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Next Steps After an Abnormal Pap Smear

Cervical cancer used to be the most common cause of cancer deaths among women. That’s changed over the last 40 years, largely because of the Pap smear, also known as a Pap test, which is now part of a routine well-woman exam.

The test is used to screen for precancerous cells, cells that aren’t yet but may become cancerous. Detecting precancerous or cancerous cells early in their development means a greater chance of beating the disease.

Dr. Hany H Ahmed, in Houston, Texas, is a board-certified OB/GYN who specializes in the management of abnormal Pap smear results. An abnormal result doesn’t necessarily indicate you have cervical cancer; Dr. Ahmed can help you understand what “abnormal” really means.

Here’s what he wants you to know.

Performing a Pap smear

Dr. Ahmed performs Pap smears right in his office, and it only takes 10-20 minutes. This test is generally done every three years, starting when a woman turns 21. 

For women over 30, he may also test for the presence of human papillomavirus (HPV). It’s the most common sexually transmitted infection (STI), and it’s also associated with cervical cancer.

The test itself is easy. Dr. Ahmed uses a speculum — a thin, metal tool — that he inserts into your vagina. He opens up the speculum so the vaginal walls widen, allowing him to see the cervix, the lower end of the uterus. 

He uses a swab to collect a sample of the cervical cells, and then you’re done. He sends the cells to a laboratory for review.

What if your Pap smear comes back as abnormal?

The results come back as one of three things: negative, positive, or abnormal. 

Just because they’re positive or abnormal, though, doesn’t necessarily mean you have cancer. Most often, abnormal results indicate changes in your cervical cells caused by HPV. There can, however, be other causes. These include:

Atypical squamous cells of undetermined significance (ASCUS)

Squamous cells are thin, flat cells that grow on the surface of the cervix. ASCUS means the cells aren’t typical of healthy cells. Dr. Ahmed tests them to see if HPV is present. If it’s not, he may repeat the test or simply adopt a wait-and-see tactic.

Squamous intraepithelial lesion

These lesions can be precancerous, and doctors classify them as “low grade” or “high grade” to describe their development. 

Low-grade lesions might not turn cancerous for many years, or they could be a sign of an HPV infection. If they’re high-grade, they can change much sooner. In both cases, Dr. Ahmed probably follows up with more tests.

Atypical glandular cells

Glandular cells grow in the opening of the cervix and inside the uterus, and their function is to produce mucus. If they’re abnormal, they could be either precancerous or cancerous, and Dr. Ahmed follows up with more tests.

Squamous cell cancer or adenocarcinoma cells

If your results show cells so atypical that Dr. Ahmed is almost certain they're cancerous, he follows up with additional tests while treating the cancer before it can spread further.

The next steps after an abnormal Pap smear

Everything depends on just how atypical the cells are. If they’re only slightly abnormal, Dr. Ahmed may recommend a second Pap smear and/or an HPV test if he didn’t do one at the time of the Pap smear. He may also order two other tests: a colposcopy and a biopsy.

For the colposcopy, he inserts a speculum into your vagina and looks at the cervix with a colposcope, a device that has a magnifying lens and a bright light that allows him to see more detail than during the Pap smear. 

He swabs the cervix with vinegar or another solution that highlights any suspicious areas, and then looks through the colposcope’s lens to see the cells up close.

If Dr. Ahmed finds areas that look to be either precancerous or cancerous, he takes a biopsy, a small sampling of the tissue that he sends to the lab for further testing. The results you get this time are far more detailed than those from the Pap smear.

If the tests indicate any cells that warrant attention, Dr. Ahmed uses cryotherapy to treat them. A specialized instrument freezes the abnormal tissue, which then dies off, and the cells are eventually flushed from your body so they can’t harm you.

If your Pap smear comes back abnormal, it’s not a death sentence — there’s a good chance the cells aren’t even cancerous. 

Dr. Ahmed is specially equipped to interpret the results for you. Give our office a call at 713-489-3348 to schedule a consultation, or book online with us today. The sooner you know, the sooner you can move forward.

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