Don’t Freak Out: Abnormal Pap Smears Are Not Uncommon

When I was in my early 20’s, I got a call from my gynecologist’s office saying that my Pap smear had been abnormal. I was told on the spot that there was nothing to worry about, but that I needed to come back in a month for a follow-up.

Now, being the extreme worrier that I sometimes always can be, I immediately broke into a cold sweat, my stomach turned inside out, and I began to picture my funeral. The “nothing to worry about” portion of the phone call clearly had not registered, and I was certain that I was going to go in for my appointment and told I had three months to live.

What happened instead was that I came back, had a pelvic exam and another Pap smear (just to be safe), and was given the green light. Everything was fine: the abnormality was probably caused by inflammation as a result of a low-grade infection, and that infection had since cleared.

Little did I know then (but I know now!) that abnormal Pap smears are extremely common, and are actually very rarely something to worry about. Even when they indicate precancerous conditions, that is almost never a death sentence, because cancer of the cervix tends to grow very slowly, and can be prevented by regular testing and monitoring.

In other words, if you get a call from your gynecologist saying your Pap smear was abnormal, you most definitely should not act like I did. Just breathe, remember it’s common, rarely anything harmful—and that anything of concern can be treated fairly easily and successfully.

“Six to 10 million women will be told at some point in their lives they have an abnormal Pap,” Nicole S. Nevadunsky, M.D., associate professor of gynecologic oncology at Montefiore Einstein Center for Cancer Care, explained to SELF. “It generates a lot of anxiety and concern, but the reality is, there are a lot of abnormal Pap smears that are not cancer.”

So what could be the cause of an abnormal Pap, and when are further tests and treatments required?

First, it’s important to understand what a Pap smear is testing. As Dr. Kirtly Parker Jones explains in an interview with the University of Utah, Pap smears are a chance for doctors to examine the cells on your cervix, to make sure that none are abnormal, and to check for precancerous cells.

But Pap smears will never tell you more than that. They are screening tests, not diagnostic tools. In other words, an abnormal Pap smear will never tell you that you have invasive cancer and are about to die. Seriously. So relax.

According to the Center for Young Women’s Health, there are two main reasons for an abnormal Pap smear.

The first is a “benign” change in your cervix, which means that your cervix is basically normal, but you have some inflammation of the cells, which likely points to some kind of infection. These infections usually clear up on their own and aren’t problems. Your healthcare provider will decide if and when this result requires a follow-up to investigate the cause of the infection.

The second possibility is something called ASCUS (short for “Atypical Squamous Cells of Undetermined Significance”), which means that some of the cells on your cervix are of concern, and you will likely need more tests to figure out what is going on. HPV can be the cause of these changes, and you will most likely be tested for that.

Depending on your situation, you will probably need a repeat Pap smear and possibly a colposcopy. Colposcopy sounds more sinister than it really is. It’s basically a procedure where the doctor uses an instrument called a colposcope (a magnifying tool) to see your cervix close-up. The colposcope is placed outside of your vagina (thank God), and the cervix is swabbed with a vinegar solution, which causes the unhealthy cells of your cervix to change color. If the doctor sees any abnormalities at that point, a biopsy will be taken.

Now, I know that for many of us, if we hear the word “biopsy,” we instantly lose our shit. First of all, just because you are getting a biopsy doesn’t mean you automatically have cancer. And in the cases of cervical biopsies, any concerning cells or growths are usually “precancerous cells.” Most precancerous cells can be removed (through fun methods like “freezing” or laser treatments) before they become dangerous.

“The good news about all this, is that if there are precancerous cells there, it does take them a very long time—years—to grow into cancerous cells,” Nevadunsky explained to SELF. “The reason women get a lot of anxiety is we all know that one woman who walked into the gyno, nothing was wrong, and all of a sudden she has invasive cancer. That’s not what usually happens, that’s an absolute outlier. With good surveillance we’re able to prevent precancerous lesions from becoming invasive.”

Have you started to unclench your teeth, drop your shoulders, and start to take in a few decent breaths by now?

Besides the fact that we all need to chill out a little more about any abnormal Pap smear results we might receive, maybe the most important take-away from all this is that we must keep our gynecology appointments and get our Pap smears on the schedule that is recommended by our healthcare providers. The great news is that something scary like cervical cancer is highly treatable and preventable, but that’s when it caught in the early stages.

So buck up, ladies. Get your Pap smears. Go to your follow-ups when needed. And relax.