For most women, a Pap test is just a routine procedure. You go to the doctor, get it done, and within a few weeks, you hear the results. Nine times out of 10, according to the American Pregnancy Association, they’re normal.
But what happens if you’re that 10th woman? How much should you worry about abnormal Pap smear results? Should you assume the worst — that you have precancerous human papillomavirus (HPV) cells or cervical cancer?
Lahey Health gynecologist Caroline Nitschmann, MD, MS, says that you shouldn’t. While abnormal results from a Pap smear or HPV test may signal the need for more testing, they don’t necessarily mean that you have cancer. We caught up with Dr. Nitschmann to learn more about testing, treating and monitoring for reproductive health issues.
What’s the first thing that happens if a Pap smear is abnormal?
“If a Pap smear is abnormal, the next step would be to do a detailed evaluation with a colposcopy including possible biopsies. A colposcopy is an examination of the cervix and vagina with a scope. Biopsies are taken for pathologic evaluation to confirm an abnormality.”
If a woman gets an abnormal result, does that mean she has HPV or cervical cancer?
“Not necessarily. Many things can cause an abnormal Pap smear such as infection or inflammation. HPV testing is separate from having a Pap smear meaning, just because you have had a Pap smear done does not necessarily mean you were also tested for HPV.”
What happens if a patient has the follow-up tests, such as the colposcopy and biopsies, and those come back abnormal, too?
“The next thing we would do would be to go for a bigger biopsy, called a loop electrosurgical excision procedure or a cone biopsy. Depending on what those results are, most patients can be observed without undergoing any further surgery or additional treatments, while others might need to go on to have further treatment, like a hysterectomy.”
In which cases would you just watch and wait, and when would you need treatment?
“Low-risk HPV infections, low grade Pap smears and biopsies, especially in younger women, often resolve on their own by the woman’s immune system. These are the patients that we typically observe as we think infections can go away and we want to minimize procedures to retain fertility. We worry more about high risk HPV infections, high grade Pap smears and biopsies particularly in older women or in those whose immune system is compromised as they are most at risk for developing cervical cancer.”
If you’ve had abnormal Pap smear results in the past, does it mean you need to get screened more often in the future?
“Future screening depends on prior results and is very patient specific. If Pap smear results are now normal after an abnormal test, some can continue on the regular recommended schedule — Pap smears every three years for women under 30 and combined Pap smear and HPV testing every five years for women over 30. Some women can never go back to a routine schedule and may need yearly evaluations for 20 years after the last abnormal test, or up until you reach 65.”
Can pregnancy impact Pap test results?
“No it should not, and we can screen for cervical cancer in pregnant women just as we can with anyone else. If you do get an abnormal result during pregnancy, we tend to defer further testing with a colposcopy or biopsies until after the baby is born unless the abnormality is very concerning.”
What’s the one thing you wish women knew about Pap test results?
“Here in the United States, we have access to excellent screening tools for the prevention of cervical cancer. Today, it is quite rare for women in the U.S. to develop invasive cervical cancer. I think a lot of people get really nervous when they’re told they have abnormal results, and that’s understandable, because you’re not expecting it. But for the most part, precancerous cells infected with HPV resolve or are cured with treatment. With the guidelines in place for screening and care, it really does make a huge difference in cervical cancer prevention.”
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