The Papanicolaou test, commonly known as a Pap smear, screens for cellular changes on the cervix that may indicate precancerous or cancerous conditions. An abnormal result means cells collected from the cervix appear atypical, requiring further investigation. Polyps are common, typically benign tissue overgrowths found in the cervical canal or uterus. While polyps are non-cancerous, their presence can indirectly complicate the interpretation of the test results.
What Are Cervical and Endometrial Polyps
Polyps are tissue growths protruding from a mucous membrane, usually attached by a small stalk. They are formed by an overgrowth of cells and are generally non-cancerous. In the female reproductive tract, they are classified by location.
Cervical polyps originate from the epithelial cells of the cervix and are often visible during a pelvic exam. They are common, particularly in women over 20 who have had children, and their formation may be linked to chronic inflammation or hormonal influences. Endometrial polyps, in contrast, grow from the endometrium, the lining inside the main body of the uterus.
Endometrial growths are located inside the uterine cavity, making them less likely to be directly involved in the cervical Pap test collection process. Both types can cause irregular vaginal bleeding or spotting, but many polyps remain asymptomatic and are discovered during routine examinations. The vast majority of both cervical and endometrial polyps are benign, with only a small percentage (1% to 3%) having the potential to become malignant.
What the Pap Test Detects
The Pap test screens for precancerous changes and cancer in the cervix by collecting and examining cells under a microscope. It is designed to identify abnormal cell morphology, or dysplasia, often caused by persistent infection with high-risk human papillomavirus (HPV).
The pathologist examines the collected cells for alterations signaling progression toward cervical intraepithelial neoplasia (CIN) or squamous intraepithelial lesions (SIL). This screening focuses on cellular abnormality, not physical masses like polyps or fibroids. An abnormal result indicates atypical cell structure but does not specify the underlying cause, which could range from HPV to infection or inflammation.
The test’s main strength is catching cellular changes before they develop into invasive cancer. Because cervical cancer develops slowly over many years, detecting these early, precancerous changes is the purpose of regular screening. The Pap test is a cytological screening tool, not a diagnostic tool for mass lesions.
How Polyps Affect Pap Smear Results
Polyps are not the precancerous lesions the Pap test seeks, but their presence can lead to an abnormal or inconclusive result. Polyps do not directly cause HPV-associated dysplasia, but they can create conditions that mimic or obscure true cellular abnormalities. This indirect interference is a primary reason why a benign growth can complicate a cervical screening.
One way polyps interfere is by causing local inflammation or infection, which triggers reactive changes in surrounding cervical cells. These changes may lead to a classification of Atypical Squamous Cells of Undetermined Significance (ASC-US), the most common abnormal Pap finding. ASC-US indicates slightly abnormal cells where the cause is not definitively clear and is often unrelated to cancer.
Because polyps are fragile, they can bleed easily, especially when touched during sample collection. Blood, mucus, or excessive discharge can obscure the necessary cervical cells on the slide, making accurate analysis difficult. If the sample quality is compromised, the result may be classified as “Unsatisfactory,” requiring the patient to return for a repeat test.
In rare instances, a large polyp may hide a separate, underlying precancerous lesion or cancer on the cervix. Although the polyp is benign, its bulk prevents the collection instrument from adequately sampling the area where the true abnormality is located. Therefore, an abnormal Pap result in the presence of a polyp requires careful consideration to determine the actual source of the cellular finding.
Next Steps After Detection
When a Pap smear is abnormal and polyps are present or suspected, the next step is determining the exact cause of the atypical cells. The most common follow-up is a colposcopy, a diagnostic procedure that allows a magnified view of the cervix. During the colposcopy, a mild solution is applied to highlight abnormal areas, and a small tissue sample (biopsy) may be taken for definitive analysis.
If a cervical polyp is visible, a healthcare provider may perform a polypectomy, removing the polyp, often in the office using specialized forceps. The removed polyp is sent to a lab for histopathological evaluation to confirm it is benign. Removing the polyp can resolve associated issues like bleeding and inflammation that contributed to the abnormal Pap result, allowing for clearer follow-up screening.
An abnormal Pap smear in this context frequently does not indicate cancer, as polyps are overwhelmingly benign. The goal of the follow-up is to rule out a true precancerous condition and ensure the abnormal cellular findings are merely reactive changes caused by the benign polyp. The appropriate follow-up plan depends on the specific classification of the abnormal cells and whether an HPV infection is detected.