So you went for your regular ob-gyn checkup, had a routine Pap smear…then promptly forgot about it as you continued your busy life. Now your doc has left you a message telling you that it came back abnormal. And you’re terrified.
We hear you; Pap panic is hard to get a grip on, especially since the words “cervical cancer” are probably flashing in bright lights in your brain. But keep in mind that an abnormal Pap almost never indicates cancer. This lifesaving test is designed to detect cervical cell changes in a precancerous stage, well before those changes become malignant. It also picks up cell irregularities caused by minor issues that have zero to do with cancer at all. So dial back the worry and let us walk you through the next steps.
Your ob-gyn will test the cervical cell sample from your Pap for a high-risk strain of HPV, the sexually transmitted virus responsible for 99 percent of all cases of cervical cancer. (If you’re older than 30, she will have tested you for HPV at the same time you get your Pap smear since the virus can be more of a threat to women 30 and older; their bodies take longer to fight it off.)
“If your HPV test is negative, your doctor will likely assume the Pap result didn’t indicate anything serious, and she’ll just retest you within the next 12 months,” says Teresa Diaz-Montes, M.D., a gynecologic oncologist at Mercy Medical Center in Baltimore.
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If your HPV test came back high-risk positive, your doc may take a wait-and-see approach and do a follow-up Pap in three to six months, says Diaz-Montes. This is especially likely if you’re in your twenties, when you’re more apt to clear the virus, and if your abnormal Pap indicated either ASCUS (“atypical cells of undermined significance”) or “low-grade,” meaning the precanerous changes are mild.
Things change if you fall into one of two categories. The first: if you’re in your 20s, are positive for high-risk HPV, and your abnormal results indicated “high risk” (more advanced) cell changes. The second: if you’re 30 or older, tested positive for high-risk HPV, and your Pap showed low-grade or high-grade changes. (Remember, women over 30 have a harder time getting rid of HPV, so even low-grade changes can be more worrisome.)
“In either of these situations, your doctor will want to do a colposcopy, when she’ll look through a large magnifying lens to view your cervix up close irregular changes,” says Diaz-Montes. If she spots something, she’ll take a biopsy that goes to a lab; you’ll feel a pinch or even a quick cramp, and it’s over.
If the colposcopy results come back benign or low-grade, you’ll probably just have to redo your Pap again in six months no matter what age group you fall into. By then, odds are good that you’ll have cleared HPV, and the cell changes will revert back to normal (or at least not get worse).
If the colp is positive for high-grade cell changes, that’s a bigger deal; those cells need to be removed. If they aren’t, over a period of years, there’s a risk they’ll become cancer, says Diaz-Montes.
To remove the high-grade changes, your ob-gyn might schedule you for a procedure called a LEEP, which involves burning off the precancerous cells via a tiny electrical wire, says Diaz-Montes. Or she’ll go with what’s called a cone biopsy and surgically remove a cone-shaped piece of tissue. Both sound scary, but they’re very safe, can be done in your doc’s office, and you’ll get a local or general anesthetic so you won’t feel anything.
After a follow-up visit or two to make sure your cervix has healed properly, you’re good to go—but your ob-gyn will want to do another Pap in six months to make sure the cell changes didn’t return.
Wondering why you have to get a Pap smear so ofen when those “abnormal” results are so often a false alarm? The U.S. Preventive Services Task Force and the American Congress of Obstetricians and Gynecologists actually now recommend that women between the ages of 21 to 29 only receive a Pap test every three years instead of annually—to minimize unnecessary panic. That doesn’t mean you can skip the screening altogether, though; it’s still your first line of defense against cervical cancer. But if you hear the word “abnormal” in the future, now you’ll know not to freak.