The Pap smear is a screening test for cervical cancer, which is caused by two strains of the human papillomavirus (HPV), a sexually transmitted disease. The Pap looks at two things:
- Are your cervical cells normal?
- Do you have the HPV virus?
"Abnormal results are quite common," says Kimberly Hartzfeld, DO, a gynecologist and independent member of the HonorHealth Medical Staff. "That's primarily because HPV is so prevalent. Up to 90% of sexually active people have been exposed. Most can clear the virus on their own as long as they have a healthy immune system."
The most common abnormalities found on a Pap are:
- ASCUS (atypical squamous cells of undetermined significance)
- LGSIL (low-grade squamous intraepithelial lesion)
- HGSIL (high-grade squamous intraepithelial lesion)
An ASCUS Pap result without HPV can be monitored with a repeat Pap in six to 12 months. ASCUS with HPV requires additional cervical evaluation with a colposcopy.
An LGSIL or HGSIL Pap result also requires further evaluation with a colposcopy as they are commonly associated with the presence of HPV.
A colposcopy is an office procedure that takes a closer look at your cervix with a microscope. Cervical biopsies are often taken to see if there are pre-cancerous changes on your cervix called dysplasia. If there is dysplasia, it is noted as mild, moderate or severe.
- Mild: Your provider will likely have you repeat the Pap every six months for two years, and if all are normal you will then resume annual screening.
- Moderate: If you are under 25 years old, you can repeat your Pap every four to six months. If you are older than 25, you will likely be advised to do a procedure to try and clear the abnormal cells either with cryotherapy (freezing the cervix) or a LEEP procedure (removing the abnormal cervical cells).
- Severe: You'll likely need to have a LEEP or cryotherapy procedure.
After having a LEEP or cryotherapy, your provider will repeat your Pap every four to six months for two years, at which point you can resume annual screening.
"The Pap is an important screening test that can reduce your likelihood of developing cervical cancer," says Dr. Hartzfeld. "That's why it's so important to see your gynecologist regularly and to follow-up on any recommendations for further testing or treatment. There are many things we can do to keep cervical abnormalities from progressing."