A Pap smear, or Papanicolaou test, is a routine screening procedure designed to examine the cells of the cervix, the lower part of the uterus that opens into the vagina. The purpose of this test is to detect abnormal cellular changes early, often before they cause symptoms. Cysts are common, non-cancerous, fluid-filled sacs that form in various gynecological locations. The question is whether the presence of a cyst can be the source of an abnormal Pap smear result. This article clarifies the relationship, distinguishing between true cellular abnormality and interference caused by a cyst.
The Purpose of Pap Smear Screening
The Pap smear is a tool used to screen for changes in cervical cells that could progress into cervical cancer. During the procedure, a healthcare provider gently collects cells from the transformation zone of the cervix, where most cellular changes begin. These collected cells are then sent to a laboratory for microscopic analysis to check for any signs of abnormal growth or morphology.
The goal is to identify precancerous cell changes, known as dysplasia or squamous intraepithelial lesions, before they become malignant. These changes are caused by persistent infection with high-risk types of the Human Papillomavirus (HPV). HPV is a common sexually transmitted virus that, if not cleared by the immune system, can cause cervical cells to develop abnormalities. An abnormal result indicates that the pathologist observed these specific cellular changes, not the presence of a mass or cyst.
How Cysts Impact Pap Smear Results
Cysts are generally benign structures, and their ability to affect a Pap smear depends entirely on their location. Cysts located far from the cervix, such as ovarian cysts, are physically separate from the collected cells. Ovarian cysts do not directly impact the results, as the test focuses exclusively on the cervical lining. The cysts themselves are not the source of cellular abnormality.
The scenario changes with cysts that are located directly on the cervix, such as Nabothian cysts. These are common, harmless bumps that form when the skin cells on the cervix block the glands that secrete mucus. While Nabothian cysts are not precancerous and do not cause the dysplasia detected by the Pap smear, their physical presence can occasionally interfere with the test. If a cyst is particularly large or multiple cysts are present, they may obscure the view of the cervix or make it difficult for the provider to gather an adequate cell sample.
The collection process can sometimes cause a Nabothian cyst to break open, releasing mucus and cellular debris onto the sample. This material can sometimes be mistaken by the pathologist for other signs, which may lead to a false positive or an ambiguous result requiring a retest. This difficulty is a technical issue related to sample adequacy, not an indication that the cyst has caused a true precancerous change. In these cases of interference, the result is often categorized as “unsatisfactory” or “atypical squamous cells of undetermined significance” (ASC-US), prompting a recommendation for a repeat test or further evaluation.
Understanding True Cellular Abnormalities
Since cysts are almost never the underlying cause of a true abnormal Pap smear, the focus should be on the conditions that actually lead to cellular changes flagged by the test. Most abnormal results are linked to HPV infection, which causes precancerous changes graded by severity. Low-grade squamous intraepithelial lesions (LSIL) are mild abnormalities that often resolve on their own. High-grade lesions (HSIL) are more severely abnormal and carry a higher risk of progressing to cancer if left untreated.
Temporary conditions that induce inflammation in the cervix can also cause a mildly abnormal Pap result. Infections such as yeast infections, bacterial vaginosis, or other sexually transmitted infections can cause cervical cells to appear reactive or atypical to the pathologist. This inflammation, known as cervicitis, can mimic minor abnormality, sometimes resulting in an atypical reading.
Hormonal shifts, such as those during menopause or pregnancy, can also lead to benign cellular changes noted on the Pap smear. These non-cancerous changes are often referred to as “reactive cellular changes” or “inflammatory atypia.” Follow-up typically focuses on treating the underlying infection or monitoring the temporary changes rather than treating a persistent precancerous lesion.