Kim, 34, received concerning Pap smear results at age 30. She shares her firsthand experience with Santé.
Annoying yet essential—that's how my friends who turned 30 first described the cervical cancer screening Pap smear. At 29, I anticipated the RIVM invitation letter arriving soon after my birthday. Spreading your legs in stirrups felt embarrassing, but I was committed to participating to prevent cervical cancer.
Each year, about 700 women in the Netherlands are diagnosed with cervical cancer. Without screening, RIVM estimates 1,300 cases annually. It's the most common cancer in women aged 35-45. Detecting abnormal cells early is crucial, I reasoned. I ended up getting my first Pap smear before my birthday—my GP spotted an issue months earlier.
I'd been experiencing intermenstrual bleeding, prompting a referral to a gynecologist for biopsies. Results: Pap 3b (severe cell abnormalities) and HPV positive—the human papillomavirus linked to cervical cancer.
I wasn't overly worried. No cancer diagnosis meant I was caught early, I thought. HPV is common—80% of sexually active people contract it asymptomatically, and most clear it naturally. I underwent outpatient treatment to burn away affected tissue, fixating more on the position than my health. Follow-ups showed improvement: Pap scores normalized, and HPV cleared. Crisis averted? Not quite.
If you've had an abnormal Pap, you're not alone. 'Thousands of women face this yearly,' says Jacqueline Louwers, MD, gynecologist at Diakonessenhuis in Utrecht. Pap classifications (named for inventor George Papanicolaou) range from 1 (normal) to 5 (most abnormal).
Pap 3 requires treatment in about half of cases; higher scores nearly always do. The score indicates issues but not severity. 'A biopsy clarifies,' Louwers explains. 'Theoretically, Pap 2 could signal cancer, though rare; Pap 4 might be benign, but unlikely.'
Biopsies grade via CIN (cervical intraepithelial neoplasia):
For Wendy, 30, one treatment wasn't enough—residual abnormal cells required follow-up. Her initial Pap 3b and HPV result hit hard: 'The letter said "precancerous," but I fixated on "cancer." I sobbed to my husband, mom, and told Dad I didn't want to die. If it's Pap 3b again, I'll demand removal. Otherwise, maybe a hysterectomy. I can't relive this.'
Louwers notes two-step treatments are common, but most normalize after one. Loop excision causes short-term bleeding but no major health effects—though it slightly raises preterm birth risk, especially if deeper or repeated. 'Risks are low; extra prenatal checks are often unnecessary.'
An abnormal result doesn't preclude pregnancy. Michelle, 32, learned this at 24 during infertility testing: Pap 3a at 7 weeks pregnant. 'Terrifying colposcopy sounds aside, my pregnancy thrived. Postpartum checks led to Pap 3b treatment. Clear for 4 years now.'
Most abnormalities are precancerous, potentially progressing over 10-15 years if HPV persists. Early detection via screening is key—symptoms like intermenstrual or postcoital bleeding are rare. HPV vaccination at age 13 protects against two high-risk strains causing 70% of cases. Unvaccinated, transmission is sexual.
'HPV isn't an STI per se but spreads sexually,' Louwers says. 'No sexual activity, no risk—for most, that's not realistic.'
Why some clear HPV fast and others don't is unclear. Immunosuppressants (e.g., for Crohn's or AIDS) hinder clearance, raising cancer risk. Smoking delays it—quitting helps.
The takeaway: Respond promptly to screening invitations. Abnormal results usually mean early intervention. I'll approach my next at 35 with optimism, embarrassment aside, for another 5-year reprieve.
Since 1996, Dutch women 30-60 receive free RIVM invitations for cervical screening via swab (GP or self-test). Since 2017, HPV tests first; cell checks if positive. Invitations every 5 years, but HPV-negative women 40s/50s wait 10. HPV+ at 65 get one more at 70.
Source: Santé April 2019, text: Kim van der Meulen. Images: Getty Images
