Real Talk Blog

I Had an Abnormal Pap Smear—What Does it Mean and What Happens Next?

July 21, 2023

Key Takeaways:

  • An abnormal Pap smear or co-test result means that cell changes were found on your cervix
  • An abnormal cytology result typically does not mean that you have cervical cancer, though changes may have been caused by HPV
  • An abnormal result can mean many things, and it’s important to work with your doctor to understand both your result and next steps 
  • Your doctor may recommend a colposcopy, a procedure done to get a closer look at your cervix

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It can be scary to find out you have an abnormal Pap smear or co-test. First of all, take a deep breath. There are many reasons for an abnormal co-test or Pap smear (also called a Pap test); and arming yourself with trusted information and resources to help determine your next steps is your best course of action.

Before we dive in, it’s important to know that there are three types of tests that screen for cervical cancer: a primary HPV test, a Pap smear, or a co-test (which combines the Pap and HPV). The HPV test is the most sensitive (which means that it is best at picking up disease or infection when it is present) and is the American Cancer Society’s recommended way of screening. However, providers may still conduct Pap smears, most often as a part of a co-test.

The Pap is a cervical ‘cytology’ screening, which means that it studies your cells. In this article, we’ll discuss different Pap smear (or cytology) results, what they mean, and what to expect as you navigate next steps with your doctor’s guidance.

What is an abnormal Pap smear? 

A Pap smear is used to detect cell changes in the cervix. It involves collecting cells from the cervix using a smallbrush. (If you’re cringing, we hear you. That’s why we’re working on an improved, at-home experience!)

The sample is sent to a lab for testing.Your result will come back as either normal or abnormal. An abnormal result means that there are cervical cell changes that are not normal. This usually does not mean that you have cervical cancer, but that the cell changes may require further investigation. The cause of the abnormal cytology results as well as the different abnormal results are often linked to high-risk HPV, which your doctor can test for as part of routine screening.

Here are some of the abnormal cytology results that can be found:

Atypical squamous cells of undetermined significance (ASC-US)
  • Most common abnormal result
  • Cell changes may be caused by things such as HPV, cervical irritation, infection, or hormonal changes (e.g. pregnancy, menopause). These cell changes are not necessarily due to cancer, and your healthcare provider will likely do a follow-up HPV test to see whether or not the changes are caused by an HPV infection.
Atypical glandular cells (AGC)
  • Glandular cells are found on the inner part of the cervix or uterus lining
  • Atypical glandular cells means that some abnormal glandular cells were found
  • This often requires further testing with a colposcopy
Low-grade squamous intraepithelial lesions (LSIL)
  • As the name suggests, these are low-grade cell changes (meaning less severe), that may be caused by an HPV infection and may require further testing
Atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H)
  • These are abnormal cells that may be high-grade cell changes (meaning more severe), which requires further testing
High-grade squamous intraepithelial lesions (HSIL)
  • These are abnormal cell changes that are more severe and may lead to cancer if not treated
  • Further testing is needed, which usually means a colposcopy
Adenocarcinoma in situ (AIS)
  • An abnormal precancerous lesion was found in the glandular tissue of the cervix
  • Next step is likely a colposcopy
Cervical cancer cells (squamous cell carcinoma or adenocarcinoma)
  • Cancer cells were found
  • Less common for people who have been screened regularly
  • A biopsy confirms the presence of cervical cancer and the type of cervical cancer present
  • Your doctor will work with you to determine next steps, which includes further testing and treatment

I had an abnormal Pap smear or co-test—now what?

Depending on the abnormal cytology result, your doctor may recommend a colposcopy. This procedure may look and feel similar to a Pap smear or co-test, although this time, your doctor will use a magnifying device (colposcope) to look at abnormal cells within your cervix. Your doctor may apply a solution to the area of concern, which turns abnormal areas white. Once your doctor identifies the abnormal cells, they may take a small amount of tissue (a biopsy) for testing. These cells will then be sent to a lab for analysis. 

This is an out-patient procedure. You may, however, experience some mild discomfort after the procedure, mild spotting/bleeding or discharge. These symptoms usually resolve within a few days.

From here, you’ll wait to hear from your doctor. Waiting on medical results is never fun, so ask your doctor when you can expect to hear your results and how they will communicate the results to you (e.g. email, a phone call, a follow-up appointment, etc.). Based on the results, your doctor will be able to guide you further on next steps, which may include further testing and treatment. 

Join us in creating a more equitable, accessible, and empowered women’s healthcare system. 

Deepa Thakor, MD
Family Practice Medical Advisor

Dr. Thakor, MD, is a board-certified family medicine physician with the American Board of Family Medicine.

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