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Understanding an Abnormal Pap Smear

An abnormal Pap smear indicates the presence of pre-cancerous or cancerous cells in the cervix. While this result does not mean that you have cancer, it does warrant additional tests by your doctor to determine the cause.

Common Causes of an Abnormal Pap Spear

Some abnormal Pap smears are related to the human papilloma virus, or HPV, which both men and women are likely to contract once they become sexually active. The HPV virus can infect people of any age, but it is most common among those in their teens and early 20s. At some point in their lives, most men and women will be affected by at least one type of HPV. Each year, 14 million Americans contract new infections to add to the 79 million currently infected with it.

The body often fights off the 40 or more strains of HPV that can infect male and female sex organs, or the mouth and throat. While most HPV causes no symptoms, some infections are serious enough to result in cancers and pre-cancers, which occur in the anus, oropharynx (mouth, tongue, throat) and penis for males, and the cervix, vagina, vulva, anus, and oropharynx for females. Less serious HPV poses fewer risks, it can cause warts and laryngeal papilloma’s in both men and women and low-grade cervical disease in women.

Each year in the United States, an estimated 26,000 new cancers are caused by HPV and the rates are increasing. Cervical cancer is the most common HPV-associated cancer among women.

Diagnoses Based on Abnormal Pap Smears

Each year, more than 12,000 women are diagnosed with cervical cancer, but as the disease is slow-growing, the figures are misleading. It takes years for abnormal cells to become cancerous. When your doctor finds abnormalities or changes in cells, he or she may order additional tests to determine what comes next.

An abnormal Pap smear might reveal:

• Atypical squamous cells of undetermined significance (ASCUS), which means that squamous cells are growing on the surface of the cervix.

• Squamous intraepithelial lesions, which indicates high-grade changes that call for further testing or low-grade changes that have just become evident are present.

• Atypical glandular cells, glandular cells produce mucus at the opening of the cervix; atypical glandular cells require additional testing.

• Squamous cancer or adenocarcinoma, are cancers and require immediate evaluation and treatment.

Abnormal Pap smears can result from causes such as diaphragm use, sexual activity, infection, changes in the menstrual cycle, or being menopausal. When the test comes back abnormal, your doctor will discuss possible reasons for the abnormality and may require a repeat of the test or prescribe other tests to reach a conclusive result.

The Next Step After an Abnormal Test

After an abnormal Pap test, the doctor might order additional procedures that may include:

• Colposcopy: the cervix and vagina are examined for abnormalities under a magnifying instrument

• Biopsy: a small piece of the cervix or vaginal tissue is removed and carefully analyzed.

• Curettage: scrapings from the canal of the cervix are carefully analyzed.

• Endometrial biopsy: samples are taken from the internal lining of the uterus (the endometrium).

• Loop Electrosurgical Excision Procedure (LEEP): a larger segment of cervical tissue is examined or treated for pre-cancer.

If any of these tests reveal cancer, the doctor will use imaging tools such as ultrasound, CT scan, MRI, or PET/CT scans to further examine the tissue.

Additional Follow-up After Testing

Since most abnormalities that show up in Pap tests do not reveal cancer, are very slow-growing, and may never become cancerous, your doctor may safely assume a “wait and see” approach to treatment.

If you are 26 years old or younger, you doctor may suggest receiving the HPV vaccine to protect you against further infections, including cervical cancer.

After receiving an abnormal Pap smear, obtaining regular screening and following any instruction your doctor might give you is important to good health.


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