What is abnormal pap test?

A Pap test (also called a Pap smear) is used to look for early changes that may become cancer of the cervix. Your Pap test was abnormal. That may mean that some cells in your cervix have changed. The cell changes are most often caused by human papillomavirus (HPV) infection.

An abnormal Pap test does not mean that the abnormal cells will lead to cancer. Changes in cervical cells may go away on their own or may progress slowly. Your doctor may have you follow a schedule of regular cervical cancer screening tests. Or your doctor may have you take other tests to find out more about your cell changes.

It is very important that you have regular cervical cancer screening tests after you've had an abnormal Pap test.

HPV, which causes most cervical cell changes, usually doesn't cause symptoms. But some people with cell changes may have abnormal vaginal bleeding. This may include bleeding between periods, heavy periods, or bleeding after sex. If another vaginal condition is the cause, you may have other symptoms, such as vaginal pain, itching, or discharge.

Not everyone needs treatment after an abnormal Pap test. Whether or not you need treatment can depend on the type of cell changes you have, your age and medical history, and the possible cause of the cell changes.

Mild cell changes.

For mild cell changes you probably will not need treatment. Mild changes often go away on their own. But if mild changes are caused by a treatable vaginal infection or atrophic vaginitis, you may be treated with medicine.

Moderate or severe cell changes.

For moderate or severe cell changes you may have treatment that focuses on destroying or removing abnormal tissue.

Treatment choices include:

• Cone biopsy, which removes a cone-shaped wedge of abnormal cells that are high in the cervical canal.
• Loop electrosurgical excision procedure (LEEP), which uses a thin, low-voltage electrified wire loop to cut out abnormal cervical cells.
• Cryotherapy, which destroys abnormal cervical cells by freezing them.
• Laser therapy, which uses a laser beam to destroy abnormal cervical cells.

If you're pregnant, you'll be monitored closely throughout your pregnancy. Most treatment for abnormal cell changes is done after delivery.

• Do not smoke. Smoking may increase your risk for cervical cell changes. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.
• Be sure to get follow-up Pap tests or other follow-up tests as recommended by your doctor.

Certain sexual behaviors, like having sex without condoms and having more than one sex partner (or having a sex partner who has other partners), can increase your risk for getting HPV. And HPV raises your risk for having an abnormal pap test.

HPV can stay in your body for many years without your knowing it. You may not know you have it until you get an abnormal pap. So it can be hard to know when you were exposed.

Other things that may also play a role in increasing your risk include:

• Smoking.
• Having an impaired immune system.
• Having been exposed to the drug DES before you were born. But this is rare.

If you have had one abnormal Pap test result, you're more likely to have another in the future.

Pregnancy doesn't seem to increase the progression of abnormal cervical cell changes. Having abnormal cervical cell changes or HPV doesn't affect the outcome of the pregnancy. Close monitoring is needed so that you and your health professional can make the best treatment decisions at each stage of the pregnancy.

An abnormal Pap test may be evaluated further with colposcopy. This may be done during pregnancy or after delivery.

If colposcopy shows normal tissue, then a repeat Pap test or colposcopy may be done later. Having a second test depends on the type of abnormalities reported on the first Pap test.

If colposcopy confirms abnormal tissue areas, a cervical biopsy may be done to diagnose the abnormal tissue. It can also make sure that cervical cancer, which is rare, is not present. If a cervical biopsy is needed during pregnancy, it doesn't usually cause problems with the pregnancy. But the risk of bleeding is greater after the first trimester. Cell changes should be monitored during the pregnancy and after delivery. Many minor cell changes return to normal after delivery. Moderate to severe cell changes can often be treated after delivery.

If you have invasive cervical cancer, it must be treated as soon as possible. It's harder to manage because of the concern for the outcome of both you and your baby. Treatment will be managed by a team of health professionals who specialize in cancer and high-risk pregnancies.

Cervical cell changes are classified according to their degree of abnormality using the Bethesda system (TBS). Further evaluation decisions are guided by the kinds of changes seen in the cells.

Minor cell changes

Minor cell changes may go away without treatment. But sometimes they turn into more serious cell changes. Types of minor cell changes include:

• Atypical squamous cells (ASC). These are changes for which the cause is unknown. They may be caused by an HPV infection. Or they may be caused by inflammation, another infection, or atrophic vaginitis. ASC is further classified as:
  • ASC of undetermined significance (ASC-US). These changes usually stay the same or return to normal.
  • ASC that cannot exclude high-grade squamous intraepithelial lesions (HSIL) (ASC-H). These changes are also minor. But they are more likely to become more serious.
• A low-grade squamous intraepithelial lesion (LSIL). This is also called mild dysplasia. This change is usually caused by HPV and may be more likely to become more severe over time. But even when it does, it usually returns to normal.

Moderate to severe cell changes

Moderate to severe cervical cell changes (also called moderate to severe dysplasia) mean cell changes that are more likely to be precancerous and develop into cervical cancer if left untreated. Moderate to severe cervical cell changes are classified in the Bethesda system (TBS) as high-grade squamous intraepithelial lesions (HSIL) or atypical glandular cells (AGC). Follow-up evaluation is needed, and treatment may be needed.

All abnormal Pap tests require follow-up to identify development of more severe cell changes, including cervical cancer. Most abnormal cells can be removed or destroyed before they become cancerous.

Most of the time, the abnormal cell changes are caused by certain types of human papillomavirus, or HPV. HPV is a sexually transmitted infection.

Sometimes the changed cells are due to other types of infection, such as those caused by bacteria or yeast. These infections can be treated.

During or after menopause, a Pap test may also find cell changes that are caused by atrophic vaginitis.

A Pap test, or Pap smear, is done to look for changes in the cells of the cervix. If your test is abnormal, it means it found some cells on your cervix that don't look normal. Having an abnormal test doesn't mean you have cancer. The chances that you have cancer are very small.