Everything You Need to Know About an Abnormal Pap Smear, According to an Ob-Gyn
When it comes to preventative exams, they can often seem like an unnecessary bother or even just another item on the to-do list, but they're an opportunity to monitor your health and touch base with your doctor. Preventative exams are exactly what they sound like — they are meant to prevent and detect any issues before they become a problem. Additionally, they are a great opportunity to discuss topics like your period, reproductive health, lifestyle updates, and other preventative measures with your doctor.
Unfortunately, the Pap smear is one of those exams that tends to be avoided. Although many people dodge their regular Pap smear out of fear of discomfort, a Pap smear (also called a Pap test) is an important preventative exam to screen for cervical cancer. John Hopkins recommends all people assigned female at birth (AFAB) should start regular screenings at age 21, with Pap smears at varying intervals depending on age and results.
The procedure is brief and involves collecting cells from the cervix — a canal located inside the vagina, which connects the vagina and the uterus, according to the Cleveland Clinic — and is typically performed by an OBGYN.
Sometimes, the results of a Pap smear come back abnormal, and it can feel confusing or even scary when the results are unclear. To help you understand what an abnormal Pap smear is and how you can prevent cervical cancer, POPSUGAR spoke with Alyssa Dweck, MD, a NY-based gynecologist and author of "The Complete A to Z For Your V: A Woman's Guide to Everything You Ever Wanted to Know About Your Vagina."
What Is A Pap Smear?
Simply put, a Pap smear is a test for cervical cancer. Cervical cancer is caused by the human papilloma virus (HPV), which is the most common type of sexually transmitted infection (STI) in the United States, per the CDC. While there are many types of HPV, and only rarely do they cause cancer, there are several strains of HPV that are considered "high-risk" by the National Cancer Institute. High-risk strains can turn normal cells in your body to precancerous cells. Sangini Sheth, MD, associate professor of obstetrics, gynecology, and reproductive sciences at the Yale School of Public Health told POPSUGAR that around 80 percent of sexually active people will have HPV at some point, though most will clear the infection without any intervention.
The point of a Pap smear, says Dr. Dweck, is to catch any changes in cervix cells caused by HPV early on before it can progress to cancer. There are vaccines that can prevent many strains of HPV, and Dr. Dweck shared that "in the medical field, we consider this to be an anticancer vaccine because HPV can cause cervical cancer, oral cancer, anal cancer, and penis cancer — so we're trying to push the vaccine for anticancer response." If you're not sure if you ever got vaccinated for HPV, speak to your doctor about getting up to date.
Pap smears don't happen during every single annual preventative exam. Those AFAB age 21 through 29 should get a Pap test every three years, according to the American College of Obstetricians and Gynecologists. The exception is when a cervical abnormality is detected, in which case your doctor may recommend more frequent follow-up screenings. For those age 30 to 65, your doctor may suggest getting a Pap and HPV test together every five years.
What An Abnormal Pap Smear Means
Finding out that your Pap smear results have come back abnormal can be daunting, but Dr. Dweck says to remain calm because a Pap smear is a screening test — the first step in the process to find out exactly what, if any, underlying medical issues may be causing abnormal results.
Abnormalities aren't a guaranteed cause for concern — they exist on a spectrum. You can have a Pap smear that shows mildly atypical cells, "and usually that's nothing to worry about," says to Dr. Dweck. These abnormalities will often be referred to as atypical squamous cells of undetermined significance (ASCUS), according to Johns Hopkins Medicine. Then, there's a low-grade abnormality (low-grade squamous intraepithelial lesion (LSIL)) in which cell changes are visible, but mild (mainly size and shape, per Johns Hopkins), and expected to resolve on their own. Finally, there's a high-grade abnormality (high-grade squamous intraepithelial lesion (HSIL)) in which cells appear very different than normal cells and are considered precancerous lesions.
Following Up with Your Doctor
If your results come back abnormal, you should work with your doctor for all necessary follow-up tests. Your doctor may suggest having a colposcopy, where your cervix is looked at with a microscope.
Dr. Dweck says that during a colposcopy, the doctor will take very small biopsies (tissue samples of the cervix) "to see if there's really an abnormality or if a Pap smear called it wrong."
A colposcopy is more accurate than a Pap smear and is considered the confirmatory test, says Dr. Dweck. "The next natural progression is that a good portion of those things will get better by themselves," added Dr. Dweck. If abnormalities are significant, Dr. Dweck explains that the next step is getting a loop electrosurgical excision procedure (LEEP) to remove areas of the cervix where the abnormal cells exist.
The entire process can certainly be daunting, but it's important to continue getting screenings and stay on top of your cervical health. When cervical cancer is caught early, usually through this type of preventative screening, the National Cancer Institute reports that the 5-year relative survival rate is 92 percent after early stage diagnosis.
– Additional reporting by Sara Youngblood Gregory