The majority of women will experience at least one irregular pap smear outcome during their lives, with approximately 3 - 5% of all pap tests yielding abnormal results. It's essential to note that an abnormal pap test result does not indicate the presence of cancer, as less than 1% of all irregular pap smears ultimately lead to a diagnosis of cervical cancer.
An irregular result signifies the detection of cell alterations on your cervix, and in over 90% of cases, these anomalies are attributable to the human papillomavirus (HPV). In most instances, these minor cellular alterations tend to revert to normal without intervention.
However, it is crucial to recognize that while an irregular pap test outcome does not equate to cancer, it does warrant vigilance and follow-up care, as HPV can potentially lead to precancerous or malignant transformations in cervical cells.
What Causes Abnormal Pap Smear Results?
HPV stands as the primary contributor to abnormal pap smears in over 90% of cases. Women who receive a positive HPV test result will undergo careful monitoring, with the frequency and nature of subsequent tests contingent upon the outcomes.
Furthermore, there are other factors that can lead to an abnormal pap smear outcome, including:
- Sexually transmitted infections (STIs) like gonorrhoea or chlamydia
- Yeast infections
- Bacterial vaginosis
- Hormonal fluctuations in menopausal women
- Impaired immune system function
Will I Have Symptoms If My Result Is Abnormal?
Cellular modifications in the cervix triggered by HPV usually remain asymptomatic. Nevertheless, if the underlying reason for your abnormal pap smear is linked to a sexually transmitted infection, you may experience symptoms associated with the infection. These symptoms can encompass:
- An unusual discharge with altered texture, odour, or colour compared to your normal discharge.
- Painful itching or a burning sensation in your genital area during urination or sexual activity.
- The development of rashes, blisters, lumps, or warts around the genital region.
What Is HPV?
There are over 100 different kinds of HPV with most of them not causing health problems. HPV is the most common sexually transmitted infection (STI) and the leading cause of cervical cancer.
A small number of HPV types (called high-risk types) are linked to a variety of cancers, including:
- cervical cancer
- anal cancer
- penile cancer
- vulval cancer
- vaginal cancer
- some types of head and neck cancer
Most people with HPV do not experience any symptoms although some might develop genital warts. The types of HPV that cause genital warts are not the same as those that cause cancer.
What Is A Pap Smear?
A pap smear is the primary approach utilized to examine cervical cells for potential changes that may progress to cancer.
Typically, a pap smear is conducted for women aged 21 and above. In the course of this procedure, your healthcare provider will collect cervical cell samples and forward them to a laboratory for evaluation to ascertain their normalcy or any abnormalities.
If you are at risk of sexually transmitted infections (STIs), your physician may also conduct gonorrhoea or chlamydia screening concurrently with the pap smear.
What Do My Pap Smear Results Mean?
The following terms are used to define the results of a pap smear:
No abnormal cervical cells were found. This is also called a negative test result.
The lab could not examine the sample provided, usually because there were not enough visible cells. You will usually need to return for a pap smear in 2 to 4 months.
This test result is mostly normal but there are signs of an infection present that has caused inflammation of your cervical cells. Your doctor would need to determine the cause of the infection and provide the necessary treatment.
Abnormal Or ASCUS
ASCUS stands for atypical squamous cells of undetermined significance and means your test results are abnormal. These abnormal cells in your cervix need to be checked for possible HPV.
What Kind Of Pap Smears Are Done In The UK?
In the United Kingdom pap smears performed by the NHS are mostly limited to identifying the presence of HPV as it is considered the leading cause of cervical cancer. Pap smear results are divided into three categories, namely:
Human Papillomavirus (HPV) Was Not Found In The Sample
This means that your risk of getting cervical cancer is very low and that no further tests to check for abnormal cervical cells is necessary.
HPV Found (HPV positive) But No Abnormal Cells
You will be invited for screening in 1 year and again in 2 years if you still have HPV. You may need to have a colposcopy if HPV is still found after 3 years.
HPV Found (HPV positive) And Abnormal Cells
You will need to undergo a colposcopy.
What Kind Of Abnormal Results Are There?
Abnormal test results are categorised by the presence of the following types of cells:
Atypical Squamous Cells Of Undetermined Significance (ASC-US)
This is the most common abnormal Pap test result. It indicates that some cells appear abnormal although it is unknown if HPV is the cause. An HPV test will normally done at this point.
Atypical Glandular Cells (AGC)
If abnormal-looking glandular cells are found it could be a sign of a more serious problem inside the uterus. A colposcopy will normally be performed to investigate the abnormality.
Low-grade Squamous Intraepithelial Lesions (LSIL)
These low-grade cellular changes are usually caused by an HPV infection. Additional testing is needed to rule out more serious (high-grade) changes.
Atypical Squamous Cells
Some abnormal squamous cells were seen that may be a high-grade squamous intraepithelial lesion (HSIL), although it is unclear. A colposcopy will be performed to investigate the abnormal cells.
High-grade Squamous Intraepithelial Lesions (HSIL)
A moderate to high amount of abnormal cervical cells were seen that could possibly become cancerous. that could become cancer in the future if not treated. A colposcopy will be performed if HSIL cells are found.
Adenocarcinoma In Situ (AIS)
An area of abnormal growth (advanced lesion) was seen in the glandular tissue of the cervix. These lesions are precancerous and may become cancerous (cervical adenocarcinoma) if not treated. You will need to undergo a colposcopy.
Cervical Cancer Cells (Squamous Cell Carcinoma or Adenocarcinoma)
Cancer cells are usually found in women who have not attended regular screenings (pap smears). A biopsy will be performed and if it shows that cervical cancer is present further tests will be done to find out if cancer cells have spread within the cervix or to other parts of the body.
What Happens If My Result Is Abnormal?
If you receive an abnormal pap smear result your doctor will advise you on the follow-up you require. This will be determined by your age and the kind of abnormal cells identified. If HPV is found but no abnormal cells are seen, you will normally only need to have another pap smear in 1 year. If you still have HPV after 3 years, you will need to have a colposcopy. If HPV is found in your smear, or if certain kinds of high-risk abnormal cells are found, you may need to have a colposcopy.
A colposcope allows your doctor to see your cervical cells more clearly. During this procedure, your cervix might be swabbed with a vinegar solution, which causes unhealthy cells to change colour. If your doctor finds unhealthy cells, a biopsy may be performed.