, the cell changes heal without intervention in around 40 percent of women, in a further 40 percent they are permanent and in 20 percent they progress, but in only 5 percent of women with CIN II do they become cancerous.
So you can see that in the vast majority of women a CIN I or a CIN II (equivalent to a PAP IIID 1 or 2) will disappear on its own.
High-risk, low-risk, HPV: they all belong together.
HPV stands for “human papillomavirus” and almost every sexually active person will come into contact with this virus at some point in their life. Often, nothing happens during an infection because the immune system can keep the virus in check. Sometimes an infection occurs and the person affected is unaware of it. But sometimes an infection is also noticed when, for example, a woman has a smear taken by her gynecologist and the smear shows abnormalities.
There are hundreds of different types of HPV, which are divided into high-risk and low-risk. This means that some types – such as the high-risk types – can be more dangerous than the low-risk types. There are some high-risk types that are responsible for cell changes in the cervix and are considered triggers for cervical cancer. These also have names in the form of numbers. The most common high-risk types are HPV 16 and 18, but the high-risk types 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73 and 82 are also possible. Although the low-risk types are not dangerous, they can cause unpleasant warts in the genital area, so-called genital warts.
