If you have a Pap test and aren't among the 96% of women whose results are normal, don't jump to conclusions. It doesn't necessarily mean you have cervical cancer.
"Having an abnormal result at some point in life is actually common because HPV is so common," said Dr. Savannah Peña of Novant Health Mintview OB/GYN - Ballantyne in Charlotte.
HPV — human papillomavirus — is a group of more than 200 related viruses and the most common sexually transmitted infection in the U.S. Millions of Americans have types of HPV that can cause disease. Low-risk HPV types can cause genital warts, while high-risk HPV types can cause cancer of the cervix, the small canal linking a woman's uterus and vagina.
A Pap test, also known as a Pap smear, not only looks for cervical cancer itself but also for abnormal cells on the outside of the cervix that could become cancerous.
During the test, a doctor uses a small brush to collect tissue. The cells are examined under a microscope, known as cytology. It takes only a few minutes.
Thanks to Pap tests and the HPV vaccine, cervical cancer death rates in the U.S. have plummeted since the mid-1970s.
Peña shares what women need to know about Pap tests and their results.
Pap tests are key for early detection of cervical cancer.
Who needs a Pap test?
Guidelines recommend screening with cytology only (testing just cells of the cervix) between 21 and 29 years of age.
Between age 30 and 65, the most common screening option for low-risk patients is co-testing every five years for abnormal cells on the cervix along with HPV.
Another screening option, which is less common, is testing only for HPV every five years. Finally, a third option is a Pap test (cytology only) every three years.
Women with a history of normal results can stop testing at 65.
What to know about Pap test results
Getting your results
Test results usually come back within a week. “Your results will be one of the following: Normal, atypical, low-grade or high-grade. Based on what we find out with the Pap test, you're going to have a range of recommendations.”
Types of results
A normal test is, of course, what everybody hopes for — meaning no atypical cells have been found.
Sometimes, the finding is unsatisfactory. This simply means the sample couldn't be evaluated — usually because there weren't enough cells to examine properly or those collected were obscured by blood or mucus. (You'll need to be retested.)
- An abnormal, or positive, finding means the lab saw cells on your cervix that differ in appearance from healthy cells.
- A low-grade result means there were mild cell changes, usually caused by HPV.
- A high-grade result means moderate to severe changes were found. If your Pap test shows low-grade or high-grade, your doctor will want to learn more.
While you wait for word on next steps, keep this in mind: Less than 1% of abnormal Pap tests are cancer.
What diagnostics follow an abnormal pap test result?
Know the signs of cervical cancer
Cervical cancer typically has no symptoms early on when it is easiest to treat, which is why regular screening is so important, the American Cancer Society states. As a cervical cancer begins to grow, the most common symptoms are:
- Unusual vaginal discharge, even between periods and after menopause.
- Abnormal vaginal bleeding, including periods that are longer than usual, spotting between periods, bleeding after sex or after menopause.
- Pain in the pelvis and/or during sex.
In advanced stages of cervical cancer, women may have trouble passing stool or urinating, may see blood in their urine and experience swelling in the legs.
See your doctor right away if you experience any of these symptoms and follow their screening recommendations.
Most women who get an abnormal pap test result either have an HPV infection or precancerous cell changes that will go away on their own.
A long as it's not a high-grade lesion, you will repeat your Pap test in one year.
If you have a high-grade lesion, the doctor will likely order a colposcopy, a LEEP or, less often, a cone biopsy.
Colposcopy and LEEP are typically done in the doctor's office using local anesthesia and perhaps, nitrous oxide, to help the patient relax. A cone biopsy is done in an operating room under general anesthesia.
- Colposcopy: This in-office exam is recommended if your Pap test is positive for the highest risk HPV strains, low-grade or high-grade changes. The biopsy performed during this procedure confirms exactly what is happening in the cervical cells. If it confirms high-grade changes, a LEEP is scheduled. If the biopsy confirms HPV-related changes or low-grade changes alone, you will repeat your Pap in one year.
- LEEP (Loop electrosurgical excision procedure): The aim of this treatment is to prevent precancerous cells on the cervix from becoming cancer. After numbing the cervix, the doctor uses a small wire loop attached to an electrical current to remove a layer of abnormal cells, which are then sent to a lab for testing. Usually, that’s all people need. This treatment may be done in the doctor’s office or an operating room.
- Cone biopsy: This treatment, also called conization, removes a larger, cone-shaped piece of suspicious tissue for lab analysis. It’s done in an operating room under general anesthesia, and the patient typically goes home the same day.
If your diagnostic test finds cancer
Less than 1% of Pap tests result in the ultimate diagnosis of cervical cancer. That's about 13,360 women a year, according to the American Cancer Society.
If you find yourself among them, your doctor will connect you immediately with a specialist in gynecological cancer care to explain your treatment options and next steps. Novant Health offers leading-edge care and resources to help manage your physical and emotional needs during cancer treatment.
Why everyone should consider getting vaccinated for HPV
Besides staying on top of recommended screening exams, HPV vaccination is a key tool to prevent cervical cancer.
Gardisil 9, which can be given to adult men and women in three shots, protects against diseases caused by nine types of HPV, including cancers of the cervix, anus, vagina and vulva in women.
It's approved for people between ages 9 to 45, but doctors can prescribe it to older patients, as well. Peña recommends it even if you have already been exposed to HPV or required a LEEP, as it can prevent a recurrence of HPV-related cell changes.
Efforts to vaccinate pre-teens before they become sexually active contributed to a 65% drop in cervical cancer cases in U.S. women under 25 years of age between 2012 and 2019, researchers recently reported in the Journal of the American Medical Association.
