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.

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