A healthy living blog from Marshfield Clinic Health System

Abnormal Pap smear: Next steps

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.

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.

Before you panic about an abnormal Pap test, remember this: Regular Pap smears are designed to catch abnormal cells before they turn to cancer.

Dr. Rebecca Downs, a Marshfield Clinic Health System obstetrics and gynecology physician, explained 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. Downs 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 can have one strain, clear it and then get another strain,” Dr. Downs said. “A woman could also have been exposed to HPV many decades ago and still has not cleared it.”

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 in-office procedure to remove the abnormal cells.

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

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. Downs 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.”

Even so, a pelvic exam is still an important part of identifying early cervical changes and is recommended annually.

Request an appointment for a Pap smear or pelvic exam.

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