A Pap test, or Pap smear, is part of a woman's routine physical examination. It is the best way to prevent cervical cancer, because it can find cells on your cervix that could turn into cancer. The cervix is the lower part of the uterus that opens into the vagina.
When your doctor says that your Pap test was "abnormal," it means that the test found some cells on your cervix that do not look normal. It does not mean that you have cancer. In fact, the chances that you have cancer are very small.
Most of the time, abnormal cell changes on the cervix are caused by certain types of human papillomavirus, or HPV. HPV is a sexually transmitted infection. Usually these cell changes go away on their own. But certain types of HPV have been linked to cervical cancer. That’s why it’s important for women to have regular Pap tests. It usually takes many years for cell changes in the cervix to turn into cancer.
Sometimes cell changes in the cervix are due to other types of infection, such as infections caused by bacteria or yeast. These types of cell changes can be treated. In women who have been through menopause, a Pap test may find cell changes that are just the result of getting older.
High-risk sex raises your chances of getting HPV and having an abnormal Pap test. High-risk sex includes having sex without condoms and having more than one sex partner (or having a sex partner who has other partners).
HPV can stay in your body for many years without your knowing it. So even if you now have just one partner and practice safe sex, you could still have an abnormal Pap test if you were exposed to HPV in the past.
Smoking or having an impaired immune system also may raise your chances of having cell changes in your cervix.
The cell changes themselves don't cause symptoms. HPV, which causes most abnormal Pap tests, usually doesn't cause symptoms either. This is why regular Pap tests are so important.
If a different sexually transmitted infection is the cause of your abnormal Pap test, you may have symptoms, including:
You will need more tests to find out if you have an infection or to find out how severe the cell changes are. These tests may include:
A colposcopy is usually done before any treatment is given. During a colposcopy, the doctor also takes a small sample of tissue from the cervix so that it can be looked at under a microscope. This is called a biopsy.
Treatment, if any, will depend on whether your abnormal cell changes are mild, moderate, or severe. In moderate to severe cases, you may have treatment to destroy or remove the abnormal cells.
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Most abnormal Pap tests are caused by human papillomavirus (HPV) infections. Other types of infection—such as those caused by bacteria, fungi (yeast), or protozoa (Trichomonas)—sometimes lead to minor changes on a Pap test called atypical squamous cells of undetermined significance (ASC-US). The most common cause is HPV infection. Natural cervical cell changes (atrophic vaginitis) related to menopause can also cause an abnormal Pap test.
Because cervical cell changes that can cause an abnormal Pap test rarely cause symptoms, regular Pap test screening to monitor cell changes is important.
Human papillomavirus (HPV) infection, which is the most common cause of abnormal cervical cell changes, usually does not cause any symptoms.
A number of infections and sexually transmitted infections (STIs) can cause an abnormal Pap test. STIs can have a variety of symptoms, including:
Only a small percentage of abnormal Pap tests indicate cervical cell changes that may progress to cervical cancer.
Symptoms of cervical cancer may include:
The cervix contains two kinds of cells: rectangular-shaped columnar cells on the surface of the cervix and in the cervical canal; and flat, scalelike squamous cells on the surface of the cervix. Columnar cells are constantly changing into squamous cells in an area of the cervix called the transformation zone.
Abnormal Pap test results can be caused by infection, which leads to cell changes in the transformation zone of the cervix. Pap test results often return to normal when the cells have returned to healthy growth or after an infection has been treated or has resolved on its own.
In some cases, untreated cervical cell changes that cause abnormal Pap tests may progress to precancerous or cancerous stages. Certain high-risk types of the human papillomavirus (HPV) have been linked to the development of cervical cancer. But changes in cervical cells usually progress slowly and take many years to become cancer cells. Treatment can remove or destroy these cells before they become cancerous.
Regular Pap test screening can detect cervical cell changes early.
Cervical polyps are unrelated to cervical cancer, but they may be found and removed at the time of a pelvic examination and Pap test.
Most cervical cell changes that cause an abnormal Pap test are the result of sexual transmission of HPV disease. High-risk sexual behaviours by you or your partner at some time, possibly even many years ago, may lead to HPV infection. High-risk sexual behaviours increase your risk of infections and sexually transmitted infections (STIs).
Other risk factors that may also play a role in increasing your risk for cervical cell changes include:
If you have had one abnormal Pap test result, you may be at higher risk for having another abnormal Pap test in the future.
Most problems that cause abnormal Pap tests do not cause symptoms, so you won't know you have cervical cell changes. Regular Pap testing is needed to detect early cervical cell changes.
Call your doctor if:
If you think you may have symptoms of a sexually transmitted infection (STI), call your doctor for an appointment. Avoid sexual intercourse until you have been treated for your symptoms and can no longer infect your partner.
If your sex partner has symptoms of an STI, both of you should be evaluated by a doctor. If you have been diagnosed with an STI, such as genital warts, your sex partner(s) may want to be evaluated.
If you have had an abnormal Pap test, be certain to complete any additional testing or treatment that your doctor recommends. You and your doctor can decide how often Pap test screening should continue or whether other tests are needed.
Your family doctor or general practitioner can manage an abnormal Pap test. You may be referred to a specialist, such as a gynecologist.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
You may have a Pap test as part of your routine gynecologic examination. A Pap test is used to identify abnormal cell changes on your cervix and to screen for cervical cancer. Pap test screening is the most effective way to detect early abnormal cervical cell changes.
Women older than age 30 may have a screening test for HPV infection at the same time they have their Pap test.2
The recommended Pap test schedule is based on your age and on things that increase your risk. For most women, it is best to have a Pap test every 1 to 3 years. Talk to your doctor about when to have your first Pap test and how often to have this test.
If your Pap test result is abnormal, the lab will use the Bethesda system (TBS) or another classification system to describe how severe the problem is. Your doctor will use these results to decide how to treat the problem.
Following an abnormal Pap test result, more tests may be needed to determine whether an infection is present or to determine the severity of cervical cell changes. These additional tests include:
For information on tests to diagnose a specific infection, see the specific topic:
Testing methods, such as liquid-based collection, are being used in many areas of Canada. Liquid-based collection methods allow testing for HPV at the same time as a Pap test, but these methods may not be available everywhere and may be more costly.
The terms used to report Pap test results vary depending on which classification system is used. The Bethesda system (TBS) is used by most labs in North America. Other classification systems are used around the world.
Even though most abnormal Pap tests are caused by an HPV infection that will go away or by an inflammation that can be treated, you will need a follow-up evaluation to make sure your abnormal cell changes have resolved. Your need for treatment will vary depending on whether your abnormal cell changes are mild, moderate, or severe. Abnormal Pap test results may show minor cell changes (most common), moderate to severe cell changes (less common), or cervical cancer (rare). Depending upon the cause and severity of the cervical cell changes, you may need treatment.
Human papillomavirus (HPV) infection is the most common cause of an abnormal Pap test. There are many types of HPV. High-risk types can cause cell changes that could develop into cancer.
An abnormal Pap test result is not uncommon because HPV infection is very common. Most cell changes seen in abnormal Pap test results will not progress to cervical cancer. If your abnormal Pap test shows minor cell changes, you may have several choices of what to do next.
If your Pap test shows that a vaginal infection or a treatable sexually transmitted infection (STI) is present, you can be treated with medicine.
Evaluation of ASC-US. If you have had a Pap test only and your test results show atypical squamous cells of undetermined significance (ASC-US), you can:
Evaluation of LSIL. If the results of your Pap test show the minor cell changes called low-grade squamous intraepithelial lesions (LSIL), your doctor may recommend a colposcopy to evaluate the cell changes. Some women, especially those who have already gone through menopause, may be treated for atrophy with estrogen cream and then have a repeat Pap test. Colposcopy is needed only if the repeat test shows cell changes.
Treatment decisions for an abnormal Pap test that shows moderate to severe cell changes are based on the Pap test results, colposcopy, and cervical biopsy. A larger tissue sample may be removed by a cone biopsy. In some cases, this procedure may serve as treatment so you are cured. Follow-up to evaluate and treat moderate to severe cervical cell changes is recommended sooner than for minor cell changes.
For moderate or severe precancerous cell changes confirmed by biopsy, treatment will focus on destroying or removing the abnormal tissue. Treatment choices include LEEP, a surgery that uses a thin wire loop to remove the abnormal tissue; cryotherapy, which destroys tissue by freezing it; laser therapy, which destroys tissue with a laser beam; or cone biopsy (conization), in which a cone-shaped piece of abnormal tissue is removed from the cervix.
For cervical cancer, treatment will focus on destroying or removing the cancerous tissue. For more information, see the topic Cervical Cancer.
A Pap test may be done during pregnancy if a woman is due for her regular screening test. A pregnant woman with an abnormal Pap test is monitored closely throughout her pregnancy. Monitoring may include evaluation by colposcopy. The goal of evaluation is to rule out cervical cancer, a rare diagnosis. Treatment for abnormalities other than cancer is done after delivery.
You cannot prevent an abnormal Pap test, but you can reduce your risk factors.
The Pap test is the most effective screening test to prevent the development of cervical cancer. Pap tests done at regular intervals almost always detect cervical cell changes before the changes become cancerous. Regular screening for and treatment of cervical cell abnormalities can prevent the abnormal cell changes from developing into cancer.
The recommended Pap test schedule is based on your age and on things that increase your risk. For most women, it is best to have a Pap test every 1 to 3 years. Talk to your doctor about when to have your first Pap test and how often to have this test.
Women who smoke are at higher risk for developing cervical cell changes that cause an abnormal Pap test. The reason for this is not fully understood. Quitting smoking may decrease this risk. Not smoking has many other health benefits. For example, non-smokers have a lower risk of other cancers and heart disease. For more information, see the topic Quitting Smoking.
Sexually transmitted infections (STIs), especially HPV infection, often cause abnormal Pap tests and can lead to other serious health problems. Preventing an STI is easier than treating an infection after it occurs.
Your risk for an STI increases if you have several sex partners at the same time or if your sex partner has more than one partner.
If you are age 26 or younger, get the HPV shot. The vaccines Cervarix and Gardasil protect against two types of HPV that cause cervical cancer. Gardasil also protects against two types of HPV that cause genital warts. Three shots are given over 6 months. The series of shots is recommended for girls ages 9 to 13, before they become sexually active.5 The series of shots can also be given to females ages 9 to 26. You can get either vaccine. For more information, see the topic Immunizations.
For more information on getting your daughter vaccinated, see:
All abnormal Pap tests require follow-up. In some cases, you may need further testing or treatment. In other cases, your doctor may recommend a period of watchful waiting that includes repeat Pap tests.
To reduce your risk of cervical problems:
Medicines may cure a bacterial, fungal, or protozoal infection and allow minor cell changes called atypical squamous cells of undetermined significance (ASC-US) that have caused an abnormal Pap test to return to normal. HPV infection cannot be treated with medicine. The infection or inflammation changes of cervical cells are monitored in the following sequence:
Estrogen cream. Women near menopause may have abnormal Pap test results because of normal body changes during menopause, such as cervical cell atrophy and estrogen loss. These minor cell changes may improve with the use of estrogen cream.
If you have had an abnormal Pap test, surgery may be an option. Surgical treatment may be recommended if:
Surgery may be done to destroy or remove the abnormal cells on your cervix, or confirm or rule out the possibility that you have cervical cancer.
Abnormal tissue that can be seen through the magnifying viewing instrument (colposcope) can often be destroyed or removed with cryotherapy, a cone biopsy, a carbon dioxide (CO2) laser, or the loop electrosurgical excision procedure (LEEP).
Abnormal cervical cells that are detected by a Pap test but cannot be seen by colposcopy may be high in the cervix (cervical canal). Before treatment is recommended, the location and type of cell change must be confirmed by a cervical biopsy. Depending on the results of the colposcopy and cervical biopsy, a cone biopsy may be done as the next step.
Surgical choices for abnormal cervical cell changes include the following:
If the results of a Pap test, colposcopy, and cervical or cone biopsy point to invasive cervical cancer, then surgery, radiation, chemotherapy, or a combination of treatments will be needed to destroy or remove the cancerous tissue.
For more information, see the topic Cervical Cancer.
Minor cell changes may not need to be treated with surgery. When deciding on treatment for minor cell changes, consider the following:
Treatment choices for moderate to severe cell changes are more likely to include surgery to specifically destroy or remove the abnormal tissue.
Removal of the uterus (hysterectomy) may be a treatment choice for some women who have had an abnormal Pap test if both of the following are true:
Society of Obstetricians and Gynaecologists of Canada (SOGC) | |
780 Echo Drive | |
Ottawa, ON K1S 5R7 | |
Phone: | 1-800-561-2416 (613) 730-4192 |
Fax: | (613) 730-4314 |
Email: | helpdesk@sogc.com |
Web Address: | www.sogc.org |
The mission of SOGC is to promote optimal women's health through leadership, collaboration, education, research, and advocacy in the practice of obstetrics and gynaecology. | |
Canadian Cancer Society | |
10 Alcorn Avenue | |
Suite 200 | |
Toronto, ON M4V 3B1 | |
Phone: | (416) 961-7223 |
Fax: | (416) 961-4189 |
Email: | ccs@cancer.ca |
Web Address: | http://cancer.ca |
The Canadian Cancer Society (CCS) is a national, community-based organization that provides information about cancer prevention, care, and treatment. The CCS also provides funding for cancer research. | |
Health Canada Sexually Transmitted Infections (STIs) Web Page | |
Web Address: | www.hc-sc.gc.ca/dc-ma/sti-its/index_e.html |
Health Canada's Web page on sexually transmitted infections provides basic education on STIs, such as HIV/AIDs and chlamydia, and what you can do to prevent and treat them. | |
sexualityandu.ca | |
Web Address: | www.sexualityandu.ca |
The Web site gives teens, adults, parents, teachers, and health professionals information and education on sexual health. | |
Citations
- Health Canada (2005). It's your health: Screening for cervical cancer. Available online: http://www.hc-sc.gc.ca/iyh-vsv/diseases-maladies/cervical-uterus_e.html.
- American College of Obstetricians and Gynecologists (2005, reaffirmed 2009). Human papillomavirus. ACOG Practice Bulletin No. 61. Obstetrics and Gynecology, 104(4): 905–918.
- Runowicz CD (2008). Approach to the patient with an abnormal Pap smear. In EG Nabel, ed., ACP Medicine, section 16, chap. 16. Hamilton, ON: BC Decker.
- Winer RL, et al. (2006). Condom use and the risk of genital human papillomavirus infection in young women. New England Journal of Medicine, 354(25): 2645–2654.
- National Advisory Committee on Immunization (2007). Statement on human papillomavirus vaccine. Canada Communicable Disease Report, 33(ACS-2): 1–32.
Other Works Consulted
- American College of Obstetricians and Gynecologists (2003, reaffirmed 2007). Cervical cytology screening. ACOG Practice Bulletin No. 45. Obstetrics and Gynecology, 102(2): 417–427.
- ASCUS–LSIL Triage Study (ALTS) Group (2003). A randomized trial on the management of low-grade squamous intraepithelial lesion cytology interpretations. American Journal of Obstetrics and Gynecology, 188(6): 1393–1400.
- Canadian Cancer Society (2010). Benefits and risks of cervical screening. Available online: http://www.cancer.ca/Canada-wide/Prevention/Getting%20checked/Benefits%20and%20risks%20of%20cervical%20screening.aspx?sc_lang=en.
- Canadian Cancer Society (2011). Abnormal pap test results. Canadian Cancer Encyclopedia. Available online: http://info.cancer.ca/cce-ecc/default.aspx?lf=bethesda&cceid=8649.
- Cox JT, et al. (2003). Prospective follow-up suggests similar risk of subsequent cervical intraepithelial neoplasia grade 2 or 3 among women with cervical intraepithelial neoplasia grade 1 or negative colposcopy and directed biopsy. American Journal of Obstetrics and Gynecology, 188(6): 1406–1412.
- Cuzick J, et al. (2003). Management of women who test positive for high-risk types of human papillomavirus: The HART study. Lancet, 362 (9399): 1871–1876.
- Guido R, et al. (2003). Postcolposcopy management strategies for women referred with low-grade squamous intraepithelial lesions or human papillomavirus DNA–positive atypical squamous cells of undetermined significance: A two-year prospective study. American Journal of Obstetrics and Gynecology, 188(6): 1401–1405.
- Money DM, et al. (2007). Canadian consensus guidelines on human papillomavirus, supplement 3. Canadian Medical Association Journal, 29(8): S1–S54.
- Wright TC, et al. (2003). 2001 consensus guidelines for the management of women with cervical intraepithelial neoplasia. American Journal of Obstetrics and Gynecology, 189(1): 295–304.
- Wright TC, et al. (2007). 2006 consensus guidelines for the management of women with abnormal cervical cancer screening tests. American Journal of Obstetrics and Gynecology, 197(4): 346–355.
By | Healthwise Staff |
---|---|
Primary Medical Reviewer | Sarah Marshall, MD - Family Medicine |
Primary Medical Reviewer | Brian D. O'Brien, MD - Internal Medicine |
Specialist Medical Reviewer | Kirtly Jones, MD, MD - Obstetrics and Gynecology |
Last Revised | February 16, 2011 |
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