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Abnormal Pap Follow-Up

Each year 13,000 women are diagnosed with cervical cancer in the United States.  In most cases cervical cancer can be prevented through early detection and treatment of abnormal cell changes that occur in the cervix years before cervical cancer develops.  We now know that these cell changes are caused by human papillomavirus, commonly known as HPV.

A Pap smear is a procedure to test for cervical cancer in women.  It involves collecting cells from your cervix.  The cells are sent to a laboratory where they are prepared and evaluated under a microscope.  Pap smear screening should begin at age 21.

Women age 20 years and younger have a very low risk for invasive cervical cancer.  The vast majority of HPV infections spontaneously clear within 2 years  in this population and are of little long-term clinical significance.

If only normal cervical cells were discovered on your Pap smear, you are said to have a negative result.  You won't need any further treatment or testing until you're due for your next Pap smear and pelvic exam.

If abnormal cells were seen on your Pap smear, you'll be contacted by your provider through MyBuckMD secure messaging. The next step in your care depends on the type of cells discovered on your Pap smear.  The two most common abnormal findings are "atypical" cells or mild "dysplasia".

  • If "atypical" or mildly abnormal cells are seen, the cytology lab will check for the presence of high-risk types of HPV (types known to promote the development of cancer).  If no high-risk types of HPV virus are present, the abnormal cells found on the Pap test aren't of great concern.  If high-risk types are present, and you are 25 years of age or older, you'll need further testing.
  • If "dysplasia" is present, the cells seen on the Pap smear may be precancerous and further testing is necessary if you are 25 years of age or older.

If your Pap smear is abnormal, you may be asked to schedule a colposcopy.  This is a procedure that allows the doctor to view your cervix using a magnifying instrument (colposcope).  The doctor may take a tissue sample (biopsy) from any area that appears abnormal.  The tissue sample is then sent to a laboratory for analysis and a definitive diagnosis.  (See Instructions for Colposcopy.)

Important points to remember:

  1. HPV is a virus that is very common.  In fact, most men and women are infected with HPV at some time in their lives.  Most HPV DNA positive women spontaneously become HPV DNA negative within 1 to 2 years due to the response of the immune system.
  2. Some HPV types cause genital warts, some cause mild changes in cervical cells that do not turn into cancer, and some cause changes that may become cervical cancer if present for many years.  Long-term, persistent infection with certain types of HPV, called "high-risk", is necessary for cervical cancer to occur.  Only very rarely does the presence of HPV lead to cervical cancer.
  3. Cervical cancer is preventable.  Early detection of abnormal cell changes is important.
  4. There is no treatment for the virus itself.  However, good treatments exist for the problems HPV can cause, such as cervical cell changes or genital warts.  Your healthcare provider will discuss these treatment options with you, if you need them.
  5. There are more than 100 types of HPV.  There are two vaccines currently available in the U.S.  Gardasil will protect you against four types of HPV, two that cause 70% of cervical cancer and two that cause 90% of genital warts.  Cervarix is the other vaccine and will protect you against two types of HPV that cause cervical cancer.

Resources on HPV and cervical cancer

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