What does my abnormal PAP mean?

Q: Hi Doctor Iram,

My gynecologist called me to schedule another appointment because my PAP smear was abnormal. She said something about doing biopsies and a virus. Should I be worried? Do I have cancer?

- Worried in San Jose, CA

A: Hi Worried,

First of all, stop worrying! Most abnormal PAP smears are nothing serious, but let me explain everything to you so that you know what to expect.

Most cases of cervical cancer are caused by a virus called HPV. This virus causes changes in the cells of your cervix that we can see under a microscope when we are examining your PAP smear. Usually, an abnormal PAP smear just means an HPV infection. The good news is that in most healthy women, their body can fight this infection off on it’s own, and in a year or two their PAP goes back to being normal. The bad news is that if the HPV doesn’t get fought off, over the course of several years it can eventually cause those abnormal cells on your cervix to turn into cancer.

Usually if your doctor finds abnormal cells on your PAP smear, the next step is to do an exam called a colposcopy. The colposcopy is like using a big microscope to zoom in on your cervix. Based on what your cervix looks like, your doctor will be able to tell if it looks like you have a new HPV infection that your body will likely be able to fight off on its own, or if it looks like you have an old HPV infection. If there is evidence of an old HPV infection, your doctor will probably take biopsies of your cervix to make sure that there aren’t any cells that are starting to make the cancerous transformation. 

While abnormal PAP smears should definitely be taken seriously, the chances of finding cancer with your very first abnormal PAP is very low. Usually cancer forms after years of an HPV infection. Before that happens, if you do have an HPV infection that your body can’t seem to fight off, your doctor will be able to offer you procedures to remove or kill the abnormal cells to stop progression to cancer.

The most important message is: make sure you go to your follow up appointment, and keep getting your regular PAP smears so that your doctor can keep an eye on that cervix!

In good health,

Doctor Iram