What Is an Abnormal Pap Smear?
A Pap smear, or Pap test, is a procedure used to collect cells from a woman's cervix (lower part of the uterus) and test them for cervical cancer or precancerous changes. The cells are collected during a pelvic exam in the clinic.
An abnormal Pap smear means the cells collected show abnormal changes. It doesn't necessarily mean cancer cells were found.
What Causes an Abnormal Pap Smear?
There are many causes for abnormal Pap smear results. Your doctor will evaluate the results to determine if further testing is necessary, including:
Repeat Pap smear.
Colposcopy. An examination of the cervix and the walls of the vagina using a special microscope (colposcope) that magnifies the view of the tissue lining the cervix and vagina. A biopsy may be taken if the doctor sees an area of abnormal cells.
Testing for human papillomavirus or HPV. The main cause of abnormal Pap test results is HPV infection, a common infection passed through sexual contact. There are many types of HPV. Some types have been linked to cancer of the cervix, vulva, and vagina. Others have been linked to genital warts.
Endometrial sampling. A test to obtain a sample of the lining of the uterus.
How Often Should I Be Screened?
Routine Pap smears have greatly reduced the cervical cancer death rate in the United States by detecting and treating cervical cancer before it becomes life threatening. Regular screening can also prevent cervical cancer by finding and treating abnormal or precancerous cells before they become cancer.
The American Congress of Obstetricians and Gynecologists (ACOG) recommends women have their first Pap smear at age 21. Guidelines on frequency depend on age and personal risk factors. According to ACOG:
(1) Women younger than 30 years should have a Pap test every two years.
(2) Women 30 years and older should have a Pap test every two years. After three normal Pap test results in a row, a woman in this age group may have Pap tests every three years if:
- She does not have a history of moderate or severe dysplasia.
- She is not infected with human immunodeficiency virus (HIV).
- Her immune system is not weakened (for example, if she has had an organ transplant).
- She was not exposed to diethylstilbestrol (DES) before birth.
Keep in mind these recommendations are for Pap smears only. Women should still continue to get annual OB/GYN checkups for well-woman care and any reproductive healthcare needs.
It is especially important to have regular Pap testing if you have the following risk factors:
- HPV infection
- Sexually activity before age 18
- Multiple sex partners
- Sexual partners with genital warts or other sexually transmitted diseases
- A personal history of an abnormal Pap test
- Pre-cancer or cancer
- Cigarette smoking
- Immune compromising conditions such as HIV or immunosuppression
- Family history of cervical cancer
Colposcopy is an examination of the cervix (the lower part of the uterus) and the walls of the vagina using a special instrument called a colposcope. The colposcope magnifies the view of the tissue lining the cervix and vagina, enabling the OB/GYN specialist to look for abnormal areas that can't be detected by the eye alone. If the doctor sees abnormal tissue, a small piece is removed, known as a biopsy, and sent to the lab for review.
The test is performed like a Pap test in the doctor's office. No anesthesia or pain medication is required.
Colposcopy is recommended for women who have abnormal Pap smear results, to provide more information about the changes in the cells of the cervix and to determine if they are cancerous or pre-cancerous. Colposcopy may also be used for women with genital warts, cervicitis (inflamed cervix), polyps, pain, and bleeding.