Your Pap Test Came Back “Abnormal”. Now What?

Nobody looks forward to getting a Pap test, but we women get them regularly – or SHOULD get them regularly because Pap tests are crucial to preventing cervical cancer. We at Cervivor want to make sure that women understand what a Pap test does, what it is looking for and what “abnormal” results may mean. Afterall, if your Pap results came back abnormal, it is important to understand what that means and what steps to take next. 

What exactly is a Pap test?

A Pap test looks for abnormalities and precancerous cell changes in the cervix. If not treated, these abnormal cells could lead to cervical cancer.

Each year, more than 50 million Pap tests are performed in the U.S. to screen for cervical cancer. An estimated 3 million of these Pap tests (5%) are read as abnormal. In fact, approximately 20% of American women have had at least one abnormal Pap test result in their lifetimes, though in the majority of cases, the abnormal cells are the result of a bacterial or yeast infection and are not pre-cancerous or cancerous. While less than 1% of abnormal Paps result in a cervical cancer diagnosis, up to 1 million Paps find early, potentially pre-cancerous cells that can be easily removed before they progress. This is why follow-up of abnormal Pap results is critical!

Pap test results will come back to your doctor as either:

  • Normal. The cells collected from your cervix during the Pap test look like they should.
  • Unclear. If results are unclear, your doctor may do more testing right away to rule out any problems, or your doctor may have you come back in 6 months or a year for another Pap test.
  • Abnormal. The cells collected from your cervix during your Pap test look abnormal. The first thing to keep in mind: abnormal Pap test results do not mean you have precancer or cancer. Sometimes the changed cells are due bacteria or yeast. But important follow-up tests will need to be done to get more information. 

What are some of the follow-ups for abnormal Pap test results?

You may need more tests to find out if you have an HPV infection and/or to find out how severe the cell changes are. For example, your doctor may do:

  • An HPV test. Like a Pap test, an HPV test is done on a sample of cells taken from the cervix to see if the abnormalities were caused by infection with any of the types of human papillomavirus that are linked to cervical cancer
  • Another Pap test in about 6 to 12 months (“watchful waiting”).
  • A colposcopy, a test to look at the vagina and cervix through a lighted magnifying tool. 

What does a colposcopy look for?

A colposcopy is when a microscope (colposcope) with a strong light will be used to look at your cervix. Hundreds of thousands of colposcopies are performed in the U.S. each year. If any abnormal areas are identified, the doctor may take a small sample of tissue (“biopsy”)  from the cervix for closer examination. A biopsy is similar to a small pinch in terms of sensation and shouldn’t be too painful. The purpose of a biopsy is to confirm whether your screening test has been correct in identifying a problem. 

The colposcopist will usually be able to tell straight away if there are abnormal cells in your cervix, but biopsy results can take a few days to a few weeks to receive. 

Understanding the Language Used to Describe Cervical Cell Abnormalities

Treatment, if any, will depend on whether your abnormal cell changes are mild, moderate, or severe. Pap and biopsy results reports commonly use these terms to report the severity of cell changes:

  • Mild: ASC-US or ASC-H. These are changes for which the cause is unknown. ASC-US (atypical squamous cells of undetermined significance) changes usually stay the same or return to normal. ASC-H (ASC that cannot exclude high-grade squamous intraepithelial lesions) changes are also minor but have a higher likelihood of becoming more serious. 
  • Mild: LSIL (low-grade squamous intraepithelial lesions). These changes, also known as CIN 1 (cervical intraepithelial neoplasia) are mild but may be more likely to become more severe over time, though could return to normal. 
  • Moderate to Severe: HSIL and AGC: These moderate to severe cell changes require follow-up. HSIL (high-grade squamous intraepithelial lesions) and atypical glandular cells (AGC) may also be referred to as CIN II and CIN III are more likely to be precancerous and turn into cervical cancer if left untreated.
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Treatments to remove abnormal, precancerous cells:

The good news is, abnormal or precancerous cells can be removed from your cervix. Your doctor will likely recommend one of the following procedures:

  • LEEP (loop electrosurgical excision procedure): A thin, low-voltage electrified wire loop is sued to cut out abnormal cervical cells. 
  • Laser or “cold-knife” conization (also referred to as a cone biopsy): A laser or scalpel (“cold-knife”) removes a cone or cylinder-shaped piece of the cervix.
  • Laser therapy: A tiny beam of high-intensity light vaporizes and destroys abnormal cells.
  • Cryotherapy: A very cold probe freezes and destroys abnormal cells.

There is a wealth of information out there from the American College of Obstetricians & Gynecologists, from the Foundation for Women’s Cancer and of course, from Cervivor

As a community of cervical cancer survivors, we encourage you to stay calm, ask questions, and be diligent about your follow-up testing.  

A History of Impact, Yesterday and Today

As Black History Month (February) comes to a close, and Women’s History Month (March) begins, we thought we’d take a walk through history and share some key Black, female leaders in the field of medicine and cancer research. 

First Black, female physician in the U.S. 

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Rebecca Lee Crumpler, MD (1831 — 1895) worked as a nurse for eight years in Charlestown, Massachusetts.  Because this was in the 1850s, she was able to work without any formal training (keep in mind the first nursing school opened in 1873).  She was admitted to the New England Female Medical College in 1860.  She graduated a few short years later in 1864 becoming the first African American to graduate from the New England Female Medical College as well as the first Black woman to earn a medical degree.  When the Civil War ended in 1865, she moved to Richmond, VA and joined other black physicians to care for freed slaves who would otherwise have had no access to medical care. She worked with the Freedmen’s Bureau, as well as missionary and community groups, even though black physicians experienced intense racism working in the postwar South.

First Black licensed nurse

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Mary Eliza Mahoney (1845-1926) knew at a young age that she wanted to be a nurse.  She had early jobs at the New England Hospital for Women and Children, working as a janitor, cook, and washer women, then got the opportunity to work as a nurse’s aide. She applied and was admitted to the facility’s nursing school (one of the first in America) in 1878.  It is said that 42 applicants were admitted to the program and only four completed the 16-month program.  Mary was one of the four and would become known as the first Black licensed nurse.  She followed a career in private nursing due to the discrimination she faced as a public health nurse. She retired from nursing after dedicated 40 years, however, she didn’t stop advocating for equality. Mary was a Women’s Rights activist.  After the 19th Amendment was ratified, she became one of the first women to register to vote in Boston! 

Founder of the first hospital for African Americans in Atlanta

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Dr. Georgia Rooks Dwelle (1884 – 1977) attended Spelman College and in 1900 she became the school’s first graduate to go on to medical school. After completing her degree, she returned to her home state of Georgia and received the highest score on the Georgia State Medical Board examination that year. She became one of only three African American women physicians in Georgia at that time. When she settled in Atlanta, she witnessed first-hand the dire poverty and terrible conditions in which many of the city’s poorest Black residents lived and the lack of medical care they received. She was determined to set up a practice where conditions would be sanitary and proper services would be offered. Her initiative started with just a few rented rooms and grew into Atlanta’s first general hospital for African Americans, the Dwelle Infirmary.  She continued expanding services for the hospital and by 1935 had a well-baby clinic, a clinic for venereal disease, and a ‘Mother’s Club’ for African American women.  

First woman president of the New York Cancer Society

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Dr. Jane Cooke Wright (1919 – 2013) was the daughter of the first Black graduate of Harvard Medical School, Louis Tompkins Wright.  She graduated from New York Medical College in 1945 and was hired as a physician with the New York City Public Schools. She decided to work with her father, who was serving as the director of the Cancer Research Foundation at Harlem Hospital.  Chemotherapy was experimental at that time, and as a team they began testing anti-cancer chemicals and helping patients achieve some remission.  Following her father’s death in 1952, Dr. Jane Wright was appointed head of the Cancer Research Foundation, at the age of 33. She went on to become the director of cancer chemotherapy research at New York University Medical Center and was appointed to the President’s Commission on Heart Disease, Cancer, and Stroke by President Lyndon B. Johnson. In 1971, Dr. Wright became the first woman president of the New York Cancer Society. At a time when African American women physicians numbered only a few hundred in the entire United States, Dr. Wright was the highest ranked African American woman at a nationally recognized medical institution.

Making Impact Today

These trailblazers of the past helped pave the way for the trailblazers of today, such as:

At the forefront of COVID-19 vaccine development

Dr. Kizzmekia “Kizzy” Corbett is at the forefront of COVID-19 vaccine development. A viral immunologist at the Vaccine Research Center at the National Institute of Allergy and Infectious Diseases, National Institutes of Health, she is one of the leading scientists behind the government’s search for a vaccine. Corbett is part of a team at NIH that worked with Moderna, the pharmaceutical company that developed one of the two mRNA vaccines that has shown to be more than 90% effective. Today, together with her research Corbett is taking on another challenge: tempering vaccine hesitancy by talking about COVID-19 science in communities of colour.

Developing cancer therapies with lasers and nanoparticles

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Dr. Hadiyah-Nicole Green, age 42, is one of the first African American women in the nation to earn a Ph.D. in physics, holds the distinction of being only the second African American woman and the fourth African American to receive a Ph.D. in physics from the University of Alabama at Birmingham (UAB). Today, Dr. Green specializes in developing targeted cancer therapies using lasers and nanoparticles. Her expertise lies at the intersection of nanotechnology, immunotherapy, and precision medicine with a focus on developing a new cancer therapy platform that uses laser-activated nanoparticles to completely eliminate tumors after a single treatment. Beyond her academic work, she founded the Ora Lee Smith Cancer Research Foundation – named in memory of her late aunt who raised her. Dr. Green has intertwined her life’s work and professional focus into the mission of the organization: to change the way cancer is treated and reduce the suffering of cancer patients by providing a treatment that is accessible, affordable, and most importantly, effective. 

Applying computational modeling to cancer therapies

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Stacey D. Finley is a professor of biomedical engineering at the University of Southern California, where she leads the Computational Systems Biology Laboratory. She applies computational modeling to study  biologic processes that underlie cancer, such as angiogenesis, metabolism, and immunotherapy. The biochemical networks that regulate these processes involve numerous cell types, molecular species, and signaling pathways, and the dynamics occur on multiple timescales. Therefore, her systems biology approach, including experiment-based computational modeling, is required to understand these complex processes and their interconnectedness in cancer, her research website explains. Models can simulate biological processes, test interventions and  identify which tumors will respond favorably to a particular therapy, aiding in the development and optimization of effective therapeutics.

These are only just a few of the incredible Black, female medical pioneers we decided to highlight.  Let’s take a moment to celebrate these individuals and their impact.  Their legacies will carry on serving all of us for many years to come.