After a certain age, women accept the fact an annual visit to the gynecologist usually is accompanied by a pap smear — that uncomfortable process of tissue sampling which checks if the cells of the female reproductive system are normal.
For many women a pap smear is out-of-sight, out-of-mind because the results never show any issues. But what happens after an abnormal pap smear? Just what should you know?
What does an abnormal pap smear mean?
First, it is important to know what an abnormal pap smear means and why it shouldn’t be an immediate cause of anxiety.
According to the Office on Women’s Health, a pap smear can be abnormal for a number of reasons including infection, abnormal cell growth, or cervical cancer, and the main purpose of the screening is to simply to examine the health of the cells in the cervix.
An abnormal pap smear is not always an indication cervical cancer is present.
Sometimes the cells in this part of the body register as “abnormal” but are not the result of any serious illness. These harmless abnormal cells usually go away on their own, which is why a doctor often rechecks an abnormal pap smear a few months down to road if no other symptoms or risk factors are present.
If the test shows abnormal cells again, a treatment protocol will be initiated.
The most common causative agent for an abnormal pap smear is infection with the human papillomavirus (HPV).
HPV is the leading cause of cervical cancer, and the primary reason pap smears are so important for women’s health.
Other issues aside from HPV can also cause an abnormal pap smear, and according to the American Pregnancy Association, those health concerns include:
- General infection
- Recent sexual activity
Pap smear results can show false positives for abnormal cells as well, and all this means is there was an error in the testing process.
Women with false positives are told abnormal cells are present when in reality there is not an issue.
So what happens after an abnormal pap smear?
There are two results from a pap smear which may indicate abnormal cells. The Centers for Disease Control (CDC) indicate these two classifications are:
- Unclear: Indicates cervical cells look like they could be abnormal and there is no clear indication the issue is the result of HPV. Unclear results on a pap smear usually will be followed up with an HPV-specific test.
- Abnormal: An abnormal pap smear means cells changes were found on the cervix. It is not an immediate indicator of cervical cancer, but usually suggests HPV infection has caused some degree of alteration in the cells. The changes may be minor (low-grade) or serious (high-grade), with minor changes going back to normal on their own the majority of the time. More serious changes can turn into cancer if they are not removed and are often called “precancer” because they can turn into cancer over time.
According to the CDC, more than 3 million women in the United States have abnormal pap smears annually. Of those, only approximately 10,000 have cervical cancer.
Just because the majority of women do not develop cervical cancer doesn’t mean they do not undergo treatment for the abnormal cells detected.
If you go to the gynecologist and end up with an abnormal pap smear, the following sequence of events may take place:
- If no other symptoms of disease are present, repeat the test in a few weeks or months, depending on the individual patient.
- If an abnormal pap smear confirms after a second test, a colposcopy, an examination in which a speculum is inserted into the vagina, is performed. During this procedure, the cervix is painted with a vinegar solution which makes any abnormal areas stand out. A biopsy of the abnormal areas is then done and cell samples are sent to a pathologist for definitive diagnosis.
- After the biopsy is obtained, cryosurgery, or a freezing of the abnormal cells, is usually performed next. Sometimes, doctors will prefer to use the LEEP procedure, where abnormal cells are removed through electric current cauterization.
- After these procedures, a pap smear will be repeated in a specified amount of time based on the individual.
Women who have an abnormal pap smear indicative of cervical cancer must usually undergo more invasive surgery, such as a hysterectomy, and usually must have follow-up radiation or chemotherapy.