Abnormal Pap Smear

The surface of the cervix comprises several layers of squamous cells. As these cells grow and develop, they move from the bottom inside layer to the top outside layer. These cells and the glandular cells that line the endocervical canal can be sampled using the Papanicolaou (Pap) smear and human papillomavirus (HPV) test.

Patients are encouraged to get a Pap smear annually, as part of their Well Woman Exam, to screen for cervical cancer or precancerous conditions such as HPV. Results of the Pap smear can be either normal, inconclusive or abnormal. 

• Normal: No abnormal cells are detected and cervical cancer is most likely not present.

• Inconclusive: Cells don’t look normal or abnormal. The majority of women with an inconclusive result have no abnormal cells on their cervix.

• Abnormal: Cell changes, either minor or serious, are present. Most women with abnormal cells don't have cancer, but more severe cases may progress to cancer. Abnormal results are either dysplasia, cervical intraepithelial neoplasia, or low-grade or high-grade squamous intraepithelial lesions.

Remember, an abnormal Pap smear result does not necessarily mean you have cervical cancer. The vast majority suggest a precancerous condition that will either resolve on its own or can be treated before it progresses to cancer. 

It is also important to note that these tests are not used to make a definitive diagnosis; the results are used to identify women who should go on to have detailed evaluation of their cervices and possible therapy.

 

Risk Factors

Cervical cancer is more common in women who have had multiple sexual partners or whose partners have had multiple sexual partners. Other risk factors include: 

• HIV infection

• the chronic use of immunosuppressive medications

• intercourse before age 17

• cigarette smoking

• a history of sexually transmitted diseases

• birth control pills

Human Papillomavirus

Abnormal cervical changes are most likely caused by either minor or serious HPV, which infects cells in the genital area of both men and women and can be transmitted during sexual intercourse. It is very common; most sexually active young men and women have been exposed to it.

HPV can cause genital warts, but may not be associated with any visible lesions or symptoms. Most HPV infections are temporary, resolving within two years. When the virus persists (in 10 to 20 percent of cases), there is a higher likelihood of developing cervical cell abnormalities and cancer. It usually takes several years for HPV infection to cause cervical cancer. Furthermore, not all HPVs cause cancer. Of the more than 70 subtypes of HPV, only 10 to 15 subtypes have been associated with the development of cervical cancer.

A vaccine is now available for HPV (Cervarix, Gardasil and Gardasil 9) and recommended for all girls and young women to prevent cervical cancer. The vaccine is administered as a series of shots over the course of six months. Women can receive the vaccine from age 11 to 26. 

Follow-Up Testing

Further evaluation depends upon the degree and type of cervical abnormality and the patient's risk factors for developing cervical cancer. Follow-up testing may involve repeat Pap smears or HPV tests, a colposcopy or a biopsy. 

A colposcopy is a painless office procedure performed during a pelvic examination. The colposcope (similar to a large microscope) magnifies the cervix 10-fold and allows the physician to better visualize the location, extent and degree of cellular abnormalities and any capillary changes on the surface of the cervix. Capillary changes, which are not detected by Pap smears or HPV tests, correlate with the degree of cervical cellular abnormalities. Using the colposcope, areas with abnormalities can be identified and biopsied to obtain a precise diagnosis.

 

Treatment

Treatment depends on the degree and type of cervical abnormality detected. A vaginal infection can usually be treated with antibiotics, while some patients can also find resolution with estrogen cream or medication.

When lesions are confirmed, the doctor may recommend treatment to eradicate the abnormal cells. This treatment may involve cryosurgery, laser treatment, electrocautery, excision of a large portion of the endocervical canal or hysterectomy.

 

Outcomes

Treatment will result in normal cervical cytology in more than 90 percent of patients. However, there is a 12 percent risk of recurrent abnormalities in low-risk women and up to a 50 percent risk of recurrence in women with certain types of HPV infection. For this reason, continued surveillance is important.

Pap smear or a combination of Pap smear and colposcopy every four to six months may be recommended for some patients. Annual screening is usually acceptable after three normal results.

 

Prevention

Adopting a lifestyle that reduces the risk factors for cervical cancer may help to prevent the disease. This includes avoiding exposure to multiple sexual partners, intercourse before age 17, cigarettes and sexually transmitted diseases (STDs). Although condoms help prevent the transmission of most STDs, they do not effectively protect against HPV infection. A few studies have suggested that dietary deficiencies of folate and beta-carotene are more common in women who develop cervical cancer. For this reason, some physicians recommend these vitamin supplements for women with abnormal Pap smears.

 

Learn More

Your gynecologist is the best resource for important information related to your particular case. Not all patients with an abnormal Pap smear are alike, and it is important that your situation is evaluated by someone who knows you as a whole person.