You've received a call from your doctor saying you have an abnormal pap smear and further testing is warranted. What does that mean exactly? An abnormal pap smear means abnormal cells were detected either on your cervix or in the vagina. When human papilloma virus (HPV), is detected on your pap smear, it does not necessarily mean you have cancer. HPV can also cause early precancerous changes on your cervix or in the vagina called dysplasia.
What Types of Abnormal Pap Smears are There?
- ASCUS - ASCUS pap means there are abnormal cells due to infection, inflammation, or HPV. This does not mean you have the HPV virus, your doctor can order a separate test to check for the HPV virus.
- LGSIL - LGSIL means some low grade, precancerous cells were detected on your pap smear.
- HGSIL - HGSIL means high grade abnormalities were detected on your pap smear. These are still generally precancerous changes, but you may need to have treatment to remove these abnormal cells.
- AGUS - Atypical Glandular pap can mean a cancerous condition of some other female organ.
- Cancer - When cancer is shown on your pap smear, further testing is still usually completed to confirm the diagnosis.
Why are Further Tests Needed with an Abnormal Pap?
A pap smear is just a small collection of cells from the cervix and/or vagina. Because the cells collected are so small, a biopsy may be recommended to give the Pathologist reviewing the cells a larger sample to either confirm or deny the pap smear diagnosis.
What is the Next Step for an Abnormal Pap Smear?
A colposcopy is generally the first step when being diagnosed with an abnormal pap smear. A colposcopy begins with a speculum being placed in the vagina, the same device used during your pap smear. Your doctor will apply a dilute acid to the cervix and the vagina, which causes the abnormal cells to show up under the colposcope, similar to a microscope used to view the cervix and vagina. Your doctor may take small biopsies of the abnormal areas or scrape inside the endocervical canal, the canal leading from your cervix to the uterus. The biopsies will be sent to a Pathologist to analyze.
When an AGUS pap is detected, your doctor may do a pelvic ultrasound to further evaluate your uterus and ovaries. An endometrial biopsy, a biopsy of the lining of the uterus, may also be completed.
What is Done Once Your Diagnosis is Confirmed?
Most low grade precancerous changes require a follow up pap smear in six months because the chance of the cells turning to cancer is minimal. It may take years for the HPV to go away, and because there still is a chance of cancer developing, close monitoring is suggested by physicians.
High grade results generally will be treated by removing the abnormal cells. This can be done in the office or outpatient surgery, followed by a 3-6 month follow up Pap smear. These treatments only get rid of abnormal cells, not HPV.
In the rare case your biopsy shows cancer, only about 10-20% of cases of HPV progress to cancer, a hysterectomy is generally recommended.
What Can be Done to Treat HPV?
Again, there is no treatment for HPV. Cigarette smoking and a decreased immune system make it more difficult to fight off the virus. Most HPV related abnormalities will not progress to cancer. Getting yearly pap smears increases your chances of detecting precancerous changes early.
Resources
Holowaty P, Miller AB, Rohan T, et al.: Natural history of dysplasia of the uterine cervix. J Natl Cancer Inst 91 (3): 252-8, 1999.
American Cancer Society. Cancer Facts and Figures, 2008. Atlanta: American Cancer Society: 2008. Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines 2006. MMWR 2006; 55 [No. RR-11].
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