Although the Pap test is designed primarily to detect cervical cancer, it’s also capable of detecting hundreds of relatively minor problems—from irritations to inflammations to infections. So if your Pap test comes back abnormal, don’t panic. Cancer is only one of many possible causes.
In fact, most abnormal Pap test results do not suggest invasive cancer (cancer that may have spread deeply into the cervix and possibly to other organs). Since cervical cancer usually develops very slowly, you’re not likely to get such a result if you’ve had Pap smears during annual gynecological examinations.
The best way to understand the difference between a normal test result and an abnormal one is to learn a little bit about the layer of tissue covering the cervix. Like your skin, this tissue regenerates itself continuously. The cells at the bottom of the layer grow, multiply and divide, forcing the more mature cells toward the surface. When they reach the surface, these cells are nearly dead. If the lab technician analyzing your Pap test sees nearly dead cells under the microscope, he or she will label the test normal.
If he or she finds bacterial, inflammatory or immature cells on the smear, however, the test will be labeled atypical or inflammatory—by far the most common “abnormal” Pap. A wide variety of conditions can trigger such changes in cervical cells, including hormonal changes that occur during menopause, vaginal or pelvic infections, even irritation from sexual intercourse.
Since many of these problems resolve themselves naturally, your “treatment” may simply be a repeat Pap test several months down the road. If the inflammation is acute or bacterial, however, your doctor will diagnose the particular condition and treat it accordingly, usually with some type of antibiotic.
Pap test results sometimes reveal a precancerous condition called dysplasia, in which normal cells are replaced by abnormal ones. If the problem cells are confined to the surface layer of a specific area of the cervix, the condition is considered mild to moderate.
Fortunately, this degree of dysplasia is 100 percent curable. But if not treated in the early stages, it may progress into a pre-invasive cancer within the surface layer or into the underlying layers as invasive cervical cancer.
A Pap test can also reveal dysplasia that is considered severe (carcinoma in situ), with cancerous cells occupying the entire surface layer of the cervix. Like mild to moderate dysplasia, the cure rate for carcinoma in situ is essentially 100 percent. But if not detected and treated, it may lead to invasive cervical cancer. Early detection and treatment is the key to recovery.
Keep in mind that the classification or diagnosis for the same Pap test may vary from lab to lab because of different reporting systems. A narrative summary of the lab’s findings will aid your doctor in proper interpretation.
So if your Pap test is abnormal, expect your doctor to describe what stage of abnormality the test suggests and how the condition can be treated.