Getting a Pap smear isn’t something anyone looks forward to. It’s uncomfortable, it’s cold, and you never know where to hide your underwear when you undress for the exam.
Paps may be cause for anxiety by their very nature, but things can get a lot more concerning when your results come back as abnormal. Your mind may immediately start wandering toward the worst-case scenario, but medical professionals warn against jumping to conclusions.
A Pap smear is a test meant to screen for cervical cancer, but abnormal results don’t automatically mean your life is in danger. In fact, experts say it is incredibly common for women to have at least one abnormal Pap smear result in their lifetime.
Here’s what you really need to know about the test and any abnormal results.
What Is A Pap Smear, Exactly?
Your doctor will take a swab to check for abnormalities in your cervical and vaginal cells. The sample he or she collects will then be shipped to a lab where a pathologist will look at the cells to see if their appearance suggests a higher risk of cervical cancer (that’s what the screening is for, after all).
The test is not diagnostic, so your gynecologist will review your results and recommend next steps. If you’re a woman who has access to regular gynecological care in the United States, chances are high that your doctor will catch something before it turns dangerous, said Denise Rubinfeld, a certified nurse midwife working at Women’s Health Specialists of Nevada.
“The majority of cases of cervical cancer occur in women who have never had access to regular screening,” Rubinfeld said. “So, if you’re following the recommendations of your provider, it is really unlikely that you will ever develop a real health problem.”
It’s currently recommended that women have their first Pap smear at (and not before) age 21, according to the American Cancer Society.
What Causes Abnormal Results
The most common cause of cervical cells showing abnormalities is human papilloma virus (HPV). Almost all of us will contract HPV at some point, Rubinfeld said.
Most people are exposed to HPV, which is spread through skin-to-skin contact, when they become sexually active. Rubinfeld said healthy immune systems typically clear the virus in a year or two, so most women who receive their first abnormal Pap in their twenties have nothing to worry about. In fact, there’s a chance that they will have normal results by the next year.
“It can take years for an HPV infection to cause an abnormal Pap smear, so a current partner is probably not the source of the result.”
- Denise Rubinfeld, certified nurse midwife working at Women’s Health Specialists of Nevada
And Rubinfeld cautioned people against assuming they know how they contracted HPV.
“A lot of people wrongly assume that their current partner is responsible for their abnormal result,” Rubinfeld said. “The truth is, it can take years for an HPV infection to cause an abnormal Pap smear, so a current partner is probably not the source of the result.”
What You Should Do If You Have An Abnormal Pap Smear
There are five types of abnormal cells that can show up on your results, according to the American Congress of Obstetricians and Gynecology. Atypical squamous cells of undetermined significance almost always signify that an HPV infection is present, but they aren’t necessarily cancerous. Low-grade squamous intraepithelial lesion are mild, abnormal cells that are typically caused by HPV infections and that usually go away on their own. High-grade squamous intraepithelial lesion indicate a more serious change in cell growth on the cervix and may be associated with pre-cancer or cancer. Atypical squamous cells are linked with an increased risk for pre-cancer. Atypical glandular cells are located in the thin layer of tissue on the inner part of the cervix. They could increase your risk for pre-cancer or cancer, but they don’t always.
Once you receive abnormal Pap smear results, your provider will generally call you to talk about next steps.
The typical course of action after your first abnormal Pap is to get tested again a year later, said Dr. Ana Cepin, an assistant professor of obstetrics & gynecology at Columbia University Medical Center. Your provider may also suggest an HPV test.
If this is not your first abnormal result, however, or if your Pap smear shows slightly more abnormal cells, your provider might recommend a colposcopy.
During a colposcopy, your provider uses a special microscope to take a closer look at the cells on your cervix and then takes a sample, or biopsy. This should happen fairly soon after you can an abnormal result, Rubinfeld said, but it’s not an emergency. The procedure is pretty straightforward, and experts say it may cause discomfort, but it won’t be debilitating. The doctor will then examine those results to determine what steps you might need to take next.
“Once in awhile, with repeated abnormal results or a particularly high-grade lesion, a provider will recommend a procedure to remove some of the cervical cells,” Rubinfeld said, noting that this should happen within a few weeks of the abnormal Pap smear result.
Whatever You Do, Don’t Panic
Should you worry about your first case of abnormal results? The short answer: No.
Whether an abnormal result is cause for concern depends on many things, like your age, your history of abnormal Pap smears, the result of your most recent screening, and whether an HPV test shows a high-risk strain of the virus.
“Speak to your doctor about what the results mean and what the possible outcomes are,” Cepin said. “The vast majority of abnormalities do not need treatment and resolve on their own.”
Fewer than 5,000 women died from cervical cancer in 2014, according to the Centers for Disease Control and Prevention, and most of those cases were in women who did not have routine checkups. Ultimately, experts stress prevention over panic.
It’s vital for everyone under the age of 26 to be vaccinated for HPV, Cepin said. The American Cancer Society also recommends that women over 30 be tested for HPV every five years, as such testing can help determine who needs more testing or treatment.
Barrier methods and safe sex can also reduce ― but not eliminate ― your risk of contracting HPV, Rubinfeld said.
The best steps you can take are getting screened, staying up to date on the latest health recommendations, being your own health advocate, and always talking to your doctor about any concerns.
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