Cancer Gone Viral: Understanding 'abnormal' Pap Smear results
HPV Human Papillomavirus Cervical Cancer

Cancer Gone Viral: Understanding 'abnormal' Pap Smear results

Dr. Talia Henkle
Dr. Talia Henkle

In 10 seconds? Doctors perform a test called the Pap smear to detect pre-cancerous cells induced by Human Papillomavirus (AKA HPV), which is a virus that can cause cervical cancer (among others). In Part 2 of our "Cancer Gone Viral" series. We are talking about the life-saving procedure that can help prevent cervical cancer.

OK, life-saving procedure sounds great. It is great! But it can also rouse up sensitive issues. Why? Well, if you are a woman who’s attended a cervical cancer screening, chances are you’ve gotten a phone call from your doctor indicating you had an ‘abnormal Pap smear’. Cue instant anxiety for yourself and maybe a partner, since HPV is a sexually transmitted infection. But really, no need to worry. Probability is on your side!

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OK, but last time I checked, a sexually transmitted infection was not good news… In this case, that might be the stigma talking. A huge percentage of the population will contract HPV in their lifetime, and the vast majority never exhibit any symptoms. And half of the population won’t even know, since men are not screened for HPV. While no one wants to have HPV, there’s a 80-90% chance that the infection will disappear within a year and you will be none the wiser.

So, this is one of those infections we live with. OK but what about those people whose infections don’t go away in a year? First off, the highest probability is that the infection will go away without causing problems. Secondly, if you are vaccinated against HPV (a topic we’ll delve into more in future digests) your chances of any harm befalling you are slashed even further. However, over the years, a minority of patients’ infections will change to become ‘pre-cancerous lesions’. This is where doctors might start to offer treatment options to prevent cancer from forming. Remember, with cancer, early detection is key for survival, and this is how Pap smears can help save patient lives.

The female reproductive organs. (Left) Vagina, cervix, uterus, Fallopian tubes, and ovaries. (Right)Arrow pointing to the cervix, from where cells are examined for HPV screening. 

What exactly is a Pap smear? The Pap smear, pioneered by George Papanicolaou in 1928, is a simple test where some cells from the cervix (the opening to the uterus at the top of the vagina) are lightly brushed off and then examined under a microscope (yes, I know… this flowery description doesn’t really cover the discomfort of the procedure – fortunately, it only lasts a moment!). When HPV infects cells, it changes their natural shape. So doctors then examine the cells for any features that may indicate that they might be infected or are turning cancerous.

Ahhh yes. The dreaded ‘abnormal cell’ phone call, right. You got it. Of course, since 1928, our technology has advanced substantially, and since multiple factors can make cervical cells look funky (like our hormones), doctors will submit ‘abnormal’ samples to a DNA test to check to see if your cells are actually infected with HPV. If so, they’ll let you know (with a cryptic and anxiety-inducing phone call) and recommend you return for another Pap smear in a year to check to see if the infection has gone away (80-90% chance it will!).

OK. But I want to have kids. Will having an HPV infection impact my fertility? Deep breath. A typical cervical HPV infection won’t impact your fertility. If you are one of the rare cases that develops a pre-cancerous cervical lesion on your cervix from your infection, some of the treatments that remove the dangerous cells can increase the likelihood you may have a pre-term delivery. Of course, at this point, you will likely have been working with your doctor for years, in which case you will be able to consult them about potential pregnancy concerns before undergoing treatment. If you really want to slash your chances of getting cancer or precancerous lesions, make sure you’re vaccinated against HPV! Stay tuned for future Cancer Gone Viral digests for more information!

Why don’t they test men for HPV?

Men can be tested for HPV by sloughing off cells from the tip of their penis and doing a DNA test for HPV the same way they do for women. But no typical health clinic will perform this test on men.

Why? Medically, it has been determined that there is no need to test men. First off, due to biological features, penile cancer caused by HPV is much rarer than cervical cancer. Secondly, the male reproductive anatomy, unlike the female's, lends itself to easy examination, so they would know if anything started to look funky–hence negating the need for screening (although, that being said, penile cancer doesn't progress through the same pre-cancerous stages as it does for cervical cancer).

Meanwhile, 100% of cervical HPV infections in women are caused by unwitting men with HPV…

Luckily, HPV vaccination is FDA-approved for men up to 45 years of age! The HPV vaccination not only can help reduce the chances of a man passing along HPV to their partner, but it also will prevent genital warts and other types of HPV-associated cancers that are more prevalent in men (particularly head and neck cancer).

Dr. Talia Henkle has distilled 4 research papers saving you 14 hours of reading time.

The Science Integrity Check of this 3-min Science Digest was performed by Flávia Oliveira Geraldes.

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