Receiving a positive pap result can be a scary experience, so I want to help you understand what it means, and what your next steps should be if you get a positive finding. I also want you to know how common it is as 75% of sexually active Canadians will have at least one HPV infection in their lifetime (1). Human Papillomavirus (HPV) is what causes cervical dysplasia, and there are many strains, some of which carry a higher risk of causing cancer compared to others.
As a starting point, it is important to make sure that you are up to date on your pap tests.
The Ontario Cancer Care guidelines recommend that women begin screening at the age of 21 if they are sexually active or if they are not sexually active at that time, they can wait and begin their screening tests when they are. From there, tests should be done every 3 years following a negative screen up until age 70, when screening is no longer necessary (2).
If a test is abnormal, it will be graded according to the type of cells detected. These may include (among others):
- abnormal cells of undetermined significance (ASC-US)
- low grade squamous intraepithelial (LSIL)
- high grade squamous intraepithelial (HSIL)
- atypical squamous or glandular cells
- squamous carcinoma and adenocarcinoma
What you need to know is that this grading indicates the degree of atypical cells detected – from simply abnormal cells to cells that have mild and high grade dysplasia to possibly cancerous cells.
Your next steps will be based on the type of cells detected.
According to the Ontario Cancer Care Cervical Screen guidelines, a ASC-US result should lead to a repeat cytology in 6 months in those under 30 years of age, and an HPV test for those over 30. If that result is positive, then a colposcopy should follow.
A colposcopy is a minimally invasive procedure where a doctor examines your cervix with a magnifying instrument, known as a colposcope. During that procedure the doctor may also take a biopsy of any suspicious looking cells to gain more information about the nature of those cells.
A finding of LSIL should lead to a repeat cytology in 6 months with any future finding resulting in a colposcopy. If any of the other cells are detected, you will likely be sent straight for a colposcopy and biopsy.
For more information on the screening guidelines, please consult the Ontario Cervical Screening Guidelines Summary.
Don’t be alarmed if you are advised to ‘watch and wait’ because this is often the recommendation when abnormal cells are discovered – watch and wait with repeat screening done at the appropriate time interval. While it can be nerve wracking to be told to wait for your next screening, we know from the research that approximately 58% of CIN1 cases (low-grade or mild dysplasia) will regress over 24 months, and approximately 2% of CIN1 cases will progress to become high grade lesions (3).
With high grade lesions (CIN 2,3), approximately 1-2% will progress to invasive cancer in 24 months (3).
While there is a high rate of regression when dysplasia is found, if you have been recommended to ‘watch and wait’, there are some things that you can do in the meantime. From a naturopathic perspective, there are evidence based treatments that have been shown to improve the regression rates of cervical dysplasia.
I always recommend working with a health care practitioner before taking any supplements to make sure you are taking the appropriate nutrients for you, in the right dose and the right form. The quality and dose of supplements certainly matters in determining how effective they are.
In terms of supplements, there are quite a few nutrients that have been shown in the research to be effective at increasing the regression rate of CIN lesions. These include folate (a B vitamin) (4), selenium (5), and vitamin D (6).
There are also a number of lifestyle changes one can consider implementing to reduce the risk of cervical cancer. We know that cervical cancer risk is increased by cigarette smoking and by a higher number of sexual partners. So if you are currently smoking, part of your treatment plan should be to quit smoking, and additionally, to always use protection when engaging in sexual activity and intercourse. While barrier contraception does not provide complete protection from HPV, it can reduce your risk of exposure.
I hope that this has provided some insight into what your pap test results mean and what the potential next steps could be for you depending upon the result of that test.
1. HPV – Sex & U [Internet]. [cited 2019 Nov 14]. Available from: https://www.sexandu.ca/stis/hpv/
2. Ontario Cervical Screening Guidelines Summary. :2.
3. Trimble CL, Piantadosi S, Gravitt P, Ronnett B, Pizer E, Elko A, et al. Spontaneous Regression of High-Grade Cervical Dysplasia: Effects of Human Papillomavirus Type and HLA Phenotype. Clin Cancer Res Off J Am Assoc Cancer Res. 2005 Jul 1;11(13):4717–23.
4. Asemi Z, Vahedpoor Z, Jamilian M, Bahmani F, Esmaillzadeh A. Effects of long-term folate supplementation on metabolic status and regression of cervical intraepithelial neoplasia: A randomized, double-blind, placebo-controlled trial. Nutr Burbank Los Angel Cty Calif. 2016 Jun;32(6):681–6.
5. Karamali M, Nourgostar S, Zamani A, Vahedpoor Z, Asemi Z. The favourable effects of long-term selenium supplementation on regression of cervical tissues and metabolic profiles of patients with cervical intraepithelial neoplasia: a randomised, double-blind, placebo-controlled trial. Br J Nutr. 2015 Dec 28;114(12):2039–45.
6. Vahedpoor Z, Jamilian M, Bahmani F, Aghadavod E, Karamali M, Kashanian M, et al. Effects of Long-Term Vitamin D Supplementation on Regression and Metabolic Status of Cervical Intraepithelial Neoplasia: a Randomized, Double-Blind, Placebo-Controlled Trial. Horm Cancer. 2017;8(1):58–67.