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What if my Pap Smear Comes Back Abnormal?

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A pap smear screens for abnormalities of the cervix, including cancer and pre-cancer. While abnormal results do not automatically mean that you have cancer, they put the doctor on notice that he or she should do further tests to determine the cause of the abnormal cells.

HPV and Cancer

The human papilloma virus (HPV) infection is most common in people in their teens and early 20s, but individuals can be affected at any age. Most women and men will be infected with at least one type of HPV at some point in their lives. It is estimated that 79 million Americans are currently infected with HPV and that 14 million new infections occur each year in the United States.

High-risk HPV can result in pre-cancers and cancers, while low-risk HPV can cause warts, laryngeal papillomas, and low-grade cervical disease. Each year in the United States, an estimated 26,000 new cancers are caused by HPV and the rates are increasing. Cervical cancer is the most common HPV-associated cancer among women.

An Abnormal Pap Smear Does not Mean Cancer

Over 12,000 women are diagnosed each year with cervical cancer, but the disease is slow-growing, and it may take years for abnormal cells to change from normal to cancerous. If the doctor finds changes in your cells or finds abnormal cells are present, he or she will determine the next course of action.

An abnormal pap smear might reveal:

  • Atypical squamous cells of undetermined significance (ASCUS) that indicate the presence of squamous cells growing on the surface of the cervix. If you also have the HPV virus, the doctor will prescribe further testing.
  • Squamous intraepithelial lesions (SIL) that indicates precancerous cells classified as low-grade, where changes have just started, or high-grade that necessitate further testing.
  • Atypical glandular cells that produce mucus at the opening of the cervix may require testing if they appear abnormal.
  • Squamous cancer or adenocarcinoma are both cancer that can arise in the cervix. These require immediate evaluation and treatment.

When is More Testing Required After a Pap Smear?

The results of the pap test can be misleading, and your doctor may require more information related to sex or diaphragm use, changes in menstrual cycle, or if you are menopausal. When the results of your pap test are inconclusive, you doctor may perform an additional pap test or other tests, which might include:

  • A colposcopy to magnify the cervix and vagina, and look more carefully for abnormalities.
  • A biopsy to take a small piece of the cervix or vagina for further analysis.
    A curettage to scrap the canal of the cervix for further analysis.
  • An endometrial biopsy to sample the internal lining of the uterus.
  • A loop electrosurgical excision procedure (LEEP) to remove a larger piece of cervical tissue for examination or treatment of pre-cancer.

If any of these tests indicates cancer, the doctor will explore the extent of the problem with other diagnostic imaging tools such as a CT scan, ultrasound, MRI, or PET/CT scan.

Abnormal Pap Smears Require Watching

Because most abnormal pap test results do not indicate cancer and may never progress into cancer,your doctor may take more of a ‘wait and see’ approach. What is important is that you obtain regular screenings and follow your doctor’s instructions if the test revealed abnormalities. If you are 26 years of age or younger, you might be able to prevent cervical cancer by obtaining an HPV vaccine that will protect you against future infections.

For help with gynecological cancer screenings or treatment, visit our new Center for Women’s Oncology in West Jordan, or any of our Rocky Mountain Women’s Health Care locations.


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