What Happens if My Pap Smear Is Abnormal?

You may hear it called either a Pap smear or a Pap test, but they both mean the same thing: a test that looks for changes in the cells of the cervix, the narrow end of the uterus that forms a passage between the uterus and vagina.

A Pap smear can detect changes in the cervix before cancer develops.

What do your results mean?

You will receive the results from your Pap smear within a few weeks. In most cases, the results will be normal. However, results can come back as normal, unclear or abnormal.

Normal

If your Pap smear results are normal, then there is no evidence of any abnormal cells in your cervix. In this case, you don’t need to do anything aside from schedule your next Pap test.

Unclear

A test can be unclear or inconclusive as a result of many different factors. For example, there might not have been enough cells in the sample tested and that led to undefined results. An unclear result does not mean that anything is wrong and is certainly no reason to panic. In the short term, it simply means that the test might need to be repeated.

Results sometimes might state the presence of “atypical squamous cells of undetermined significance” (abbreviated to ASCUS or ASC-US). In a healthy cervix, thin, flat cells called squamous cells grow on the surface. If these cells do not look typical, they are called ASCUS. If ASCUS are present, your medical practitioner will do another test to see if human papillomavirus (HPV) is present.

If your Pap test results are unclear, your doctor may schedule a repeat Pap test in six to 12 months. This is usually nothing to worry about, and your medical practitioner will tell you all about the next stages: In some cases, that might be a colposcopy to look at the cervix in more detail. More information about a colposcopy can be found below.

Abnormal

An abnormal test result means that cell changes have been found on your cervix. This does not mean that you have cervical cancer. Abnormal cell changes can be caused by HPV and may be minor or serious. Minor changes often resolve on their own with no treatment. However, more severe changes could develop into cancer if left untreated.

Depending on the type of change, you might need further tests to determine whether you need any treatment. Some types of abnormal changes you might hear about include:

• Minor changes, also known as low-grade squamous intraepithelial lesion (LSIL). These are borderline changes, often due to HPV, that usually resolve over time. If you have minor changes and have not had an HPV test, your doctor will order one. If HPV is not present, the changes will usually resolve independently, and no further treatment is needed. However, you may be asked to have your next Pap smear sooner than normally scheduled. If HPV is present, there is a chance that the changes will not improve.
• Atypical squamous cells, but cannot exclude HSIL (ASC-H). Sometimes the atypical cells seen in an unclear result are concerning and suggest, but do not confirm, that high-grade squamous intraepithelial lesion (HSIL) cells are present.
• Moderate to severe changes, also known as HSIL. These types of changes are more likely to be associated with precancer or cancer.
• Atypical glandular cells (AGC). These are changes in a type of cell that lines the cervical canal. Changes in these glandular cells raise concern that precancer or cancer is present.
• Squamous cell cancer or adenocarcinoma cells. In very rare cases, the cells may be so abnormal that it could be a sign of very early cervical cancer.

In all five cases listed here, your medical practitioner will recommend that you have a colposcopy to look at the cervix in more detail. Sometimes, an endometrial biopsy (EMB), taking a sample of the lining of the uterus, may be performed at the same time.

If your results are abnormal, what’s next?

If it’s confirmed that you have abnormal results, you will often need to undergo further tests. In mild cases, this might just be an HPV test or a repeat Pap smear. However, depending on the type of abnormal results, you may be asked to have a colposcopy.

A colposcopy uses a type of microscope called a colposcope to look at your cervix in more detail. At the beginning of the colposcopy, your medical practitioner will insert a speculum into your vagina to open up the walls of the vagina. While looking at your cervix with the colposcope, the doctor uses a liquid to help differentiate normal areas from abnormal ones.

If the doctor sees abnormal areas, he or she will conduct a biopsy to remove a small sample of tissue. This may feel like a mild pinch but is really nothing to worry about. The biopsy sample will be sent to a laboratory for further testing, and you will receive the results in a few weeks. Your doctor will advise you if you need any treatment or not.

A colposcopy takes about 20 to 30 minutes. Just like with the Pap smear, you may want to bring a sanitary pad to protect your underwear in case you experience some spotting afterward.

What happens afterward?

A colposcopy or biopsy may identify that no further treatment is required, in which case, you will return to your regular schedule of having Pap smears as recommended.

In the case that treatment is required, there are several options, such as cryosurgery, a cold knife cone biopsy, or a loop electrosurgical excision procedure (LEEP) to excise the abnormal cells. Your doctor will talk through each surgical intervention with you in detail. Removing abnormal cells is a preventive measure and can stop cervical cancer from developing.

If your biopsy confirms cancer cells are present, your doctor will refer you to a specialist, and treatment moving forward will depend on various factors such as the stage the cancer has reached.

An early warning

In most cases, Pap smear results are normal or don’t indicate treatment is required. Even if treatment is needed, it is often preventive and solves the issues before cancer can develop. And in cases where cancer is already present, a Pap smear can help your doctor identify the abnormal cells and catch it early, making your condition more treatable and curable.

Make sure you schedule regular Pap smears as recommended by your doctor, so any issues can be identified and treated as early as possible.