Pap Smear Came Back Abnormal
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Pap Smear Came Back Abnormal
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If you get a call from your doctor’s office about an abnormal pap smear, you might start to freak out. Dr. Kirtly Parker Jones says it’s a good idea to take a deep breath first. Many times, the doctor doesn’t scrape enough cells and you need another smear. Dr. Jones explains the many reasons you could be called back—including some comforting information and statistics about treatments.
Announcer: Covering all aspects of women's health. This is The 7 Domains of Women's Health with Dr. Kirtly Jones on The Scope.
Dr. Jones: So you just got a call from your doctor or probably your doctor's nurse, who told you that your pap smear was slightly abnormal or was abnormal and you need to come back in. Well, should you hang it up and write your will or is it going to be okay?
Well, here's the scoop on that. The Pap smear is a screening test to pick up pre-cancerous abnormalities in the cervix before they become cancer. So the vast majority of abnormal pap smears that you might get a call about are actually not cancer. They are pre-cancerous conditions that we want to investigate a little bit further and can treat these little local areas in the cervix before they become cancer.
So if you go back in, what might happen? Well, your pap smear may have been abnormal because for some reason the fluid got screwed up or they didn't collect enough cells. So sometimes you get a call not because there's anything wrong, but because there wasn't enough to look at. Okay. So that's not a scary thing, but your nurse should explain that you. "No problem. We just didn't get enough cells on your pap smear to look at."
So what's the chance that if the Pap smear said you have some abnormalities on your cervix that you really do have something, abnormalities on your cervix? So we mentioned that a pap smear is a screening test. It's not a diagnostic test.
How good is it as a screening test? How true is it? That's a difficult question, but I would say that if you have mild dysplasia on your pap smear, the chances of us not finding anything on a colposcopy may be as high as 50 percent to 60 percent. On the other hand, if you have severe dysplasia or high-grade dysplasia on your pap smear, the chances that we're going to find something is more like 90 percent.
So a few little mild changes, which will trigger the callback, may not mean that you have anything. So if you have a low-grade lesion, that may not mean that you really have anything to worry about. If you have a high-grade lesion, that doesn't mean cancer, but it does mean that you really need to have it looked at and probably treated because a high-grade lesion on a pap usually means there's something there to treat.
If there's an abnormality, or what we call dysplasia or cervical intraepithelial neoplasia . . .There are a bunch of scary words. Usually, what happens is you go in, and the doctor puts a speculum in that device to look at your cervix. And then he or she rolls up this little instrument that looks like binoculars on a stick.
So they use these very special binoculars to magnify the cervix so they can look for areas that might be a little bit abnormal. This is called colposcopy. The "colpos" is the upper vagina and "scopy" means to look. So they are going to look at your cervix with these kinds of binos.
They may put some vinegar. So if you smell like a pickle, that's because they're using just ordinary vinegar to clean off your cervix. And vinegar makes the areas that might be abnormal turn white. So then they can look at the cervix, paint it with a little vinegar, look for areas that might be a little bit abnormal, and then they will take a tiny bit of tissue. Now, you think, "Oh, my god. They're going to operate on my cervix." Well, the amount of tissue they take is about the size of a hangnail.
So they take a tiny little biopsy, and they send that to pathology. And they say, "Is this something to worry about or not?" And if it's not something to worry about, then people come back, and they may have a few more pap smears than every three years. Maybe they're going to have a few extra in the next couple of years.
If it is dysplasia that is moderate or severe, that isn't cancer yet, but then we can actually treat the cervix. Usually, we use freezing or sometimes we use a little laser, but freezing is very cheap and very common. And we make a little cold blister. So we make a little blister, and the abnormal cells just come off. And then new, healthy cells grow in.
Well, the treatment can get rid of abnormal cells about 98 percent of the time so that's really good news. Now, we know that new, healthy cells can get infected by the virus. So it turns out that almost all cervical dysplasias and cancers are caused by the HPV virus .
So now you have all these pretty new cells covering your cervix. Well, they can get infected, too. So first, you want to make sure that you're in that 98 percent cure rate. So they'll probably ask you to get pap smears more frequently, maybe twice a year for a couple of years. If they all stay normal then you are back on to your every other, every third year screening. If, for some reason, you're at high risk, meaning you have a high-risk virus or you have a high-risk lifestyle where you might get more viruses, then you probably need to be screened a little more often.
So the treatment is about 98 percent effective at getting rid of the dysplasia that you have, and new, healthy cells will grow in. But as long you've got the virus or are exposed to new viruses, it's possible that you could get these changes come back. So once a woman's been treated for dysplasia, she's very likely to be cured, but she has risk factors for getting it again. Not that it wasn't cured the first time, but getting it all over again.
Think of it as sun exposure on your face. So you're a little bit older, and you've got this little area on your face that the dermatologist wants to burn off. You can burn off that one, but it's very likely that a year or so from now you'll get another someplace else. So it's not unlike that with cervical cancer as well.
Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.
updated: July 26, 2018
originally published: May 11, 2015
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Good news: It might not be the nightmare you think it is.
So you went for your regular ob-gyn checkup, had a routine Pap smear...then promptly forgot about it as you continued your busy life. Now your doc has left you a message telling you that it came back abnormal. And you’re terrified.
We hear you; Pap panic is hard to get a grip on, especially since the words “cervical cancer” are probably flashing in bright lights in your brain. But keep in mind that an abnormal Pap almost never indicates cancer. This lifesaving test is designed to detect cervical cell changes in a precancerous stage, well before those changes become malignant. It also picks up cell irregularities caused by minor issues that have zero to do with cancer at all. So dial back the worry and let us walk you through the next steps.
“If your HPV test is negative, your doctor will likely assume the Pap result didn’t indicate anything serious, and she’ll just retest you within the next 12 months,” says Teresa Diaz-Montes, M.D., a gynecologic oncologist at Mercy Medical Center in Baltimore.
“In either of these situations, your doctor will want to do a colposcopy, when she’ll look through a large magnifying lens to view your cervix up close irregular changes,” says Diaz-Montes. If she spots something, she’ll take a biopsy that goes to a lab; you’ll feel a pinch or even a quick cramp, and it’s over.
If the colp is positive for high-grade cell changes, that’s a bigger deal; those cells need to be removed. If they aren’t, over a period of years, there's a risk they'll become cancer, says Diaz-Montes.
After a follow-up visit or two to make sure your cervix has healed properly, you’re good to go—but your ob-gyn will want to do another Pap in six months to make sure the cell changes didn’t return.
Wondering why you have to get a Pap smear so ofen when those "abnormal" results are so often a false alarm? The U.S. Preventive Services Task Force and the American Congress of Obstetricians and Gynecologists actually now recommend that women between the ages of 21 to 29 only receive a Pap test every three years instead of annually—to minimize unnecessary panic. That doesn’t mean you can skip the screening altogether, though; it's still your first line of defense against cervical cancer. But if you hear the word "abnormal" in the future, now you'll know not to freak.
Medically Reviewed by Nivin Todd, MD on April 26, 2021
If the results of your Pap test come back positive, that means your doctor found abnormal or unusual cells on your cervix . It doesn’t mean you have cervical cancer .
Most often, the abnormal test result means there have been cell changes caused by the human papilloma virus ( HPV ). That’s the most common sexually transmitted infection (STI), and can be linked to cervical cancer . Changes to your cervical cells caused by HPV can be mild, moderate, or severe.
Your doctor will review your test results and let you know. Their answer will depend on what type of abnormal cells are found in your cervix. The most common ones are listed below.
Atypical squamous cells of undetermined significance (ASCUS). Thin, flat cells called squamous cells grow on the surface of a healthy cervix. ASCUS occurs when these cells are not typical. Your doctor will do a test with a special liquid to see if HPV is present. If it’s not, there’s probably no need for concern.
Squamous intraepithelial lesion . These cells may be pre-cancerous. Doctors call changes to them “low-grade” or “high-grade.” If they’re low-grade, a pre-cancerous cell may not turn to cancer for many years. If it’s high-grade, the cells could turn to cancer much sooner. Your doctor will likely order more tests, including a colposcopy, an instrument that shows changes in the cervix that may lead to a biopsy of cervical tissue to check for cancerous cells.
Atypical glandular cells . These cells make mucus . They grow in the opening of your cervix and inside your uterus. If they appear to be abnormal, your doctor will order more tests, including a colposcopy, to find out for sure if it’s cancer .
Squamous cell cancer or adenocarcinoma cells . This means the cells on your cervix are so abnormal, your doctor is almost certain it’s cancer.
To be sure, your doctor will likely order two other tests -- a colposcopy and a biopsy .
During a colposcopy, your doctor will insert a speculum into your vagina , just like they did for the Pap test. This time, they’ll look at the cervix with a colposcope. This is a tool that has a lens and a bright light that allows your doctor to get a better look at your cervix. They will swab your cervix with vinegar or some other liquid solution. It’ll highlight any suspicious-looking areas. Your doctor will be able to see them through the lens on the colposcope.
If your doctor finds areas that don’t look right, they’ll take a sample, called a biopsy. They’ll send the tissue to a lab for further testing.
Association of Reproductive Health Professionals: “Understanding Cervical Cancer Screening Results.”
National Cancer Institute: “Cervical Intraepithelial Neoplasia.”
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WebMD does not provide medical advice, diagnosis or treatment.
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