Getting an abnormal Pap test (or Pap smear) result can cause concern. It’s easy for the word abnormal to make your mind jump to worst-case scenarios.
While your first thought may be about cancer, Robin Lacour, MD, a gynecologic oncologist with Banner MD Anderson Cancer Center, explains that a Pap test is just a screening tool and the results could mean many things.
“Millions of people have abnormal Pap tests each year, but less than 1% of these tests are associated with cervical cancer,” Dr. Lacour said. “Abnormal results just mean that additional testing needs to be done.”
While it’s natural to feel worried, an abnormal Pap test is simply the first step in understanding more about your health.
Read on to learn what Pap tests are, what abnormal results mean, and what to expect next.
What does an abnormal Pap test mean?
A Papanicolaou test (Pap test for short) looks for changes in the cells of your cervix, the lower part of the uterus that opens into the vagina.
These changes could be caused by:
HPV (human papillomavirus)
HPV is one of the most common causes of abnormal Pap test results. HPV is a virus that can infect the cervix and nearly everyone who is sexually active will get it at some point. There are more than 100 types of HPV.
HPV often doesn’t cause any symptoms, so you may not even know you’ve been infected. Most HPV infections go away on their own within a year or two. The good news is that there’s now a way to help prevent some of the most dangerous strains of HPV: the HPV vaccine.
“HPV vaccines stimulate the body to produce antibodies that, in future encounters with certain strains of HPV, bind to the virus and prevent it from infecting cells,” Dr. Lacour said. “Reducing HPV infections of our cells reduces occurrences of HPV-related cancers, including cervical cancer.”
Infections
Some infections, including yeast, bacterial and sexually transmitted infections, can cause changes in cervical cells that show up as abnormal on a Pap test. These changes are often not related to cancer but you may need medication to treat the infection.
Inflammation
Irritation from things like sex, tampons or douches can affect test results. You may be asked to avoid sex for two days before the test. You should also avoid tampons, douching or vaginal creams.
Precancerous cells or cancer
In rare cases, abnormal cells may be precancerous, meaning they could eventually develop into cancer if not treated. The good news is that most precancerous cells can be removed or treated before they turn into cancer.
While this is also less common, some abnormal cells may indicate early signs of cervical cancer.
Types of abnormal Pap test results
If your Pap test comes back abnormal, your health care provider will give you information on the type of abnormality. These include:
- ASC-US (atypical squamous cells of undetermined significance) is the most common abnormal result. ASC-US almost always indicates an HPV infection.
- SIL (squamous intraepithelial lesion) is an abnormal change that may signal precancer. Depending on the severity, it can be either LSIL (low-grade squamous intraepithelial lesion) or HSIL (high-grade squamous intraepithelial lesion). LSIL usually clears up on its own but HSIL may progress to cancer if left untreated.
- AGC (atypical glandular cells) is a less common result. It indicates cell changes that suggest precancer of the upper part of the uterus or cervix.
What should I do if I get an abnormal Pap test?
Getting an abnormal result doesn’t always mean you need treatment right away. Your health care provider will work with you to determine what further testing is needed and what next steps to take.
Here’s what to expect:
- HPV test: You may have an HPV test if it wasn’t performed along with your Pap test and your results came back abnormal.
- Follow-up Pap tests: If your results show minor changes, your provider might recommend monitoring the situation with regular Pap tests over time.
- Colposcopy: If further investigation is needed, your provider might use a special tool called a colposcope to get a closer look at your cervix. “The colposcope is a microscope that allows us to see abnormal cells up close,” Dr. Lacour said. “This can be done by applying a vinegar-like solution to the surface of the cervix, which turns abnormal areas white.”
- Cervical biopsy: If your provider sees anything concerning during the colposcopy, they may take a small tissue sample (biopsy) for further testing. You may feel a tiny pinch but nothing more.
What if my biopsy results show precancerous or cancerous changes?
If the biopsy confirms precancerous changes, your health care provider will discuss treatment options.
Low-grade lesions often don’t require immediate treatment and may improve on their own. In these cases, your provider may recommend monitoring the area with follow-up Pap tests every six months.
If the changes are moderate to severe, treatment is needed to prevent cancer. Common procedures include:
- LEEP (loop electrosurgical excision procedure): Removes abnormal tissue using a thin wire loop with an electrical current.
- Cryotherapy: Freezes and destroys abnormal cells.
- Laser therapy: Uses a laser to target and eliminate abnormal cells.
“Sometimes freezing (or cryotherapy) and lasering of the cervix are offered but if it’s a high-grade lesion, LEEP or cone biopsy are the most effective because they remove deeper layers of abnormal tissue,” Dr. Lacour said.
What to expect after treatment
Most procedures for removing abnormal cells are quick and involve minimal recovery time. After a LEEP or similar treatment, you might experience mild cramping, spotting or temporary discharge.
Your health care provider may recommend avoiding exercise, sexual activity and tampons for a few weeks to allow your cervix to heal.
The importance of regular screening
“My best advice regarding Pap tests is to stay on the schedule for screening as recommended by your health care provider,” Dr. Lacour said. “This is the best way to catch abnormal cells early before they become cancer.”
These visits include pelvic exams, which allow your provider to check for other health concerns, such as ovarian cysts, uterine fibroids or signs of infection.
According to the Centers for Disease Control and Prevention (CDC), pap tests are recommended for anyone with a cervix, usually starting at age 21. After that, the schedule depends on your age and health history:
- Ages 21 to 29: Pap test every three years.
- Ages 30 to 65: Pap test every three years or a Pap test and HPV test together every five years.
- Over 65: You may not need Pap tests anymore if your past results have been normal.
Your provider might recommend more frequent testing if you’ve had abnormal results or other risk factors. Learn more about other important screenings for every phase of life.
Takeaway
A call about abnormal Pap test results can cause concern but it’s often just a precautionary step. Thanks to regular screenings and advances in medical care, cervical cancer is one of the most preventable cancers.
Stay proactive by scheduling your well visits, asking your provider about the HPV vaccine and following up on abnormal results.
