If you are the owner of a vagina and vulva, chances are you're familiar with the routine Pap test, also known as a Pap smear. Pap test results are either normal or abnormal, depending on whether abnormal cells are found, and while an abnormal test result can be frightening, it doesn't always mean you have cervical cancer. Here's what an abnormal Pap test actually means for those who get that phone call.
What is a Pap test?
If you've experienced a Pap test, you know the drill — you visit your doctor, assume the position (in stirrups) while they swipe cells from your cervix that will later be examined under a microscope. Cervical cancer screenings are a vital part of routine health care for those with a cervix. The American College of Obstetrics and Gynecology notes that it can take three to seven years for high-grade changes in cervical cells to turn into cancer — in other words, a Pap test can catch cancer before it really even starts.
Current recommendations from the ACOG note that most women should have a Pap test every three years — but women who are aged 30 to 65 can stretch that to every five years if they also have an HPV test at the same time. Of course, certain circumstances will dictate more frequent screenings, such as prior history of cervical cancer or an HIV infection (talk to your doctor to find out how often you should go).
What does an abnormal Pap smear mean?
First of all, it's important not to fear the worst once you get the news, says Dr. Sherry Ross, an OB-GYN at Providence Saint John’s Health Center in Santa Monica, California. "Abnormal Pap smears are very common," she tells SheKnows. "But the good news is it rarely means cancer. Millions and millions of women will experience an abnormal Pap smear in their lifetime. If you haven’t experienced one yet, chances are your BFF has."
That being said, an abnormal Pap test does merit attention, as it shows that your cervical cells may be going through some changes that may lead to cancer. That's definitely not always the case, though. Dr. Prudence Hall, an OB-GYN and author of Radiant — Again and Forever, tells SheKnows that there are a few different reasons an abnormal result might pop up.
"It could be something mild, like a yeast infection," she explains. "Or it could be an STD. Or it could be something like a virus (the virus that most commonly causes an abnormal cervix is HPV)." She also notes that it could be due to something as simple as aging, because thinning vaginal walls and cervical tissue can cause a Pap test to look abnormal.
Ross says it's also possible that the presence of blood can alter results, which means that it's vital not to go for a checkup while you're on your period, even if you're spotting. However, there are other reasons for an abnormal Pap that aren't a yeast infection or bleeding or aging — and these reasons include precancerous cells.
Next steps for an abnormal Pap smear
No matter what the suspected cause is, cervical cell changes should always require a second glance, even if you or your doctor think it's nothing serious. Dr. Latasha N. Murphy, a gynecologist and surgeon at Mercy Medical Center, explains that abnormal Pap results fall somewhere on a spectrum from mild changes to more severe, all of which require different levels of follow-up or treatment.
"There are mild dysplasia Pap smears, which may require simply repeating the Pap smear at some interval between six and 12 months," she tells SheKnows. "There are more severe abnormalities that require a cervical biopsy or deeper sampling of the cervical tissue."
If you fall into the latter range of the spectrum, however, you're definitely not alone. "Approximately 6 percent of the Pap smears obtained annually require further evaluation with colposcopy or biopsy," Murphy explains. "A colposcopy is an outpatient procedure where a provider looks at the cervix under a microscope for better evaluation of abnormalities." A biopsy is the direct sampling of cervical tissue that is then sent off to a lab for evaluation.
The type of cells that are found via a biopsy will also dictate how your treatment goes, says Ross. "Moderate or severe precancer cells need to be removed," she explains. "But if the biopsies are completely normal, then more frequent Pap smears would be recommended."
The bottom line is that abnormal Pap smears are common, but it doesn't always lead to a cancer diagnosis — not by a long shot. It's crucial, though, to stick to your doctor's recommended timeline for your Pap tests and follow up any time you have an abnormal result. It may be nothing, but it can also be a prelude to cancer, so you want to get diagnosed and treated early.