Buzz
The news of a medical test returning 'abnormal' is always unsettling, especially when human papillomavirus (HPV) is involved. When I first heard those two words together, as you might imagine, I was completely shaken.
HPV has the potential to cause cervical cancer, though it typically takes many years for this to occur. In the meantime, a Pap test can identify cells that are starting to change abnormally, even if they aren't cancerous yet.
This can still occur even if you’ve received the HPV vaccine. While the vaccine protects against certain strains of the virus (with the latest version, Gardasil 9, covering nine), there are over 100 strains that could impact your body. Although I had the vaccine, I’ve experienced abnormal Pap results more than once. The first instance was five years ago, and more recently, I was informed that my cells exhibited 'high grade' lesions, which indicates that my cells were changing quickly and raised concerns.
The virus can remain dormant in your body for up to 16 years before it causes any abnormal cell changes or symptoms. Additionally, HPV can 'persist and recur,' according to Clinical Advisor.
Abnormal Pap smear results occur due to the presence of the virus in cells on the cervix, specifically squamous cells. Your cervical cancer screening could include a Pap test, an HPV test, or both. There are several other potential causes for abnormal results, such as bacterial or yeast infections, though HPV remains the most common.
What Results Are Considered Abnormal?
Low-grade squamous lesions: These are mild changes in the cells on your cervix. In most cases, your body can naturally clear this HPV infection without intervention.
High-grade squamous lesions: These indicate more severe cell changes on the cervix that, if untreated, may lead to cancer.
Squamous cell carcinoma: This represents cervical cancer that has spread deep into the cervix and potentially other tissues or organs. Most doctors do not detect cervical cancer through a Pap test alone.
If any changes are detected after a Pap test, a colposcopy may be necessary. This is often scheduled during a separate visit with your doctor. Similar to a Pap test, a colposcopy involves you sitting in stirrups while the physician uses a colposcope to examine the cells. A vinegar-like solution will be applied to your cervix to help highlight any problem areas. If changes are seen, your doctor will take a tissue sample for lab analysis. You may feel cramping, similar to menstrual cramps, which can sometimes feel more intense, like the sensation during an IUD insertion. If the lab results are inconclusive or show more abnormal cells, additional procedures may be required.
As stated by Women’s Health Specialists, 90% of low-grade and 70% of high-grade cells will naturally return to normal when the body's immune system clears the HPV virus. In most cases, the body will heal on its own, but in some situations, additional tests and procedures may be necessary.
According to Dr. Nicole S. Nevadunsky, most women clear the infection within 20 months without the need for medication, as reported by SELF Magazine. However, there are dangerous strains that can lead to cervical cancer. What happens to those whose bodies do not clear the infection?
Options Available
If the results show low-grade cells, your doctor will recommend a follow-up Pap exam in a year. If the results are high-grade cells, a procedure to remove the abnormal cells will be suggested to prevent them from developing into cervical cancer in the future.
Available treatment options include:
LEEP (Loop Electrosurgical Excision Procedure), which uses a wire loop that carries an electrical current to remove cervical tissue.
Cryotherapy, a method where abnormal tissue is frozen and removed.
Laser Therapy, which involves a focused beam of light to destroy or remove abnormal cells.
Conization, a procedure that uses a knife, laser, or electrical current to remove a cone-shaped piece of tissue from the cervix.
Does an abnormal Pap result indicate cancer?
The answer is a definitive ‘no.’ An abnormal result does not automatically suggest cervical cancer. However, it's important to note that nearly all cervical cancer cases are linked to two types of HPV, 16 and 18, which account for about 70% of cervical cancer cases, as per the National Cancer Institute.
Cervical cancer develops slowly over many years. The CDC's current guidelines recommend that individuals aged 21 to 29 be screened every three years, and those between 30 and 65 be screened every five years. If abnormal cells are found, follow-up screenings will be scheduled every six months to a year.
It's important to note that an abnormal Pap test result does not necessarily imply something life-threatening, but it should not be overlooked. Given that sexually transmitted infections (STIs) are on the rise, it's crucial that we have conversations about safe sexual practices and promote regular Pap screenings.
Understanding the LEEP Procedure
My diagnosis of high-grade cervical cells increased my chances of developing squamous cervical cancer. After the initial abnormal Pap results, I underwent two biopsies. Following the second biopsy, I was scheduled for an excision procedure known as LEEP.
The LEEP procedure is performed in the gynecologist's office. Initially, a numbing solution is applied to alleviate any pain. A wire with an electrical current is then used to cauterize the tissue, and the excised cells are tested for precancerous or cancerous changes. It feels similar to an IUD insertion—expect cramping, discomfort, and possible nervousness. The whole process takes about ten minutes, and mild bleeding is common afterward. For six weeks, you should avoid any vaginal activities, including intercourse and tampon use, to reduce the risk of infection.
After a LEEP, your healthcare provider may request a follow-up Pap test in about four to six months.
Every year, approximately 12,900 women are diagnosed with cervical cancer, and 4,400 succumb to the disease. Despite the widespread nature of HPV, which SELF magazine referred to as “NBD” in a 2016 article, procedures like LEEP come with a slight risk of complications, including excessive bleeding. However, if high-risk HPV cells go undetected or are ignored, the likelihood of developing cervical cancer increases. This makes regular screening crucial. By taking charge of your health, avoiding smoking, using condoms during sexual activity, and getting the HPV vaccine, you can significantly lower your risk and ensure a safer future for both you and your cervix.
