So you've gotten word that your Pap wasn't perfect. Ugh. I hope that you didn't learn of it on Friday night and then had to spend all weekend with wave after wave of anxiety washing over you.
Relax. Remember that the reason you went through this awkward procedure in the first place was to look for early signs of cervical cancer, at the time when it's most treatable. So let's run through what may happen next.
First, find out what abnormality was identified. Was it a simple infection? Infections identified on Pap smear generally warrant treatment, especially if you are in your child-bearing years, but all that will likely be needed in such a case is a run of oral or vaginal antibiotics.
Was the abnormality labeled as an "ASCUS?" (That's a lovely abbreviation that stands for abnormal squamous cells of unknown significance.) An ASCUS result means it's not cancer, but the swab revealed some unhappy-looking cervical cells that may still be cause for concern. In the past, an ASCUS finding would mean that you'd have to come back more frequently for Pap smears, all the while waiting either for the abnormality to start looking enough like cancer to cause real concern, or for it to simply disappear on its own.
These days, though, ASCUS may also mean an HPV (human papillomavirus) infection that warrants further investigation. HPV is a common virus with dozens of types or strains, only a few of which are known to cause almost all cases of cervical cancer. HPV has been making headlines now that a vaccine to prevent it has become available. (The HPV vaccine, by the way, works best in young women before they become sexually active). If your HPV virus test is negative, you'll likely go back to a schedule of routine Pap screening. But if it's positive for a concerning strain of HPV, you'll move on to the next level of evaluation because cancer is a real possibility.
The next step is to diagnose the reason for an abnormal Pap smear, regardless of the HPV result. This must be done by a gynecologist, so if the Pap was done by a generalist (like a family practitioner, pediatrician, or internist), you'll be referred to a specialist.
The first level of the gynecologist's diagnostic schedule is a procedure called a colposcopy, in which a painless acid is applied to the cervix so that any patches of abnormal cells can be closely examined (the acid makes the abnormal cells turn white) and then sampled by means of a biopsy. Those samples are then sent off to the lab to be looked over for the presence of any cancer cells. If cancer cells are indeed found, the intervention moves on to the next level.
If the findings are of real concern to the gynecologist, a LEEP (loop electrosurgical excision procedure) may be indicated. As implied by the name, this is a bit more involved than colposcopy and aims to eradicate the affected areas of the cervix.
This multi-layered diagnostic process may seem a bit overwhelming to you (as well as time consuming) but remember: The goal is to catch cancerous cells before they have spread so far that major surgery is necessary. Ultimately, this process is meant to prevent the cancer from disrupting your life.
You should also know that your doctor will gladly walk you through all your concerns and questions before the procedure, so don't hesitate to ask!
