Should I Be Concerned About an Abnormal Pap Smear?

Cervical cancer was once the most common cause of cancer-related deaths among women. That changed, largely because of a test called the Pap smear, now part of a routine well-woman exam.

The Pap smear, or Pap test, is a screening tool for precancerous cells that may become cancerous. Detecting such cells in their early stages of development means a greater chance of treating them effectively.

Board-certified OB/GYN Dr. Hany H Ahmed specializes in managing abnormal Pap smear results for his patients in Houston, Texas. He wants you to know that an abnormal result doesn’t necessarily mean you have cervical cancer. 

Here’s what “abnormal” means and what Dr. Ahmed can do about the problem.

Pap smear basics

A Pap smear is an in-office procedure that takes no more than 20 minutes. Doctors recommend women get tested every three years, starting when they turn 21. 

For women over 30, Dr. Ahmed may also test for the human papillomavirus (HPV), the most common sexually transmitted infection (STI). It’s also associated with cervical cancer.

The Pap test is simple. You lie down on an exam table with your heels in stirrups, and Dr. Ahmed inserts a thin, metal speculum into your vagina. When he opens it up, he can see clear through to the cervix, the opening at the lower end of the uterus. 

He collects a sample of the cervical cells with a simple swab, which he sends to a lab for analysis.

Should you be concerned about an abnormal Pap smear?

The results of a Pap smear can be negative, positive, or abnormal. 

A negative result means no cancerous, precancerous, or other abnormal cells were detected. Abnormal results usually indicate cervical cell changes caused by HPV, and there’s not much to worry about. But that’s not the only possibility. Here are a few more:

Atypical squamous cells of undetermined significance (ASCUS)

Squamous cells are flat, thin cells that grow on the cervical lining, and ASCUS means the cells don’t look like normal, healthy cells. Dr. Ahmed tests the abnormal cells to determine if HPV is present. If this test is negative, he may repeat it or take a wait-and-see approach.

Squamous intraepithelial lesions

These lesions may be precancerous, but it’s uncertain how long it may take for them to become malignant. Doctors classify them as low or high grade to describe how they appear. 

Low-grade lesions could indicate an HPV infection, and the cells might take years to turn cancerous. High-grade lesions become cancerous much sooner. In both cases, Dr. Ahmed follows up with more tests to develop a treatment strategy.

Atypical glandular cells

Glandular cells are mucus-producing cells at the opening of the cervix and inside the uterus. An abnormal test result may mean they’re precancerous or even cancerous, so Dr. Ahmed performs additional tests.

Squamous cell cancer or adenocarcinoma cells

Highly atypical cells are almost certainly cancerous. Dr. Ahmed follows up with additional tests while at the same time treating the cancer before it can develop further.

Following up on an abnormal Pap smear

The tests Dr. Ahmed orders depend on how atypical the cervical cells are. If they’re just slightly abnormal, he may suggest a second Pap smear, either immediately or after a few months, and/or an HPV test if he didn’t do one before. He may also order a colposcopy and a biopsy.

For the colposcopy, the doctor again inserts a speculum into your vagina and follows it with a colposcope, a long, thin tube with a magnifying lens and light at the end.

This device lets him see the cervix and its cells more clearly than during the Pap test. He uses vinegar to swab the cervix to highlight any suspicious areas he sees.

If he finds patches that look precancerous or cancerous, he takes a biopsy, a small tissue sample. He sends this to a lab for further testing. These results are more detailed than those from a Pap smear.

If the tests highlight suspicious cells, Dr. Ahmed treats them with cryotherapy, using a specialized instrument to freeze the tissue. It dies off, and your body eventually eliminates it so it can’t harm you.

Should you be concerned about an abnormal Pap smear? Not necessarily, but it’s a good idea to get follow-up tests to be sure. To learn more about abnormal cells or schedule a Pap smear with Dr. Ahmed, call the office or schedule online.