Panic or embarrassment usually stems from a lack of understanding of what abnormal results may really mean.
It’s a situation I encounter far too often: A woman comes into my office visibly shaken and on the verge of tears because she’s been told by her primary care doctor that her Pap smear came back abnormal. She’s spent the better part of the last week Googling worst case scenarios, convinced she’s developed cervical cancer or has been shouldered with the stigma of a horrifying sexually transmitted disease.
The saddest aspect of these scenarios is that these feelings of crippling fear and shame would not be so prevalent if there wasn’t so much misinformation surrounding cervical cancer and the human papillomavirus (HPV). The fact is, an “abnormal” Pap result does not usually mean cancer, and HPV is exceptionally common to the point that almost all of us have been exposed to this virus and have had a transient infection.
Since the vast majority of cervical cancers are caused by HPV, it is important to test for it regularly. Usually, an HPV test is performed alongside a Pap exam, using the same sample of cells taken for the Pap smear. The Pap itself looks for precancerous cell changes and other abnormalities on the cervix such as inflammation or infection.
The American Pregnancy Association reports that about 1 in 10 Pap smears come back with some sort of abnormality. Compare that number with the latest report from the Centers for Disease Control and Prevention (CDC), which states that just over 12,500 American women – about 1 in 10,000 – are diagnosed with cervical cancer each year.
So take a deep breath. Center. Let’s talk about Pap smears, HPV and cervical cancer. Let’s talk about why screening and prevention are important, and what to do if a test comes back with abnormal results.
What happens when a Pap smear is abnormal?
During a Pap smear, a small swab of cells is collected for examination to detect abnormalities that may indicate cervical cancer, precancerous cells or other problems such as infection or inflammation. The presence of abnormal cells in the cervix that may be precancerous is called cervical dysplasia. During the Pap smear, your doctor may also conduct an HPV test on the same cells that were collected during the Pap.
If your Pap smear results come back abnormal and/or you test positive for HPV, your doctor may advise further testing and monitoring so that a clear diagnosis can be made. This may mean:
- Following up with another Pap smear in one year (sooner than the recommended frequency) to keep an eye on things
- Getting a colposcopy exam, which involves a special lighted microscope that closely examines the cells of the cervix
- A biopsy, which involves collecting a small tissue sample for a laboratory test that can detect precancerous or cancerous cells.
If a biopsy is needed, more tests and tissue sampling may be required to determine if the abnormal cells are in fact precancerous. Your doctor may even recommend removing an area of tissue if it is identified as precancerous. Even in the unlikely and very worst case scenario in which cancer cells are found, the survival rate for cervical cancer is very high when it’s detected early. That’s why regular cervical cancer screening (i.e. Pap smears and HPV testing) is so important.
HPV is very common and nothing to be ashamed of
Now, a word or two on HPV.
The human papillomavirus is actually a group of over 100 viruses. Around 60 percent of these viruses are non-sexually-transmitted types, which are harmless or at worst annoying, causing things like warts on the hands and feet.
The types that are transmitted sexually are exceedingly common. In fact, according to the CDC nearly every sexually active person will develop sexually-transmitted HPV in one form or another at some point in his or her lifetime. And 1 in 4 people are currently affected at any given time. Sometimes HPV shows up in the form of genital warts. Sometimes it will not cause any symptoms at all, and the affected person will be unaware that he or she even has or had the virus.
There are a handful of more serious types of HPV that are known to cause cancer, including cervical cancer. Fortunately, cervical cancer is easy to detect early – sometimes before it even turns into cancer – if a woman is getting routine exams. And of course, women and men alike are always encouraged to practice safe sex with barrier methods to avoid the transmission and spread of HPV.
But the point here is that HPV is extraordinarily common. A positive HPV test absolutely does not mean that you are promiscuous or gross or have any reason to feel shame.
Cervical cancer is more preventable than ever
As of 2006, preventive vaccines that protect against the high-risk types of HPV became available. These vaccines are administered by a primary care physician in a series of three shots, between the ages of 9 and 26, but recommended before the patient becomes sexually active. And they’re not just for girls – preteen boys should get the vaccines too to prevent other cancers that may be caused by HPV including anal, penile and some oral cancers.
Teens and young men and women who have not been vaccinated, or did not finish their vaccine series when they were younger, may still receive the vaccines up to age 26. However, it is important to note that the vaccine does not cure HPV once it is acquired – it is only preventive. So girls and boys should ideally receive and finish their HPV vaccine before they become sexually active.
If you get an abnormal Pap smear or HPV test result, please, please, please do not let fear or shame creep into any of your thoughts! Get going to an OB-GYN to get a handle on what is likely a no-worries situation. We are here to educate, reassure and keep you safe!