Why is it important for me to have a regular Pap test?
What does an abnormal Pap result mean?
I've been told I have HPV. What it is? Does it cause cancer?
Why is it important for me to have a regular Pap test?
The Pap test detects cervical changes that might develop into cancer over many years. These changes have no specific symptoms. The Pap test is not 100% effective in finding changes though newer types of cervical cytology have fewer errors. Having regular tests is the way to make sure that cervical changes are detected early.
You should have regular Pap tests beginning a year after you start having sex or around the age of 18 even if you are not sexually active. All women who have ever been sexually active including lesbian and queer women should have the test, even if you are not sexually active right now. Recommendations for how often to have the test vary from province to province and among practitioners.
You should be particularly sure to have routine Pap tests if:
- You have already been treated for cervical abnormalities or cancer.
- You have undergone a partial hysterectomy (removal of the uterus without removing the cervix).
- If you or your mother took a drug called Diethylstilbestrol (DES) during pregnancy. This was a drug given to millions of pregnant women between 1941 and 1971 to help prevent miscarriages.
If you are over 70 years old and have had three normal tests within the last ten years, you do not have to continue having tests. But if you are over 70 and have never had a test, then you need to have one.
The Canadian Women's Health Network has gathered a number of resources on Pap tests. You can access the listing at the following web address:
What does an abnormal Pap result mean?
The Pap test detects changes in the cells of the cervix. The cervix is the opening to the uterus at the end of the vagina. A doctor or nurse practitioner takes a sample of cells from an area on the cervix called the transformation zone. This zone divides the cells of the cervix from different ones in the uterus. This is an area vulnerable to abnormal changes.
Changes in the cells could be a result of:
- a vaginal infection or sexually transmitted infection (STI)
- human papilloma virus (HPV), which is a specific sexually transmitted infection and some types of HPV are linked to serious cervical changes and cervical cancer
- being a daughter of women who took DES (diethylstilbestrol) during pregnancy
- hormonal changes that happen to post-menopausal women
Most women experience some anxiety when they are told they have abnormalities. Remember that most women with an abnormal test result do not have cancer. Talking to someone you trust might help you deal with your fear and anxiety.
Ask your doctor or nurse practitioner to show you the written report. Across Canada there are several systems for classifying abnormal Pap test results. You will also find a description of the abnormality. Knowing this will help you decide upon your next steps.
Your test result says: Unsatisfactory smear
What does this mean? 1. The doctor or nurse practitioner did not take an adequate sample. 2. If you are pregnant or take oral contraceptives and hormonal changes may influence the smear quality. What usually happens next? Repeat test in three months. This is the minimum time needed to replace new cells on the cervix.
Your test result says: Benign or reactive changes or Mild atypia.
What does this mean? Your cervix is normal. What usually happens next? You may have a vaginal infection or sexually transmitted infection. Treat any infection or wait for active virus like Herpes to pass. Then repeat Pap test in six months.
Your test result says: ASCUS (atypical squamous cells) or AGUS (atypical glandular cells) of undetermined significance
What does this mean? Cells cannot be classified. Most ASCUS regress or return to normal on their own. You may be infected with HPV. What usually happens next? You may have an HPV test. Repeat Pap test in six months.
Your test result says: LSIL (low-grade squamous intraepithelial lesion) or mild dysplasia or CIN 1
What does this mean? These changes need to be watched. Most regress or return to normal. For women under 34 approximately 80% regress. For older women approximately 40% regress. Cell changes may be caused by low hormone levels in menopausal and postmenopausal women. What usually happens next? You may be referred for colposcopy. Or you could repeat the Pap test in six months. In that time you could try self-help options. Doctors may prescribe estrogen cream for a few weeks to clarify the cause of cell changes.
Your test result says: HSIL (high-grade squamous intraepithelial lesion) or Moderate to severe dysplasia or Carcinoma in situ or Adenocarcinoma in situ or CIN 2 or CIN 3
What does this mean? These are more severe abnormal results. This still is not cancer. No one can tell if they will progress or regress. You may be at risk of developing cervical cancer. What usually happens next? Colposcopy will be recommended. Or you could repeat the Pap test in six months. In that time you could try self-help options.
Your test result says: Squamous Carcinoma.
What does this mean? These results indicate the presence of cancerous cells. What usually happens next? Colposcopy will be recommended immediately.
The Canadian Women's Health Network has gathered a number of resources on abnormal Pap tests. You can access the listing at the following web address:
I've been told I have HPV. What it is? Does it cause cancer?
HPV stands for human papilloma virus. There are over 100 types of HPV. Some types produce warts on the hand, and some infect the genital area. Most seem to have no harmful effect. If you are sexually active, you can be exposed to genital HPV through vaginal, anal, or oral sex play. Vaginal intercourse is not necessary to contact HPV – women who have sex with women get HPV. As well, people who have had only one sexual partner can get it.
Some types of HPV can cause genital warts. Other types may cause changes in cells. These types are linked with cancers of the cervix, vulva, vagina, and anus. Almost 100% of cervical cancers have these types of HPV present.
It is important to note that the body's immune system usually gets rid of HPV on its own within a year or two. Most women with HPV will not develop cervical cancer.
Most types of HPV are harmless and do not require treatment. Like many viruses, there is no cure for HPV, however, treatments can help the symptoms. For example, genital warts can be treated with medications applied directly to warts.
HPV is necessary for the development of cervical changes, but it does not cause cancer by itself. No one knows for sure what else is needed for cancer to develop. Some factors might be:
- unprotected sex at a young age
- smoking
- lowered immune system
- poor nutrition and a diet low in vitamins A, folate (a B vitamin) and C
- stress
- not using condoms or other barrier methods of birth control
- having another sexually transmitted infection like chlamydia.
Most women only become aware of the fact that they have HPV when they have genital warts or abnormal Pap test results. HPV can also be detected by a test that analyzes DNA from the body's cells. This test called Hybrid Capture II (HCII) detects the specific types of HPV that have been linked with cervical cancer.
Many messages about HPV warn against having more than one sexual partner. They mention "multiple partners" as a "risk factor" for HPV and cervical cancer. It only takes one sexual encounter to become infected with HPV. An abnormal Pap test result could be the outcome of unprotected sexual activity from many years ago. Some researchers think that unprotected early first intercourse is a more important risk than how many partners you have had. No one knows for sure. What is important is that you seek treatment and not worry what people will think.
The Canadian Women's Health Network has gathered a number of resources on HPV. You can access the listing at the following web address: