Abnormal Pap smear: Next steps

Pap smears are an important part of a woman’s health care because they detect abnormal cells on the outside of the cervix, including cervical cancer and pre-cancerous changes. Before you panic about an abnormal Pap smear, Dr. Jan Goral, OB-GYN physician with Marshfield Clinic Health System, says to remember that regular Pap smears are “designed to catch abnormal cells before they turn to cancer.”

Thoughtful woman looking out a window - Abnormal pap smear

An abnormal Pap smear doesn’t always mean cervical cancer. You will undergo more tests and your doctor may perform a procedure to remove abnormal cells.

He explains what might cause an abnormal Pap smear and the next steps after an abnormal test.

HPV causes abnormal Pap smear results

Human papillomavirus (HPV) is the most common cause of abnormal cervical cells, Dr. Goral said.

Cells infected with HPV undergo changes that can turn into cervical cancer, but an abnormal Pap smear doesn’t always mean you have cancer. The test often catches pre-cancerous cells.

The HPV virus is sexually transmitted. There are many strains of HPV and some can be present without any symptoms.

“A woman could also have been exposed to HPV in her teens or 20’s, but the virus can lie dormant for many years before causing abnormalities,” Dr. Goral said. “This means that a women may go decades with normal pap smears, and suddenly have an abnormal pap smear despite maintaining the same sexual partner.”

Additionally, he said a woman can have one strain of HPV, clear it and then catch another strain.

Other infections like chlamydia, bacterial vaginosis or yeast infections also may cause abnormal test results.

Abnormal results mean more tests

The type of follow-up recommended after an abnormal test depends on the severity of the abnormality and the presence of HPV.

Your doctor will use an in-office procedure called a colposcopy to get a close-up view of the cervix and take a tissue sample. It’s similar to a Pap smear. If the tissue sample shows a higher level of abnormal cells, you may need a loop electrosurgical excision procedure (LEEP). This is another procedure to remove the abnormal cells, which is often curative.

Following abnormal test results, your doctor will probably recommend more frequent follow-up Pap smear and HPV testing to check for progression or resolution of abnormalities.

“Follow-up is extremely important, as changes can progress or improve, often times without need for treatment depending on the severity of the abnormality,” Dr. Goral said.

If any of these procedures show cervical cancer, your doctor will refer you to a gynecologic oncologist – a doctor who specializes in female reproductive cancers.

Who needs a Pap smear?

Pap smears are recommended for all women ages 21-65. Women 21-29 years old should get the test every three years if previous tests were normal. Women over 30 can continue testing every three years, but every five years with an HPV test done at the same time is preferred.

“In the past, Pap smears were done every year for all women,” Dr. Goral said. “We found that if we use age-based and HPV-based testing methods that we can better risk stratify women to determine how often they need a pap smear and still detect changes in the cervix. For example, a woman at age 35 with a normal pap test and negative HPV can have screening done every five years, whereas a 35-year-old woman with a normal pap and positive HPV may need yearly testing.”

HPV vaccine is the best prevention against cancer

Because most cervical cancers are caused by the HPV, vaccination against HPV is an option for cervical cancer prevention. Vaccines protect against several strains of HPV. Dr. Goral recommends Gardasil-9 because this HPV vaccine protects against nine strains of HPV, seven of the highest risk strains which cause cervical cancer, and two strains which cause genital warts.

“It is often part of childhood vaccine protocols, but this is not always the case, so you should check your vaccination records,” he said.

To be most effective, HPV vaccines should be administered before children and adolescents are sexually active. However, Dr. Goral explains due to the body’s ability to potentially clear different strains and contract others, it is still extremely beneficial to receive the vaccine well into adulthood.

“Studies have shown that patients who receive the vaccine after undergoing a LEEP procedure have higher success rates of clearing the virus and regaining normal pap smears,” he said.

Gardasil-9 protects against more than just cervical cancer and genital warts. The same strains of HPV also are a leading cause of throat, anal, vulvar and penile cancers.

Dr. Goral said both males and females are eligible for the HPV vaccine. He said males spread the virus often without symptoms. People ages 9-14 receive two doses, six months apart, and ages 15 and older receive three doses – the first dose, then at two months and six months thereafter.

Talk to your child’s provider or your OB-GYN or primary care provider for more information.