Every woman who goes for the annual gynecological exam gets a pap smear as part of a standard protocol to maintain optimal health. A pap smear is a quick procedure in which a sample of cells are collected from the cervix or vagina. This test looks for any changes or abnormalities in cervical or vaginal cells that may indicate cancer or other conditions. Many women get normal results but some will get results that show an abnormality. This abnormality is something that needs to be explored through further testing but many women worry or instantly assume that an abnormal pap smear automatically means a cancer diagnosis.
If you have an abnormal result from your pap test, it is considered a positive result. A positive test result means that you will require additional testing to determine what is causing the abnormality. Tests may include a colposcopy or cervical biopsies, of which, there are a few different types. Below, the American Cancer Society provides a detailed explanation of the three different types of abnormalities that may occur and be detected in a pap test, and what they mean. If your pap test returns an abnormal result, consult your physician about the next steps and what testing is needed to determine the source of abnormality and how to maintain your best health moving forward.
1. Atypical squamous cells (ASC-US and ASC-H)
- If the Pap results show atypical squamous cells of uncertain significance (ASC-US), some doctors will repeat the Pap test in 12 months. Another option is to test for human papilloma virus (HPV). What is done next depends on how old you are. If you are 21 to 24 years old, and HPV DNA is found, the doctor will recommend a repeat Pap test in a year. If you are at least 25 years old and HPV is detected, the doctor will recommend a colposcopy. If HPV is not detected, then the doctor will recommend the Pap test be repeated in 3 years. If you are at least 25 years old, an HPV test will be done at the same time as the repeat Pap test. If the results of a Pap test are labeled atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion (ASC-H), it means that a high grade SIL is suspected. The doctor will recommend colposcopy.
2. Squamous intraepithelial lesions (SILs)
- These abnormalities are divided into low-grade SIL (LSIL) and high-grade SIL (HSIL).
- For LSIL, further testing depends upon HPV testing:
- the HPV test result was negative (meaning the virus wasn’t detected), then repeating the Pap test and HPV test in one year is recommended.
- HPV was found, then colposcopy is recommended.
- no HPV test was done and the woman is at least 25 years old, colposcopy is recommended.
- the woman is under 25, she should have a repeat Pap test in a year.
- women with LSIL should have colposcopy.
- For HSIL, either colposcopy or a loop electrosurgical procedure is recommended for women 25 and older. For women under 25, colposcopy is recommended.
3. Atypical glandular cells and adenocarcinoma in situ (on a Pap test)
- If the Pap results read atypical glandular cells or adenocarcinoma but the report says that the abnormal cells do not seem to be from the lining of the uterus (the endometrium), guidelines recommend colposcopy with the biopsy type called endocervical curettage (endocervical scraping). The doctor may also biopsy the endometrium (this can be done at the same time as the colposcopy). For information about endometrial biopsy, see our document Endometrial (Uterine) Cancer. If the atypical glandular or adenocarcinoma cells look like they are from the endometrium (based on how they look under the microscope), experts recommend a biopsy of the endometrium along with an endocervical curettage, but a colposcopy isn’t needed unless the results from the endometrial biopsy are negative and do not explain the Pap test result.