What is an abnormal Pap smear?

Being told you have an abnormal Pap smear is a stressful experience, but there are many reasons why it could be abnormal aside from cervical cancer.

Every year, over 2 million women will have an abnormal Pap test, yet nowhere near that many women will be diagnosed with cervical cancer. So clearly an abnormal Pap smear result is more likely to be caused by something a lot less serious.

A Pap smear is usually not how cancer is diagnosed unless it's sitting right on the top of the tissue. Usually a Pap smear just shows normal cells, abnormal cells, infection or inflammation.

You may hear of CIN1, CIN2, and CIN3. That's old terminology, but it means "cervical intraepithelial neoplasia." None of those are cancer. Today, a newer grading system would call CIN1 "mild dysplasia" or LSIL; CIN2 is "moderate dysplasia" or HSIL; and CIN3 is severe dysplasia or also HSIL.

You may hear that your Pap smear showed "ASCUS." That's also considered abnormal.

Some infections, like candida or even herpes, can be found on a Pap smear. Inflammation from infection can also be found, and sometimes it's bad enough that it's hard for the lab to tell if the cells are normal or not.

Read more about who examines Pap smears at the lab.

If a Pap smear is difficult to interpret because of inflammation, your doctor may give you antibiotics and then have you come back for a repeat test. The reason for this is that inflammation can often be caused by an infection, and if you treat the infection, the Pap test may become normal. But, also, inflammation can hide dysplasia.

But if you have an abnormal Pap smear, it's graded as mild, moderate or severe dysplasia. That's still not a diagnosis of cancer. If it's mild, many gynecologists will wait and have you come back in 6 months for a repeat test.

The reason why they don't do more right away is that only about 10% of mild dysplasia cases go on to become cancer. So treating everyone with mild dysplasia would be overkill. If, however, a repeat Pap smear still shows dysplasia, your doctor will want to do a biopsy.

Now, if your Pap test shows mild dysplasia and HPV and you're in your 30s, like I was, your doctor will probably want to do more immediately, specifically, a colposcopy and biopsy. The reason is that your body should put HPV into hibernation in about 2 years, and if you were infected in your 20s, your Pap smear in your 30s should not be positive for HPV. If it is, then your body has not conquered the HPV, and it may have done some damage.

No matter what your age, if your Pap results show moderate dysplasia and HPV, your doctor will want to look at your cervix under colposcopy (a microscope) and do a biopsy. This is done in the doctor's office and you don't need anesthesia. The doctor literally pinches off a tiny piece of your cervix with a metal tool.

Definitely if your Pap smear shows severe dysplasia (with or without HPV), you will need a colposcopy exam and biopsy. More cases of moderate and severe dysplasia become cancer, so it's not something to ignore.

Cervical cancer is slow-growing, but it does grow over time. You don't have to freak out that mild dysplasia will become cancer in just 6 months. If your doctor recommends a colposcopy and biopsy, do it.

Remember that cervical cancer is uncommon despite how common HPV is. An abnormal Pap smear doesn't necessarily mean you have cancer, and some Pap smear results are false positives. It's a great screening test that has saved thousands of women's lives, so make sure you get an exam every year.

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