A pap smear is a screening test for your cervix. It is meant to detect any abnormal changes in the cells on the surface of your cervix, including cancer. Most often, especially if you are getting pap smears regularly, if there is an abnormal result it is NOT cancer. The test is meant to pick up abnormal cells before they ever get to be a cancer so that we can monitor or treat them to prevent cancer from happening.
A pap smear does NOT detect ovarian cancer or uterine cancer.
Any woman between the agesStyle of 21 and 70 who has had any form of sexual contact at any point in her life should have pap smears regularly. The current recommendation is that if pap smears have been normal, you should have one every 3 years.
Most of the time, your pap smear will come back normal and you simply need to remember to get your next one 3 years later. There are a few abnormal results that might be seen:
ASCUS – this is a very mildly abnormal result and if it is the first time your pap smear has been abnormal, you just need to have your pap smear repeated in 6 months. If in 6 months the pap smear still shows any abnormal result you should be assessed in colposcopy.
LSIL – this is a low grade abnormal result and can be managed by either repeating the pap smear in 6 months (especially in younger women) or by being assessed in colposcopy.
ASC-H – this is a result where high grade abnormalities can’t be ruled out and therefore needs assessment in colposcopy.
HSIL – this is a high grade abnormal result and needs assessment in colposcopy.
AGC/AGUS, atypical endometrial cells, or any cancer cells – needs assessment in colposcopy.
These abnormal changes that are found on the surface of the cervix are caused by the human papilloma virus (HPV). This is a very common virus with many different strains. Some strains are completely asymptomatic and you would never know you had it. Some strains cause genital warts. And some strains cause abnormal cells or cancer on the cervix. Very nearly 100% of cervix cancers are caused by HPV infection. HPV is sexually transmitted through any sexual contact. About 75% of people who are sexually active have been infected with one strain or another of HPV at some point in their life. For many women, their immune system will eventually clear the virus and the abnormal changes that are seen on the cervix can go back to normal. Young women who are non-smokers are most likely to effectively get rid of an HPV infection on their own. For some women, HPV infection persists and can eventually lead to high grade abnormalities on the cervix, or even cervix cancer. This process can take years, which is why there is normally plenty of opportunity to detect, follow, and treat abnormal cells on the cervix and thereby prevent cervix cancer.
You can reduce your chances of being infected with a dangerous strain of HPV by getting the Gardasil vaccine. This vaccine protects against 9 strains of HPV. It protects against 7 strains that are responsible for about 90% of cervix cancers, as well as 2 strains that cause about 90% of genital warts. This kind of protection dramatically reduces your chance of abnormal pap smears, cervix cancer, and genital warts, but does not bring the risk down to zero – therefore going for regular pap smears is still important. It is best to get this vaccine before you are sexually active, before exposure to any strain of HPV has occurred. However, most people will not be exposed to all 9 strains covered by the vaccine, so even if you have been sexually active the vaccine will still be helpful in protecting against any strains you have not been exposed to yet. It will not help treat or get rid of an HPV infection that you already have.
If you have an abnormal pap smear, you may be referred for colposcopy. Colposcopy is a detailed assessment of your cervix using a microscope. A speculum is inserted in order to see the cervix, the same as when you have a regular pap smear. A solution is applied to the surface to help any abnormal cells stand out to be seen better. A microscope is used to get a close-up look at the surface of the cervix. Depending on what is seen at the time of colposcopy, and what your initial pap smear result was, different sampling techniques might be used to rule out high grade changes or cancer. Usually your pap smear is repeated at the time of colposcopy. A biopsy can be done by taking a small piece of cervix (3-4mm). This feels like a small pinch. A sample of the inner canal of the cervix may be done with a small brush. This sometimes feels a bit crampy. If your initial pap smear result was a mild abnormality, and the cervix is able to be seen well and nothing looks abnormal or suspicious, you may not need to have any sampling done.
If the findings at the time of colposcopy continue to be only mildly abnormal, typically you are followed periodically with colposcopy. Often the abnormal findings resolve on their own and then you no longer need to be seen in colposcopy but should still get regular pap smears. If the abnormal findings seem to be worsening, or if the findings are high grade, you may be offered a procedure to remove the portion of the cervix that is abnormal. This can be done with a LEEP procedure. Some hospitals can also do laser procedures. After a procedure to remove abnormal cells, you will have followup appointments in colposcopy to ensure that the abnormal cells are gone and that your pap smears go back to normal.