Basic Human Papillomavirus (HPV) Education

What you need to know about HPV and how it can effect you

An Abnormal Pap Test


What is a Pap Test?

A Pap test (sometimes called a Pap smear) checks for changes in the cervix that could, over time, become cancer. During your recent Pap test, cells were taken from the surface of your cervix and inside its opening. These cells were sent to a pathologist, a doctor who specializes in finding abnormalities of cervical cells. The pathologist examined your cells under a microscope and noted their size, shape, color, and contents. Your cervical cells were not entirely normal.

Is having an abnormal Pap test serious?

Hearing that you have an abnormal Pap test may make you worry that you might have cervical cancer. The good news is that you probably do not. Cervical cancer is a relatively rare condition. Most abnormal Pap results are not cancer. It may be comforting to know that abnormal Pap test results are not uncommon. About 1 in every 20 Pap test results are considered abnormal.

What is abnormal about my Pap test cells?

There are many reasons why a Pap test may be interpreted as abnormal, most of which are not serious. Some of the most common causes of abnormal Pap smears are described below.

Atypical (atypical squamous cells of undetermined significance (ASCUS) or atypical glandular cells of undetermined significance (AGUS)).

Atypical means that abnormalities were found in your cells. Pathologists are uncertain what these cells actually represent. So a woman with these results needs to have follow-up. Your clinician will determine which type of follow-up is best for you. Some women need a repeat Pap testing 6 months. Others may have an HPV test. In most cases, women will not be found to have a serious problem following further evaluation. However, a few women will actually have significant cervical disease that should be treated.

Dysplasia means that cells from an abnormal precancerous growth were found on the Pap smear.

Dysplasia describes the cells that are no longer normal but are not yet cancer.
There are many stages in the process of a normal cell becoming cancer. Dysplasia is call mild (low-grade squamous intraepithelial lesion or LGSIL) and moderate to severe (high-grade squamous intraepithelial lesion or HGSIL) depending on how abnormal the cells have become and the extent of tissue affected. In a small number of women, dysplasia may eventually develop into cancer, if not treated.

Cancer or carcinoma of the cervix may be detected by a Pap smear. In addition, Pap smears can also recognize cancer cells from other sites in the body (such as the uterus) that may have moved to the cervix.

How did this happen?

It is often hard to know what exactly caused you to have an abnormal Pap smear.
Because there are many types of abnormal Pap smears, the reason for abnormal changes on your cervix varies. The changes may result from a sexually transmitted infection (including human papilloma virus), lack of a hormone, intravaginal medication, contraceptives, irritation or a cancer-associated growth.

How long have the abnormal cells been on my cervix?

It is difficult to know how long the abnormal cells have been on your cervix. Abnormal cells caused by an infection may have been present for a just a brief time. In contrast, abnormal cells caused by dysplasia may have been present for much longer. Normal cells change very slowly to become precancerous cells, and it takes many years for precancerous cells to become cancer. Most abnormal cells never change into cancer.

Does an abnormal Pap smear mean that I won’t be able to have children?

An abnormal Pap smear can be caused by lots of different things, most of which have no effect on your fertility or ability to have children. It is extremely unlikely that your abnormal Pap smear or treatment for an abnormal Pap smear will prevent you from having children, unless it was reported as invasive cancer.

Does this mean that I could pass something to my partner?

Most causes of an abnormal Pap smear are not things that you could pass to your partner.
If your Pap smear report indicates that you may have a sexually transmitted infection,you could pass this infection to your partner. Many of these infections can be successfully treated with antibiotics or other medications.

How can I make sure my next Pap smear will be of good quality?

There are a few things that you can do to ensure that your next Pap smear is of good quality. Don’t use vaginal medications, douches, or tampons 2-3 days before your Pap smear. Also, avoid having sexual intercourse for 24 hours before your appointment. Don’t schedule your appointment during your period. Menstrual blood and vaginal medicines can make it difficult to see your cervical cells clearly.

What should I do now?

If your report found inflammation or infection, you may need to return to the clinic to be examined so that your healthcare provider can determine what is causing your abnormality. Sometimes you can be treated without another examination based on the abnormal Pap smear report.

If your Pap smear report indicated atypical cells, you may need a repeat Pap smear, a test for human papillomavirus or you may need an examination by colposcopy. Your healthcare provider will let you know what type of additional test may be best for you. If you are a postmenopausal woman not taking estrogen replacement treatment, you may be asked to take estrogen and return for another Pap smear in one month.

If dysplasia or a squamous intraepithelial lesion was found, the next step may involve taking a closer look at the cervix using a colposcope. A colposcope is like a microscope positioned outside the vagina that magnifies the cervix. A vinegar solution is applied to the cervix which turns abnormal tissue white. A white region contrasts with the rest of your cervix which is pink. By using a colposcope, we can find out the source of the abnormal cells that were seen on your Pap smear by taking a biopsy (a tiny sample of tissue). If your tests show only a mild abnormality, your health care provider may recommend close follow-up with Pap smears in within 6 months because often your body overcome mildly abnormal cells. For more severe abnormal cells, treatment to destroy the abnormal area is recommended. In the rare event that your Pap smear reported carcinoma, your health care provider will discuss further evaluation and treatment options with you.

Can I be cured?


Keep in mind that there may actually be nothing wrong with your cervix.
Some infections can be treated with medication. If precancerous cells or cancer are on your cervix, there are a variety of treatments available to remove the abnormal cells, including freezing, burning, laser treatment, or surgical removal. If invasive cancer is found, more intensive therapy is needed.

What can I do to prevent having cervical cancer or precancerous changes in the future?

You can increase your chances of not having cervical cancer or precancerous changes in the future by protecting yourself against sexually transmitted infections, not smoking tobacco products, and by getting routine Pap smears.

A Pap smear is only useful in detecting and preventing cervical cancer or precancerous changes if you return for follow-up evaluation and treatment appointments, when necessary. Keep in mind that it is very likely that the cause of your abnormal Pap smear can be easily treated, if treatment is necessary. In addition, the earlier abnormalities are treated, the easier they are to treat.

These materials were developed by the American Society for Colposcopy and Cervical Pathology (ASCCP) Patient Education Committees and approved by the Board of Directors for use by patients.

This material is provided for informational purposes only. It does not constitute medical advice and is not intended to replace professional care. Please consult your health care provider with any questions or concerns you may have regarding your condition. The ASCCP National Office does not provide individual consultation on cases or diagnoses.

While you may download, print and distribute these materials freely, they are copyrighted materials and all rights are owned by ASCCP. Therefore, they may not be changed, edited or altered in any way.

Copyright © 2003, 2008 ASCCP. All Rights Reserved.

PG

Author: H. Sandra Chevalier-Batik

I started the Inconvenient Woman Blog in 2007, and am the product of a long line of inconvenient women. The matriarchal line is French-Canadian, Roman Catholic, with a very feisty Irish great-grandmother thrown in for sheer bloody mindedness. I am a research analyst and author who has made her living studying technical data, and developing articles, training materials, books and web content. Tracking through statistical data, and oblique cross-references to find the relevant connections that identifies a problem, or explains a path of action, is my passion. I love clearly delineating the magic questions of knowledge: Who, What, Why, When, Where and for How Much, Paid to Whom. My life lessons: listen carefully, question with boldness, and personally verify the answers. I look at America through the appreciative eyes of an immigrant, and an amateur historian; the popular and political culture is a ceaseless fascination. I have no impressive initials after my name. I’m merely an observer and a chronicler, an inconvenient woman who asks questions, and sometimes encourages others to look at things differently.