Non-scary reasons to get called back after a pap smear
May 31, 2019 4:31 AM   Subscribe

A young friend got her first pap smear recently. Today she got a letter that says the doctor wants to see her in a couple of weeks but not why. She is freaking out. Hive mind, I would like to reassure her. As an Old with a vagina, I have been called back several times for wonky-looking cells that turned out to be benign. Can you help me come up with non-scary reasons that they might want to see her again?
posted by Bella Donna to Health & Fitness (21 answers total)
The vast majority of people that they call back do not have a serious problem.

Some people are called back because they did not get a sample that's good enough.

Some people are called back because of an abnormality. This happens to about 1 in 20 women. And of those 99 out of 100 do not have cervical cancer. Women under 25 are particularly likely to show 'abnormalities' that are not going to turn into cancer.

Actual cervical cancer is relatively rare (it's about as frequent as throat cancer). It's just that a pap smear is a (somewhat blunt) tool for helping prevent it happening at all. So, the downside of screening is that a lot of women get called back (and get treatment) for things that were never going to turn into cervical cancer with all the anxiety that involves, including the belief that they nearly had cancer. The upside is that it's possible to prevent people dying of cervical cancer.

None of this may be particularly reassuring to your friend.
posted by plonkee at 4:47 AM on May 31, 2019 [14 favorites]

Don't speculate. She can simply call the office and ask why the appointment was requested. Yes, she's happy to wait on hold for the nurse.

She'll have a real answer within 10 minutes max, and then you can help her react to real information.

Also, as an old it is a kindness for you to encourage your young friend to take an active role in her healthcare. This is her body and she has a right to know things about it. She can call her doctor!
posted by phunniemee at 4:48 AM on May 31, 2019 [48 favorites]

Yes, ask. My thought was to recheck on a fibroid, or cyst on an ovary. Both are common and don't have to be alarming.
posted by agregoli at 5:18 AM on May 31, 2019 [1 favorite]

Yes, call. And I'm not sure what's typical in your area but I would find the policy of sending a letter saying "come back" with no additional information to be...almost reason to find a new doctor (although I'd discuss this with them first.) It's not good communication. What's going on with your body shouldn't be a secret from you.
posted by needs more cowbell at 5:25 AM on May 31, 2019 [16 favorites]

Many many many of us have been called back to check on an anomalous cell, and as plonkee says it is precautionary and the vast majority of them resolve without further concern. I wish I had known this when it first happened to me and I consumed my imagination fulltime imagining the worst. It is incredibly common. However I agree that the easiest thing to do is call and ask the reason. It may not allay all concern but your friend may appreciate the knowledge that large numbers of people have been through exactly this with no further concern. It's preventive care.
posted by Miko at 5:25 AM on May 31, 2019 [1 favorite]

There was a five-year period where I did not have a single normal Pap result. Every time they called me back in to do an HPV test and etc. and every single time it was fine.
posted by goodbyewaffles at 5:27 AM on May 31, 2019 [2 favorites]

I once got called back because they put the wrong stickers (someone else's) on my sample.
posted by Hypatia at 5:45 AM on May 31, 2019

When I was 20 I got a call to say I had to come back to be retested and no I couldn't make an appointment another time, they wanted to see me right now.

It turned out that the first sample had gotten contaminated somehow and so gave weird results. The follow up was absolutely fine.
posted by kitten magic at 5:54 AM on May 31, 2019

My doctor says they do not recommend Pap smears under the age of 23, because young women’s results are so frequently weird for no reason.
posted by Malla at 5:57 AM on May 31, 2019 [1 favorite]

And I'm not sure what's typical in your area but I would find the policy of sending a letter saying "come back" with no additional information to be...almost reason to find a new doctor (although I'd discuss this with them first.) It's not good communication. What's going on with your body shouldn't be a secret from you.

Confidentiality risk to send anything more detailed. We don't know who's reading your mail.
posted by chiquitita at 6:12 AM on May 31, 2019 [11 favorites]

In addition to the above responses, they may call you back if they detect a yeast or bacterial infection from the swabs they take, so they can give you some pills to treat it (not sure if this is a routine practice everywhere - from what I understand it's separate from the pap itself but done at the same time).

Also, even if the call-back is due to abnormal results and even if those are confirmed to be caused by "suspicious" cells, they will usually just make an appointment to remove the cells and that's the end of it. That's kinda the point of paps, to catch those and remove them before it turns into actual cancer. That might not be helpful to mention to someone freaking out until she actually gets to the suspicious cells point, though, since that's already quite rare.
posted by randomnity at 6:17 AM on May 31, 2019

I once has to retest because the sample had been taken too closely in relation to my cycle and blood had contaminated the smear. Innocuous reason and everything was fine.
posted by rdnnyc at 7:13 AM on May 31, 2019 [1 favorite]

I had years of abnormal pap results and to be honest, in my case, it turned out to be endometrial hyperplasia. This is fairly common, it’s the thickening of the lining of the uterus and it increases the risk of uterine cancer (there are different classifications and risk factors, thankfully mine is only a very small elevated risk of progressing to cancer).

Anyway, my point in this comment isn’t to actually tell you to make your friend worried. It’s the opposite. In all the research I did for this and now under the care of a truly caring doctor, I found that reproductive cancers tend to progress slowly. IF, in the highly unlikely event she’s being called back for anything other than “we didn’t get the sample the first time” it’s extremely likely she’s being diagnosed with something slow-moving and highly treatable. Even now that I know I have increased risk for cancer and have gotten an IUD, not the biggest inconvenience in terms of treatment, my doctor is like “let’s follow-up in six months, no, no need to rush in for a biopsy any sooner.”

But like everyone says this is super likely to be something like an inconclusive result for some reason. But I would take the lesson mentioned above about calling the doctor’s office back and getting answers as the most important advice in this thread. Women’s healthcare is often filled with gaslighting and confusion. It’s good to find out now if her doctor is going to operate like that or treat her like a competent partner in her own care.
posted by the thorn bushes have roses at 8:08 AM on May 31, 2019

My clinics office has this policy where the office staff aren't allowed to say anything at all basically and usually the doctor won't call you. It sucks, but I've learned to live with it. If she really doesn't want to wait, it might be possible to get a copy of the actual test results.

When I've done paps, they've often tested for yeast and BV, and some STIs at the same time. It could be one of those - I've had positive BV and yeast results without symptoms.
posted by lookoutbelow at 8:12 AM on May 31, 2019

You didn't say where your friend was located, but in many parts of Canada, for example, it's normal for a doctor to call you back in for a followup appointment even if it's perfectly good news, or no news.

They get paid per visit :-)
posted by MiG at 8:48 AM on May 31, 2019

She has a LETTER to come back in a few WEEKS. If the doc’s office is on this timeline, yes, call. If it was truly anything anxiety-provoking for them, THEY would call the patient, stat.

This sounds like a double check. Ideally someone on the other end of the phone can give her rationale as we hear about cancer WAY TOO OFTEN, and not enough about other wonkiness or outcomes that are part of self-care.
posted by childofTethys at 8:55 AM on May 31, 2019 [1 favorite]

Yeah I agree with childofTethys, if this were something important she'd have gotten a phone call and a tighter timeline. This is a no big deal followup of some kind - she'd get a faster followup if she had a yeast infection, let alone cancer.
posted by bile and syntax at 9:09 AM on May 31, 2019

Add me to the list that had an abnormal pap, a follow up colposcopy, and then all cleared and back to normal paps since then. This is a standard cervix-owner experience and yes, it’s scary but no need to worry yet!
posted by amaire at 11:24 AM on May 31, 2019

I got a (terrifying) letter (!?!?!) like this once, and they didn’t get a good sample, so they did another PAP, and I was fine. I wish I could have the two weeks of my life back between the letter and the appointment - another vote for call. (And tell them to stop sending scary letters, how is this still a thing?)
posted by zibra at 1:18 PM on May 31, 2019 [1 favorite]

I've been asked back because of blood contamination (too close to my cycle) and also because of a very minor yeast infection that contaminated the sample. Those were "come back in a few weeks" letters. When I had abnormal cells, it was a phone call and "make an appointment at your earliest availability"
posted by assenav at 1:22 PM on May 31, 2019

Thank you for all the helpful answers, especially this from plonkee: Women under 25 are particularly likely to show 'abnormalities' that are not going to turn into cancer.

In fact, the letter my friend got explained that there were some abnormalities and that, it turns out, was the part freaking her out but another friend who is in med school explained what plonkee said about how common this is. So many thanks to all for sharing your experience and experiences. Am adding this note for any future reader to note that my friend's follow up was fine, and this is a common thing that can be serious but rarely is.
posted by Bella Donna at 6:24 AM on July 1, 2019

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