Pregnancy can be an overwhelming time in a woman’s life and the presence of an abnormal Pap smear can turn overwhelming into distressing. A Pap test (or Pap smear) is a screening tool used by health care providers (HCPs) to detect cervical cell abnormalities and cervical cancer. During a Pap test, your HCP takes a sample of the surface cells on your cervix with a small brush used for cell collection. The cell sample is sent to a specialized lab for evaluation and your HCP will share the test results with you.
How common is cervical cancer?
Cervical cancer used to be one of the leading causes of cancer death in the US. But over the past 30 years, there has been a 50% reduction in cervical cancer deaths attributed to the use of routine Pap tests. However, almost 13,000 new cases of invasive cervical cancer and 4,000 deaths are projected to occur in 2015, so testing continues to be very important. Regular screening exams with Pap tests decreases the risk of developing cervical cancer by finding cellular changes early and treating them.
What causes cervical cancer?
The most common cause of cervical cancer is the human papillomavirus (HPV). It is important to know that few diagnosed cases of HPV will progress to cervical cancer when they are found early by Pap testing. Precancerous cervical changes caused by HPV are more commonly diagnosed and much easier to treat than cervical cancer itself.
What if my test results are abnormal?
Results of your Pap test can be normal or can range from a few, mildly irregular cells to many highly abnormal cell changes. Abnormal cervical changes will not progress simply because you are pregnant, nor will the abnormal cells or the presence of HPV have a negative effect on the outcome of your pregnancy. During pregnancy, abnormal pap smear findings can be safely evaluated with a colposcopy and, if needed, a biopsy. Your HCP will take a close look at your cervix through a colposcope which magnifies the cells on your cervix and vagina. If there are any visibly abnormal areas, a biopsy (where a small piece of the abnormal area is removed) may be warranted. Because pregnancy increases the amount of blood flow to the cervix after the first trimester, a biopsy may increase the risk of bleeding. However, the biopsy itself is generally considered safe and should not cause any pregnancy complications. In some cases of suspicious cellular changes, a cone biopsy (removal of a cone-shaped piece of your cervix) may be necessary to determine if cancer is present.
Most minor cellular changes will normalize following the birth of your baby. In the presence of moderate to severe cellular changes, follow-up pap smears and colposcopies may be performed until delivery. Many times, treatment can be delayed until after the birth of your baby.
What if it is cervical cancer?
The most concerning Pap test or colposcopy finding during pregnancy is, of course, invasive cervical cancer. Diagnosis of cervical cancer during pregnancy is pretty rare, occurring in about 1 in every 10,000 pregnancies. If cervical cancer is diagnosed during pregnancy, treatment will depend on several factors including the stage of cancer and the stage of the pregnancy when it is diagnosed. Cervical cancer can compromise the pregnancy and can spread to other sites in the body so treatment is important. This is a difficult condition to manage during pregnancy, both physically and psychologically. You will be referred to cancer specialists and counselors with experience treating pregnant women.
If you have any questions about your Pap test results or follow-up, speak with your health care provider for more insight into your personal plan of care.