Understanding Abnormal Pap Smear Test Results and Next Steps

Understanding Abnormal Pap Smears

Getting the news from your doctor that you have an abnormal Pap smear result can be scary. A Pap smear screens for changes or abnormalities in the cells of the cervix that could potentially lead to cervical cancer if left untreated. While alarming, an abnormal Pap smear does not necessarily mean you have cancer. In fact, most causes of abnormal Pap smears do not progress to cancer. Understanding why you may have received an abnormal result can help guide next steps.

What Is a Pap Smear Screening For?

A Pap smear collects cells from the surface of the cervix, at the top of the vagina. The lab analyzes any changes to those cells. An abnormal result means that some cervical cells appear different than expected. These cellular changes are called "precancerous," meaning they are not yet cancer, but could become cancer over time if left untreated.

There are two main types of abnormalities that may show up on a Pap smear. One is called squamous cell abnormalities. This refers to changes in the flat, skin-like cells on the surface of the cervix. The other is glandular cell abnormalities, which means there are unusual changes in the gland cells of the cervical canal.

Common Causes of Abnormal Results

There are several common causes for abnormal cellular changes that may lead to an abnormal Pap smear. These include:

• HPV (human papillomavirus) infection
• Inflammation or infection
• Hormonal factors
• Injury or damage to the cervix

Most cases of abnormal Pap smears are due to HPV infection. HPV is extremely common - most sexually active people contract the virus at some point. While high-risk strains of HPV can cause cervical cell changes, most HPV infections go away without treatment. Let's look more closely at common causes of abnormal Pap smears.

HPV Infection

HPV is by far the most common cause of abnormal Pap smear results. There are over 150 known strains of the HPV virus. Certain high-risk strains, especially HPV 16 and 18, are strongly linked to cervical cancer as well as other cancers. HPV is transmitted by intimate skin-to-skin contact and sexual activity.

When you contract high-risk HPV, the virus can infect the skin-like squamous cells on the surface of the cervix. In response, these cells may start to exhibit abnormal changes which might lead to precancer. However, your immune system will often suppress the virus naturally within 1-2 years. Cellular changes often resolve without ever progressing to true cancer.

Cervical Inflammation and Infection

Inflammation and infection may be behind some abnormal Pap smear findings. Inflammation refers to irritated, red, swollen tissue. Various conditions like vaginal infections or sexually transmitted diseases (STDs) can cause cervicitis - inflammation of the cervix. In response to irritation, cervical tissue attempts to repair itself which may lead to detectible cell changes on Pap screening.

Hormonal Influences

Hormonal factors can also spark cervical cell changes leading to an abnormal test. The cells of the cervix are sensitive to hormones like estrogen. Hormone changes from birth control pills, pregnancy, or menopause may all cause cellular abnormalities resembling early precancer. However, these changes typically resolve once hormone levels stabilize postpartum or after stopping the pill.

Cervical Damage

Physical damage to the cervix can predispose you to abnormal cellular changes. Causes include prior excisional procedures (removing portions of the cervix) or cervical cryotherapy (freezing off damaged cells). The healing process may temporarily cause detectible abnormalities. Cervical cancer screening guidelines account for a history of abnormalities due to prior procedures which may alter Pap smear interpretation.

What Do Abnormal Pap Smear Results Mean?

If you have an abnormal Pap smear, what happens next? What do the test results mean? And how concerned should you be about the findings leading to cancer down the road?

First, remember that most causes of abnormal Pap smears do NOT progress to cancer, especially with appropriate follow up. HPV - the most common culprit - usually clears on its own. Other common causes like inflammation or hormonal changes tend to resolve with time. Even higher grade abnormalities showing more significant changes may remain stable and not advance. Nevertheless, abnormal Pap smears deserve careful monitoring and management.

Interpreting Pap Smear Results

Pap smear findings fall into basic categories reflecting the severity of abnormalities. Results ultimately get classified as either positive or negative for abnormal cell lines. Positive findings indicate abnormal changes were detected. The degree of changes then determines if ASCUS, LSIL, or HSIL subcategorization applies. Meanwhile, a negative result means no abnormal cells of concern were found. Let's break down what each classification level means:

• Negative for Intraepithelial Lesion or Malignancy - No cell abnormalities. Continue routine Pap screening.
• ASCUS - Atypical Squamous Cells of Undetermined Significance. Some abnormal squamous cells but could be from HPV or other causes. Monitor with repeat Pap smears.
• LSIL - Low-Grade Squamous Intraepithelial Lesion. Mild cell changes that may become cancer. Follow up annually.
• HSIL - High-Grade Squamous Intraepithelial Lesion. More pronounced cell changes that may likely become cancer. Treatment recommended.

Rarer glandular abnormalities may also appear such as AGCUS or adenocarcinoma in situ (AIS). Gland cell changes behave differently than squamous cell abnormalities. Make sure you understand how your doctor interprets your particular Pap smear results.

Abnormal Paps and Cervical Cancer Risk

It's important to understand your risk of developing cancer based on your Pap findings. Fortunately, most low grade abnormalities like ASCUS and LSIL do NOT immediately mean you will get cervical cancer. One study found that an ASCUS Pap result only confers a 1% increased cancer risk compared to women with normal results. LSIL bumps the risk up slightly to around 2%. However, 20-30% of HSIL cases may progress to cancer without treatment.

In the end, your individual risk depends enormously on follow up and whether cellular changes persist, worsen, or improve over time. This highlights the importance of adhering to your doctors repeat Pap and HPV DNA testing recommendations. Proper surveillance and management lets you catch problems before they spiral into malignancy.

Treating Abnormal Paps

While mild abnormalities may resolve spontaneously without therapy, your doctor will tailor treatment recommendations to your particular case based on several factors like:

• Severity of cell changes (ASCUS vs HSIL)
• High risk HPV status
• Repeat Pap/HPV test results trending worse or stable
• Immune status
• Age and fertility wishes
• Prior history of abnormalities or excision procedures

Common ways doctors treat abnormal Pap smears when concerning cellular changes persist over time include:

• Continued Monitoring - Repeating Pap smears every 6-12 months.
• HPV Testing - Sample tested for high-risk HPV strains.
• Colposcopy Procedure - Views cervix under magnification to biopsy abnormal areas.
• LEEP Excision - Thin wire loop removes abnormal cervical tissue.
• Cone Biopsy - Removes portion of abnormal cervix.
• Hysterectomy - Surgical removal of the cervix and uterus for higher grade changes like recurrent HSIL not improving with other treatments. Does not allow future pregnancy.

Discuss all treatment options thoroughly with your gynecologist. Certain procedures like LEEP or cone biopsy may impact future pregnancy outcomes. Weigh the benefits and risks carefully for your situation.

Can Abnormal Cells Return After Treatment?

Yes, abnormal cell changes may recur even after treatment procedures. This occurs most often when high risk HPV infection persists in cervical tissue. HPV can remain dormant and resurface later to spark new precancerous cell growth on the cervix. Using condoms between sexual partners reduces, but does not eliminate, HPV transmission risk.

Post-treatment, your doctor will have you return for frequent Pap smear follow ups to monitor for recurrent abnormalities or new cases of LSIL/HSIL. Annual co-testing with Pap and HPV DNA testing improves detection of lingering infection or precancer. Unfortunately, no current HPV test can determine whether the virus will remain inactive or activate again down the road. But diligent surveillance gives the best chance for early detection and retreatment if abnormal cells return on the cervix.

Preventing Future Abnormal Pap Smears

If you have had an abnormal Pap result in the past, you will need regular Pap screening moving forward as recommended by your provider. However, researchers continue working on primary and secondary prevention measures aimed at curbing cervical cancer risk. These include:

• HPV Vaccination - CDC recommends ages 11-26 receive the multi-strain vaccine covering cancer-linked HPV types 16/18 and more. Reduces future cancer risk.
• Safe Sex Practices - Condoms reduce HPV exposure risk to new partners.
• Smoking Cessation - Smoking impairs immune function, delaying HPV clearance which may allow precancer progression.
• Regular Screening - Get Pap tests at frequency advised by your doctor depending on results and risk factors.
• Follow Up Care - Complete all recommended testing and procedures to catch recurrence early.

Discuss your ongoing prevention plan thoroughly with your gynecologist. While abnormal paps can cause concern, most women go on to have normal Pap smear results in the future with proper follow up care.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.