How to deal with an abnormal pap smear


A pap smear should be part of every woman's annual health exams. But what happens when a routine test returns results that aren't routine? Dr. Jennifer Wu, an OB/GYN at Lenox Hill Hospital in New York, explains how to deal with word that you've had an abnormal pap smear.

How to deal with an abnormal pap smear

If you hear from your doctor that you have an abnormal pap smear, one of your first questions will most likely be—how serious is it?

What is a pap smear?
A pap smear is a screening tool for cervical cancer. The procedure is done by your doctor with a tool that brushes across the surface of the cervix to collect cells, which are then analyzed. If you are a woman who takes care of your health, chances are you get a pap smear once a year. And you should, because in most cases if you go for a yearly pap smear you doctor will be able to catch anything abnormal before it becomes cervical cancer.

What is an abnormal pap smear?
An abnormal pap smear means that you have atypical cells or abnormal cells in your cervix. What needs to be determined is if any of the abnormal cells are pre-cancerous or cancerous cells. In some cases the abnormal cells can be secondary to inflammation or infection. For example, a very bad yeast infection that can alter the look of the cells. In that case, after treatment for the yeast infection, a repeated pap smear will most likely be normal.

Additional testing after an abnormal pap smear:

  • Testing for the Human Papilloma Virus (HPV) is one way to help differentiate whether the abnormal cells are caused by an infection or if they are pre-cancerous. HPV is the virus that causes change in the cervix that lead to cervical cancer. If your doctor determines that you have HPV then your gynecologist will likely perform more extensive testing.
  • A colposcopy is a more extensive type of test you may undergo. A colposcopy is a test using a colposcope, which presents a magnified view of the cervix. The magnified view enables your gynecologist to paint the cervix with acetic acid, which doesn’t burn or hurt. The acetic acid turns the abnormal cells white and a pinch biopsy can be performed. The biopsy is then analyzed to determine if there is a more serious abnormality involved than was initially detected on the pap smear.

The four types of abnormal pap smears:
There are ranges of abnormal pap smears. The mildest is called atypical squamous cells of undetermined significance. More serious abnormalities involve low-grade lesions (LGSIL) and high-grade lesions (HGSIL). The progression is atypical cells, low-grade lesions, high-grade lesions and then cancer. Often times, however, pap smears can miss certain lesions or the readings can be ambiguous. If your pap smear is ambiguous your doctor may suggest you get a pap smear every four to six months to ensure it’s not developing into a higher grade lesion.

If you have low-grade lesion, and you are a young, healthy woman with a healthy immune system, the abnormal cells may simply go away on their own. High-grade lesions, on the other hand, should be treated. You doctor may want to take out the portion of the cervix that looks abnormal. If you are diagnosed with cervical cancer there are various treatments available—surgical and radiation.


Hi. I'm Denise Richardson, for If you're a woman who takes care of her health, you probably get a Pap smear once a year. Usually, of course, everything's normal. But sometimes we hear that we've had an abnormal Pap smear. How serious is it? Here to help us understand abnormal Pap smears is Dr. Jennifer Wu. What is a Pap smear? And then let's talk about abnormal ones.


So, a Pap smear is a screening tool. Basically, it's a brush across the surface of the cervix, and it collects cells, which are then analyzed. Most doctors are using a liquid-based, versus the old microscopic slides, because it's more accurate. And occasionally you can get some abnormal cells there. What we're really trying to determine is whether there are any precancerous or cancerous cells there.


I associate an abnormal Pap smear with a doctor saying to me you have cancer. Is that the only possibility?


Basically, an abnormal Pap smear means that there are atypical cells there, or abnormal cells there. And you can get abnormal cells if you have a very bad yeast infection, or inflammation in the vagina. One way to help differentiate whether an abnormal cell may lead to cancer is whether HPV is present or not. So most of the time, when a mild abnormality comes back, there will also be an HPV test with it. And it'll tell the doctor, OK, there's a mild abnormality, and HPV is present. Then the doctor will likely go on to more extensive testing.


What kind of testing is that person going to undergo?


It's probably going to be a colposcopy, which is a test using a colposcope, which gives a magnified view of the cervix. So the gynecologist is looking at the cervix on a magnified view, and paints the cervix with some acetic acid. I know it sounds terrible, but it doesn't burn, and it doesn't hurt. And the acetic acid will turn abnormal cells white. So then the gynecologist will likely take pinch biopsies from those sites.


And there must be ranges of abnormal readings.


There are. There are. The mildest of abnormality is atypical squamous cells of undetermined significance. It's when you have these atypical cells plus HPV that you're concerned that there actually could be a precancerous lesion there. More serious abnormalities involve LGSIL and HGSIL, which are low-grade lesions or high-grade lesions. Basically the progression is atypical cells, low-grade lesions, high-grade lesions, and then cancer.


Low-grade lesions. Treatment for that.


Often, in young healthy patients, with a normal immune system, low-grade lesions will go away on their own.


And the next step would be--


High-grade lesion.


High-grade lesion. And treatment for that.


Usually if patients have high-grade lesions, then you may want to do an excisional biopsy, meaning taking out that portion of the cervix that looks abnormal. To certain populations of patients you may not want to be so aggressive. Like a very young patient, a teenager, you probably don't want to take out part of their cervix, if at all possible.


And once you say cancer.


Well, when it's cervical cancer, there are various treatments available for that, also. They can be surgical and radiation.


Do people make mistakes in the readings?


Oftentimes Pap smears can miss certain lesions, or the readings can be a little bit ambiguous. Usually patients who go yearly for checkups, we will catch anything before it becomes cancer.


But if it's ambiguous, do you continue to test, or do you say let's wait it out to see if it changes in six months?


Oftentimes we'll just follow these Pap smears to see that it doesn't seem to progress on to a higher-grade lesion. So patients with abnormal Paps may then need Pap smears every four to six months for a while, to make sure that they're not developing into a higher-grade lesion.


Dr. Wu, thank you. I'm Denise Richardson, for

meet theexpert
  • Dr. Jennifer Wu

    Dr. Jennifer Wu Obstetrician-Gynecologist Dr. Jennifer Wu is a practicing board-certified obstetrician-gynecologist in New York City. She is a Fellow of the American College of Obstetrics and Gynecology and a member of the American Medical Association and the New York Country Medical Society. more about this expert »

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