Your Pap Smear Is Abnormal -- Now What?

The phone rings. It's your OB-GYN's office.

"Your Pap smear came back abnormal."

... What does that mean?

As if going to an annual appointment that brings apprehension and anxiety to even the most mindful health enthusiasts wasn't enough, now your test has been dubbed that scary word: abnormal.

The Centers for Disease Control and Prevention estimate that 3 million women receive unclear or abnormal Pap smear results each year. About 10,000 women per year will actually have cervical cancer.

"The most important thing is not to panic and not to start writing a will," says Dr. Constance Bohon, an assistant clinical professor of OB-GYN at George Washington University Medical Center who's also in private practice at Capital Women's Care in the District of Columbia.

What Does Abnormal Mean?

One of the first things you'll be asked by your doctor is if you've had an abnormal Pap smear in the past. While normal results mean that no cell changes have been discovered in your cervix, unclear test results are often due to life changes such as pregnancy, menopause or an infection. The doctor may recommend a follow-up immediately, in a few months or in one year, depending on your age and risk, to check if cell changes are related to the human papillomavirus -- or HPV -- infection.

An abnormal result simply means cell changes were found on your cervix, but it doesn't necessarily mean you have cervical cancer, says Dr. Eduardo Lara-Torre, interim chair of the Carilion Clinic in Roanoke, Virginia, and associate professor of OB-GYN and pediatrics at Virginia Tech-Carilion School of Medicine.

"The major obstacle in the last few years has been delivering the message to women that HPV is likely responsible for the abnormal Pap smear, and explaining how the disease behaves," Lara-Torre says.

The CDC estimates that roughly 79 million Americans are infected with HPV, and approximately 14 million people are diagnosed with the virus each year. That's why your doctor will test the cervical cells from your Pap smear for two high-risk strains of HPV -- types 16 and 18 -- that cause most cervical, penile, vulvar, vaginal, anal, oropharyngeal and pre-cancers, according to the CDC. If you're older than 30, you'll be tested for HPV at the same time as your Pap smear, since the virus tends to be more of a threat to women in their 30s and older.

"Women in their early 20s are more likely to have a lower abnormality compared to older women," Lara-Torre explains. "We think that's because the age has something to do with how the body responds to the virus. Younger people have a better immune system. It's the reason why we do pap smears at 21 rather than 18 or when they become sexually active."

Cell changes in an abnormal Pap smear can be broken into four categories: normal; atypical or low-grade, signaling little concern; abnormal, warranting further screening; and pre-cancer -- meaning a heightened risk for cancer that, if left untreated, could lead to cancer or cancer that can only be detected at the microscopic level.

The American Congress of Obstetricians and Gynecology website lists the following terms your doctor may use to describe an abnormal result:

-- Atypical squamous cells of undetermined significance: Thin cells have grown on the surface of your healthy cervix, but they aren't necessarily precancerous.

-- Low-grade squamous intraepithelial lesion: Mildly abnormal cervical cells usually caused by an HPV infection that can go away on its own.

-- High-grade squamous intraepithelial lesion, or HSIL: More serious change in the cells of the cervix that may be associated with precancer and cancer.

-- Atypical squamous cells, cannot exclude HSIL: Changes in cervical cells that also raise the risk for precancer.

-- Atypical glandular cells: Changes to the cells that make up the thin layer of tissue that covers the inner canal of the cervix, increasing the risk for precancer or cancer. Although they aren't always cancerous, they'll still show up as "abnormal" on your test results.

It's important to keep in mind that most women will not require surgery, says Dr. Alson Burke, clinical assistant professor of OB-GYN at the University of Washington in Seattle, and member of the ACOG. However, if you're in a higher-risk category, you'll probably be asked to go back for additional testing.

What Comes Next?

"It's really important to comply with the follow-up recommendations your health care provider gave you to prevent this from progressing forward," Burke says. "It can take eight to 12 years for abnormal pap smears to turn into cancer. Additionally, the mortality for cervical cancer has dropped 50 percent. Very few women slip through the cracks."

If it hasn't been done yet, your doctor will recommend a screening to check for HPV types 16 and 18. He or she will use the same cells used for the initial Pap smear.

Bohon, also the District of Columbia legislative chair for the American Congress of Obstetricians and Gynecologists, says women ages 21 to 24 who have lower levels of abnormal cells will often be instructed to come back in a year. She asks those older than 24 to come in for a colposcopy.

This procedure -- usually completed in your doctor's office when you're not having your menstrual period -- allows the doctor to view the cervix, vagina and vulva with a magnifying device called a colposcope. The scope shines a light into the vagina and onto the cervix, allowing the doctor to view any potential problems that cannot be seen by the naked eye. The doctor may take a biopsy or sample of cells for further testing during this time.

"The colposcopy is a really straightforward procedure, and it's mildly uncomfortable, but very manageable," Burke says. "Have an open conversation with your provider to make it an experience that's no worse than a Pap smear in terms of discomfort." She adds that women should ask their doctor about using a painkiller like ibuprofen ahead of time to minimize a side effect that feels like mild menstrual cramps.

After the colposcopy, your doctor will determine if you have cervical intraepithelial neoplasia, a growth that can lead to cancer on the surface of the cervix. That's when you'll need endocervical sampling, which is another method for collecting tissue samples in the cervical canal.

In these severe instances when cancer is detected, your doctor may recommend what's referred to as an excisional treatment, like loop electrosurgical excision procedure -- or LEEP. This involves a thin wire loop that carries an electric current to essentially erase abnormal cells in the cervix. Conization is another type of treatment that involves the removal of the cone-shaped piece of the cervix housing the abnormal cells. LEEP can be performed in your doctor's office, but the conization procedure must be done in an operating room.

"If a woman is considering childbearing in the future, all of this is safe," Burke says. "We don't perform endocervical sampling while someone is pregnant, but if someone has had an abnormal Pap smear and has had appropriate follow-up, there's no reason to think she won't have a healthy pregnancy."

Potential Preventions

The U.S. Preventive Services Task Force and American Congress of Obstetricians and Gynecologists recommend women ages 21 to 29 only receive a Pap test every three years instead of annually to reduce unnecessary panic caused by abnormal results due to an HPV infection. Women with persistent HPV infections may be asked to return for an annual Pap smear due to their risk for cancer, Burke says. The test remains the best way to prevent and screen for cervical cancer and HPV. "I can't overemphasize enough that although they are less often, you still need to get them," Lara-Torre says, adding that women should also have a yearly checkup with their OB-GYN for any other health concerns.

OB-GYNs also recommend all young people receive the HPV vaccine -- it's considered the best way to prevent cervical cancer.

Samantha Costa is a Health + Wellness reporter at U.S. News. You can follow her on Twitter, connect with her on LinkedIn or email her at scosta@usnews.com.