What Happens After An Abnormal Pap Smear?

In India, out of all the health-related complaints, female health problems receive the least attention. Female health issues are most commonly neglected or considered to be a part of the normal physiology, thereby receiving limited or no medical attention and treatment.

Unhygienic living conditions, poor nutritional status, limited access to health services and inability to maintain hygienic conditions during menstrual cycles make Indian women susceptible to a wide variety of infections of the reproductive tract.

Cervical cancer is one of the commonest affections of the reproductive tract caused due to Human Papilloma Virus (HPV) infection. Screening for precursors of HPV by means of Papanicolaou (Pap) smears is known to substantially reduce the incidence of cervical cancer.

During the last few years, there has been an increase in awareness programs for women all over the country regarding the importance and uses of a Pap smear test. This article will let you understand what a Pap smear test is, the purpose of doing the test and what happens after an abnormal Pap smear.

What is a Pap Smear Test?

A Pap smear is also known as cervical cytology or Papanicolaou smear. This test involves microscopic examination of cells scraped from the cervix to detect the presence of pre-cancerous condition and cancer of the cervix or infections.

Interpretation Of A Normal Pap Smear

To begin with a little bit of anatomy, the cervix is normally made up of two types of epithelial cells at different locations.

• Endo-Cervical Canal – Columnar Cells
• Exo-Cervical canal – Squamous Cells

The junction at which the two canals meet is called the squamocolumnar junction. The sample for a Pap smear test is collected from this site.

The Following Types Of Cells Can Be Visualized On A Normal Pap Smear

• Cells from the basal layer, intermediate layer and the superficial layer of the cervix.
• Endometrial cells
• Histiocytes
• Blood cells
• Some bacteria

Interpreting An Abnormal Pap Smear Test

Medical terminologies and abbreviations can sometimes appear complicated and even difficult to understand unless explained by the doctor. Some common terms used for reporting a Pap smear test are given in the table below:

Pap Smear Findings	Interpretation
Atypical squamous cells of undetermined significance (ASCUS)	Abnormal squamous cells present but do not fit into the criteria for squamous intra-epithelia; lesion (SIL)
Low-grade squamous intraepithelial lesion (LSIL)	Mild abnormal cells or changes in tissues attributable to Human Papilloma Virus (HPV) infection
High-grade squamous intraepithelial lesion   (HSIL)	Moderate to a severe abnormality in squamous cells or tissue changes
Carcinoma	High possibility of cancer of cervix and needs evaluation.

Presence of atypical cells on microscopic examination suggests an abnormal Pap smear. This can occur as a result of cervical cancer from infection of the cervix. Causes for an abnormal Pap smear besides HPV are

Causes Of An Abnormal Pap Smear Test

• ASCUS – A typical squamous cells of undetermined significance
• Yeast infection
• Bacterial vaginosis

What Happens After An Abnormal Pap Smear?

It is essential for all sexually active women to undergo a Pap smear test annually. If the smear appears to be abnormal, then it is repeated at an interval of 3-6 months. Three consecutive abnormal results is an indicator for further evaluation.

Pap smear test is capable of detecting cervical cancer or pre-cancerous condition of the cervix at an early stage. When found early, the chances of being cured are significantly high.

The following set of tests may be done after an abnormal Pap smear test depending upon the patient’s age and the first Pap smear test result.

1. Repeat Pap Smear Test – Tests may be repeated every 1 year or 3 years depending upon the age of the patient
2. HPV Test – To look for the presence of HPV types that have been linked to cervical cancer. Types of HPV tests that may be done include the following:
   ● Reflex HPV testing
   ● HPV Typing – This is done to specifically detect HPV-type 16 and HPV-type 18
3. Colposcopy – Examination of the cervix and vagina using a magnifying glass or an instrument called a colposcope
4. Cervical Biopsy – A small sample of cervical tissue is collected and sent to the laboratory for evaluation
5. Endo-Cervical Sampling – A sample of cervical tissue is collected from the lining of the cervix
6. Endometrial Sampling – A sample of endometrium (lining of the uterus) is also collected for evaluation

After an abnormal Pap smear test, if further studies too suggest the presence of abnormal cells within the cervix, the treatment can be of the following two types:

1. Excision

In the excisional treatment, the abnormal cervical tissue is excised or removed and sent to the laboratory for study. The laboratory then reverts back with results whether cervical cancer is present and how severe it is.

Types of excisional treatment are:

• Loop electrosurgical excision procedure (LEEP) – A thin wired loop carrying electric current is used to excise or remove the abnormal tissues of the cervix
• Conization – A cone shaped piece of the cervix is excised which contains abnormal cells

2. Ablation

In ablation, abnormal cervical tissue is destroyed. In this type of treatment, the abnormal tissue is not sent to the laboratory.

Types of ablative Treatment Are:

• Cryotherapy – In this type of treatment, the abnormal tissues of the cervix is frozen using an instrument. The frozen tissue is eventually shed at the slough
• Laser therapy – A beam of light or laser is focused on a specific area of the abnormal cervix to be destroyed

It is generally recommended for women to begin Pap smear testing right from the age of 21 years. A Pap smear test should be repeated every three years in women in the age group of 21 to 65 years.

Pap smear tests can be stopped if they are negative for women up to the age of 65 years or if the woman has undergone hysterectomy (surgical removal of the uterus).

Although the Pap smear test is one of the best screening tools of cervical cancer, yet, there are chances of receiving false-positive or false-negative results.