Abnormal Pap Smear: What Your Result Means and What Happens Next

“Your Pap came back abnormal” is a sentence that can ruin a week. It shouldn’t. An abnormal result is common, it almost never means cancer, and it usually leads to nothing more than a repeat test. Here’s what the words on your report mean, how HPV fits in, and what each possible next step involves.

What an abnormal result usually means

“Most of the time, abnormal results do not mean you have cervical cancer. Minor changes in the cells usually go back to normal on their own. But your provider may recommend a follow-up test to check,” says MedlinePlus (MedlinePlus). The National Cancer Institute is just as clear: “Keep in mind that most people with abnormal cervical screening test results do not have cancer,” and “People who have cervical cancer screening at regular intervals are rarely found to have cancer” (NCI).

Abnormal results are also common. In one large U.S. health system’s data published by the NCI, about 6 in 100 Pap results among people screened with both a Pap and an HPV test were abnormal, most of them the mildest category (NCI).

What the result names mean

Your report uses the lab’s terms. Here’s what each means, in the NCI’s words (NCI):

Result	What it means
Normal (negative, or NILM)	“No abnormal cervical cells were found.”
Unsatisfactory	The sample didn’t have enough cells, or they were hidden by blood or mucus. You’ll be asked to repeat the test in 2 to 4 months.
ASC-US	“This is the most common abnormal Pap test finding.” Some cells don’t look completely normal, but it’s not clear if HPV caused the changes.
LSIL	“Low-grade changes that are usually caused by an HPV infection.” You’ll likely be asked back for more testing.
ASC-H	Abnormal cells that may be high-grade, though it’s not certain. A colposcopy is likely.
HSIL	“Moderately or severely abnormal cervical cells that could become cancer in the future if not treated.” A colposcopy is likely.
AGC	Abnormal glandular cells, which can be a sign of a problem higher up, so a colposcopy is likely.
AIS	An advanced area of abnormal growth in the glandular tissue, which may become cancer if not treated.

The CDC notes your provider may also describe an ASC-US result as “equivocal” or “inconclusive” (CDC).

Where HPV fits in

Long-lasting infection with high-risk types of the human papillomavirus causes virtually all cervical cancers, and two types, HPV 16 and HPV 18, cause 70% of cervical cancers worldwide (NCI). That’s why many results come with an HPV test, and why your HPV status changes the next step.

A positive HPV test is not a cancer diagnosis. In MedlinePlus’s words, it “does not mean you have precancer or cancer or that you will get cancer,” though it does mean an infection that raises your future risk (MedlinePlus). And most infections don’t last: “Most HPV infections (9 out of 10) go away by themselves within 2 years” (CDC).

Other things that can make cells look abnormal

HPV isn’t the only explanation. The NCI lists “irritation, some infections (such as a yeast infection), growths (such as polyps in the uterus), and changes in hormones that occur during pregnancy or menopause,” and adds that “Although these things may make cervical cells look abnormal, they are not related to cancer” (NCI). If the HPV test is negative, your provider may prescribe an estrogen cream to see whether low hormone levels are causing the changes.

What happens next

Follow-up no longer depends on one result alone. The NCI explains that updated risk-based guidelines “advise a more tailored approach to follow-up care,” based on your current results, your HPV status and your history (NCI). The options are:

• Watch and repeat: a repeat HPV test or HPV and Pap test together in 1 or 3 years.
• Look more closely: a colposcopy, usually with a biopsy.
• Treat: remove the abnormal cells, for higher-risk results.

Here’s how that played out in the NCI’s risk tables for people with no earlier results (NCI):

Result	Usual next step
HPV negative, ASC-US	Repeat testing in 3 years
HPV negative, LSIL	Repeat testing in 1 year
HPV positive, normal cells	Repeat testing in 1 year
HPV positive, ASC-US or LSIL	Colposcopy
HPV positive, ASC-H, AGC or HSIL	Colposcopy, or treatment

Even with an HPV-positive ASC-US result, the chance of a serious precancer (CIN 3 or worse) being present at that moment was under 5 in 100 in those tables. Your provider will tell you which path applies to you.

What a colposcopy is like

“During a colposcopy, your doctor inserts a speculum to gently open the vagina and see the cervix. A vinegar solution is applied to the cervix to help show abnormal areas,” the NCI explains, and it “usually includes a biopsy” (NCI). According to MedlinePlus (MedlinePlus):

• It’s usually done in the provider’s office and takes 10 to 20 minutes; a biopsy may add about 10 minutes.
• The vinegar or iodine solution may sting, tingle or burn, and you may feel a pinch when the tissue sample is taken. You may be sore for a day or two.
• After a biopsy, a little bleeding and discharge for up to a week is normal. Don’t douche, use tampons or have sex for a week, or for as long as your provider advises.
• Call your provider for heavy bleeding, belly pain, or signs of infection such as fever, chills or bad-smelling discharge.
• Colposcopy is generally safe during pregnancy, but pregnancy raises the risk of bleeding after a biopsy.

ACOG suggests scheduling it for a time when you won’t have your period (ACOG).

Understanding biopsy results: CIN 1, 2 and 3

A biopsy is graded by how much of the tissue is affected (NCI):

• CIN 1: “mild, or low grade. They usually go away on their own and do not require treatment.”
• CIN 2: “moderate and are typically treated by removing the abnormal cells. However, CIN 2 can sometimes go away on its own.” In a review of 36 studies, half of untreated CIN 2 had gone away within two years (Tainio et al., 2018).
• CIN 3: “severely abnormal. Although CIN 3 is not cancer, it may become cancer and spread to nearby normal tissue if not treated.”

The NCI also notes that about 70% of ASC-US results and CIN 1 changes go away within 6 years (NCI). Cervical changes usually develop slowly, over many years, which is why screening on schedule works so well.

Treatment, if you need it

“The most common treatment for high-grade cervical cell changes is conization, the removal of a cone-shaped piece of tissue from the cervix and cervical canal,” the NCI explains. The usual method, LEEP, “is typically done in a doctor’s office. It usually takes only a few minutes, and local anesthesia is used to numb the area.” Cryotherapy, which freezes the abnormal cells, “takes only a few minutes and usually does not require anesthesia” (NCI).

After a LEEP, ACOG describes watery, pinkish or brownish discharge and a few weeks of healing, and says to call for bleeding heavier than a period, clots or severe belly pain (ACOG). Follow-up continues afterward: ACOG recommends an HPV test 6 months after treatment (ACOG), and the CDC’s guidance calls for continued surveillance for at least 25 years (CDC).

Follow-up at Ambert

Pap smears are done at the Miami Lakes office, and your provider will explain your result and the next step in English or Spanish. If you need a colposcopy or treatment, your provider will explain why and help you arrange it with a gynecologist. See women’s health and Pap smears, and read what to expect at a Pap smear test if your next screening is coming up.

If you’re due for a repeat test, or want to go over a result you received elsewhere, call the office. New patients can start with the new patient guide, and if you have other screenings due, an annual physical can cover them.