You just went in for your annual gynecology appointment. The doctor said your pelvic exam looked good, took a quick swab to send off for the usual testing, and now you’re good to go until next year.
But a few days later, you get a call from your gynecologist’s office and someone is telling you the results of your Pap smear came back abnormal. Your heartrate shoots up, your palms begin to sweat, and the panic starts rising in your throat. What does this mean? Do you have cancer? What happens next? A series of painful and expensive treatments? Whoa—slow down!
An abnormal Pap smear is no reason to panic. Let’s take a closer look at what your results really mean and what you can expect to happen next.
What does an “abnormal” Pap smear mean?
Let’s start with the most important thing for you to be aware of right now: abnormal does not mean cancer. Healthy cervical cells appear flat and thin under a microscope. An abnormal Pap result means slight changes were detected in the appearance of these cells, usually in their shape. It’s important to understand that abnormal Pap smears are common in women, with less than 1% of those detected developing into cervical cancer each year.
What causes an abnormal Pap?
Human papillomavirus is the most common STI in the United States. The virus is usually harmless with no symptoms, although sometimes it may manifest as genital warts. HPV can sometimes cause changes to your cervical cells that, if left untreated, can develop into cervical cancer.
Cervical dysplasia is the medical term for abnormal cells that are found on the surface of the cervix. Dysplasia can be a result of the aforementioned changes caused by HPV or even just inflammation from other STDs, yeast infections, or benign cysts. If left untreated, cervical dysplasia can develop into cancer. There are a few different stages of dysplasia, defined by their severity:
- Atypical Squamous Cells of Unknown Significance (ASCUS)—cervical cell abnormalities are mild to moderate and the cause is not immediately clear
- Low-Grade Squamous Intraepithelial Lesions (LSIL)—LSIL usually indicates HPV, cells with this type of dysplasia may display precancerous features but typically are not cancerous, in most cases these lesions go away on their own
- High-Grade Squamous Intraepithelial Lesions (HSIL)—high-grade dysplasia means the cell abnormalities are moderate to severe, these cells are considered precancerous with a greater risk of developing into cancer (this still does NOT mean you have or will get cancer), most of the time HSIL is treated successfully before cancer develops
- Atypical Squamous Cells of Unknown Significance Cannot Rule Out HSIL (ASC-H)—these are observed abnormalities with no clear cause that raise concern for higher-grade dysplasia
Other Benign Causes
Sometimes, a Pap smear may come back as abnormal for reasons unrelated to your health at all. A simple lab error is always possible. Or, more commonly, your cervical cells have been affected by recent intercourse, menstruation, tampon use, or even just taking a warm bath. A follow-up Pap in these instances will likely come back normal.
What happens after a Pap comes back abnormal?
Depending on the severity of the abnormal cell changes in your original Pap smear, there are a few courses of action your doctor may want to take.
If the results of your first Pap smear were unclear or inconclusive, your doctor will likely ask you to come in for another one. If you are under the age of 30 and negative for HPV, this repeat Pap may not be necessary until your next yearly appointment, as changes in this scenario are likely to go away on their own.
If you haven’t already been tested for HPV, your doctor will probably want to have you tested if your Pap comes back abnormal. If you have been tested and are positive, they will want to test for the exact strain to determine if it is one of those that are considered more high-risk.
A colposcopy is a simple procedure, usually completed right in your doctor’s office, during which your doctor more closely inspects your cervix using a colposcope. They will also use a special solution on your cervix to differentiate between abnormal and normal cells. A biopsy of the abnormal cells may also be taken for further microscopic analysis. If your Pap detected ASCUS with HPV, LSIL, ASC-H, or HSIL, a colposcopy will probably be your next step.
How are abnormal cells treated?
If the results of your colposcopy indicate serious cervical cell changes that are at higher risk of turning into cancer, your doctor can remove them before they become a bigger problem. The most common two procedures for this are:
- Loop Electrosurgical Excision Procedure (LEEP)—a thin wire loop is used to cut away a layer of abnormal cervical cells, this can be done in a doctor’s office using local anesthesia
- Conization—you will be put under general anesthesia in a hospital while the abnormal cervical tissue is removed using a scalpel, the layer removed during conization is deeper than that removed in a LEEP procedure
If a biopsy of the removed abnormal cells is confirmed to be cancer, your doctor will discuss a treatment plan for you. The survival rate for cervical cancer that is still localized and detected early is over 90%.
Routine Pap smears are the most effective tool for prevention and early detection of precancerous or cancerous cervical cells. That’s why it is essential that an annual trip to the gynecologist is part of every woman’s healthcare regimen.
At South Avenue Women’s Services, in addition to being a leading abortion clinic, we also provide compassionate and comprehensive well-woman care to women throughout Rochester and Western NY. We offer annual gynecology exams, Pap smears, and full specialist services in the case of any discovered abnormalities—including diagnosis and surgery.
Contact our team of medical professionals today to schedule your next healthcare screening!