The worry over an abnormal Pap test and what happens next

The Pap test, also known as a Pap smear, is very few women’s favorite visit to her doctor. Wearing only an exam gown, laying flat with feet in stirrups, and a cold speculum opening the vaginal canal allowing the doctor to see better, is not day in the park. Pap tests are vital however for finding and detecting precancerous cells that may indicate cervical cancer. When found in a precancerous condition, also called dysplasia, cervical cancer is very treatable when caught early.

Abnormal Pap test results

Each year, more than 50 million Pap tests are performed in the U.S. to screen for cervical cancer. During this simple test, a small sample of cells are scraped from the cervix and examined under a microscope to look for precancerous changes. Healthy cells will look thin and flat.  If the Pap test is abnormal, this means the samples contained abnormally shaped cervical cells.  Receiving this news is understandably worrisome for women.  Thoughts of now what and what exactly will these abnormal results mean will be a concern.

First, abnormal Pap tests are very common – every year, 200,000 U.S. women will be found to have an abnormal Pap tests each year, 11,000 will be diagnosed with cervical cancer and 4,000 women will die from it, according to the CDC. Most abnormal Pap tests are usually the result of a cervical or vaginal infection and are not cancerous.

The most common cause of cervical cancer is from the human papillomavirus (HPV) causing more than 9 out of every 10 cases of this cancer. HPV is a common infection and most sexually active individuals have been exposed to at least one of the more than 100 known strains of HPV. Cervical cancer can be largely prevented by the HPV vaccine (more than 90 percent of HPV cancers can be prevented) and by regular Pap test.

Other reasons for abnormal cells found during a Pap test include:

·      Changes of levels of estrogen in the cells of the cervix

·      In the months after delivering a baby and breastfeeding

·      During or after menopause

Generally the changes in these cells are not cancerous. The tissues of the vagina contain estrogen, helping the cells stay plump and moist. When the body’s supply of estrogen is lowered, sometimes the cells can look abnormal on a Pap test.

What happens when a woman has an abnormal Pap test?

Women with an abnormal Pap test will be advised to have a minimally invasive procedure called a colposcopy.  This procedure is a visual examination of the cervix – the opening to the uterus - using an instrument called a colposcope, a low-powered microscope with a bright light used to find precancerous or cancerous cells and then biopsy abnormal areas in the cervix that could lead to cervical cancer. It’s a quick and easy way that may or may not find cancer and is a standard follow-up test to any Pap test that has found abnormal cells.

The purpose of the colposcopy is that cervical cancer cells are hard to notice but this test can find abnormal cells before they turn into cancer.

Twenty-four hours before the procedure, women will be advised to refrain from douching, using tampons, sex, and to let the doctor know if they are pregnant. It is also recommended to avoid scheduling a colposcopy during a menstrual cycle as it can obscure the examination of the cervix.

During the procedure, the doctor will insert a speculum into the vagina, and then apply a couple of different solutions to help highlight any precancerous changes. The first solution is a strong vinegar solution used to remove the mucus that covers the surface and highlights abnormal areas by turning them white. Most women will not feel this at all or may have only slight stinging. The doctor will examine the cervix identifying any abnormalities. If an area is white is found, a small piece of the cervix will be taken for testing. Some women may feel a pinch or pull when the biopsy is taken but most feel little pain at all. The biopsy will be sent to a pathologist to evaluate under a microscope to rule out any possibility of cancer.

The doctor may also take a sampling from inside the cervix to make sure there are no abnormalities beyond what can be seen.

After the procedure

Most women will likely experience a small amount of vaginal drainage or spotting and therefore should bring a pad or tampon to wear afterwards. The discharge is from the solutions used to highlight the abnormal cells.

Once results come back from the lab, which usually takes one to two weeks, depending on what was found, a plan will be made. If the results are low-grade, then a woman will be advised to continue to have a Pap test yearly since low-grade changes are unlikely to become cervical cancer. If the results are moderate- to high-grade, then the doctor may want to do more options as these changes may lead to a higher risk of cervical cancer.

All women who have this procedure should bring up any questions they may have about it and the Pap test in general.

David B. Samadi, MD, Urologic Oncology Expert and Robotic Surgeon located at 485 Madison Avenue on the 21st floor, New York, NY – 212-365-5000.  Follow Dr. Samadi at www.samadimd.com,  www.prostatecancer911.com, and www.roboticoncology.com.