What happens if I have an abnormal Pap test?

Patricia Geraghty, NP
Women's Health

The pap test is a test for one disease—cancer of the cervix. The good thing about cervical cancer is that it is one of the few cancers that has detectible small changes in the cells that precede actual cancer. These changes are graded, low and high, according to how close to cancer the cell is. Low grade changes almost always revert back to normal cells through the function of the body's own immune system. If the low grade changes are associated with HPV infection, particularly strains 16 and 18, then the chances of spontaneous resolution are smaller and more testing with closer follow up should be done. High grade changes require more testing. Further testing involves colposcopy, looking at the cervix under magnification and, possibly taking biopsy samples.

If a Pap test shows abnormal cells, the following tests may be performed:

  • Colposcopy: a special viewing scope with magnifying lenses is used to examine the surface of your cervix.
  • Cervical biopsy: A thin, flexible tube is inserted through the vagina into the uterus to remove a sample of cells from the lining of the uterus. The cells are then examined under a microscope for signs of cancerous changes.
  • Colposcopic biopsy: While viewing your cervix with a colposcope, the physician removes a tiny portion of abnormal tissue from the surface of the cervix with a special tweezers. The cells are then examined under a microscope.
  • Endocervical curettage: Often performed at the same time as a colposcopic biopsy, this procedure uses an instrument to scrape cells for further testing from the canal joining the cervix and uterus.
  • Cone biopsy: A cone-shaped piece of tissue is removed from your cervix for further examination with either a heated, thin wire loop (known as a loop electrosurgical excision [LEEP] procedure or large loop excision of the transformation zone [LLETZ] procedure); or a cold knife—a surgical scalpel or laser. Sometimes a cone biopsy also serves as a treatment to remove pre-cancers or early cancers.

If your Pap test is abnormal, your doctor may decide to do one of several other tests, depending on your age and sexual and medical history. If your Pap shows only mild abnormalities, your doctor may decide to check you for the human papillomavirus (HPV) if this was not done already, and/or repeat the Pap test in several months to ensure that the abnormalities have cleared up (they usually do). Your doctor may also decide to perform a colposcopy. This test allows your doctor to see any abnormal areas of your cervix. Biopsies (samples of tissue) can be taken during this procedure to determine whether these abnormal areas are cancerous or precursors to cancer. If so, your doctor will need to perform a procedure to remove these abnormal areas. It is important to remember that most changes seen on Pap tests will likely resolve with time, but should be monitored so that cervical cancer can be prevented or treated early in its course.

If you have an abnormal Pap test, you should call your doctor right away—or more likely, your doctor will call you. An abnormal result on your Pap test does not mean you have cancer. A Pap test, in which cells collected from your cervix during a pelvic exam are examined under a microscope, is a screening test only, not a diagnostic test. If you have an abnormal Pap test, your doctor may suggest further testing that could include:

  • a repeat Pap test
  • an HPV test, which looks for the presence of the human papilloma virus on cervical cells. This virus can put you at risk for developing cervical cancer.
  • a colposcopy—an examination of the cervix using a magnifying device. During this exam, your doctor may also take a small sample of cervical tissue for a biopsy.
  • endometrial sampling, in which a small piece of tissue from the lining of the uterus is collected for laboratory analysis

Many things, from medications you take to whether or not you douched or had sexual intercourse before your pelvic exam, can affect the outcome of your Pap test. However, all abnormal Pap results should be discussed with your doctor.

A Pap test is a screening tool; other procedures are necessary to confirm Pap test abnormalities and diagnose conditions. All abnormal Pap tests should have some form of action plan. This may include a watch-and-wait approach with retesting in several months. Or, depending on the degree of abnormality, your healthcare provider may order other tests, including:

  • Colposcopy: The doctor uses a colposcope to magnify and focus light on the vagina and cervix to view these areas in greater detail. Depending on these findings, your healthcare professional may then use one or more of the following tests:
    • Biopsy: During this procedure, sample tissue is taken from the cervical surface. Often several areas are biopsied.
    • Endocervical curettage: Cells are scraped from inside the cervical canal using a spoon-shaped instrument called a curette to help make a more precise diagnosis. This procedure evaluates a portion of the cervix that cannot be seen.
    • Cone biopsy: When biopsy or endocervical curettage reveals a problem that requires further investigation, a cone biopsy may be performed. A cone of tissue is removed from around the opening of the cervical canal. In addition to diagnosing an abnormality, cone biopsy can be used as a treatment to remove the abnormal tissue. A pathologist examines tissue removed during cone biopsy to be sure all the abnormal cells are removed.
    • Loop Electrocautery Excision Procedure (LEEP): The suspicious area is removed with a loop device and the remaining tissue is electrocoagulated (vaporized with electrical current). LEEP is both a diagnostic test and a treatment. A pathologist examines tissue removed during LEEP to be sure all the abnormal cells are removed.
Dr. Kevin W. Windom, MD
OBGYN (Obstetrician & Gynecologist)

If you have an abnormal Pap test then a few different things may happen. Sometimes it needs to be repeated in 4-6 months. You may need to have a colposcopy (magnified view of the cervix) and a biopsy. Lastly, your healthcare provider may want to prescribe an antibiotic or antifungal medication.

If a Pap smear is abnormal, the next step is usually colposcopy, which is nothing more than a microscopic examination of the cervix done in the office. While a Pap smear samples random cells, colposcopy allows the gynecologist to inspect the surface of the cervix under magnification so that the area where the abnormality is can be targeted and biopsied. The small sample of tissue removed is then sent to a pathologist, who will report one of the following:

Normal tissue: Frequently, the cervical cells are normal, which indicates that the cells reverted back to a normal growth pattern. Occasionally, abnormal cells are present, but are high up in the cervical canal, beyond the view of the colposcope, which is why a follow-up short interval Pap smear is always done.

HPV changes: Human papilloma virus (HPV) is responsible for dysplasia and cervical cancers. Sometimes, cellular changes indicate the presence of the virus, but there are still no actual precancerous cells.
  • CIN I: Mild dysplasia or low-grade squamous intraepithelial lesions.
  • CIN II: Moderate dysplasia or high-grade squamous intraepithelial lesions.
  • CIN III: Severe dysplasia, or high-grade squamous intraepithelial lesions, also known as carcinoma in situ.
Invasive cancer: True cancer that has infiltrated surrounding tissue and has the ability to spread.

If you have an abnormal Pap test and are HPV (human papillomavirus) positive, then the next step is a colposcopy. This is a procedure where the abnormal spots of the cervix are found and biopsies are taken to confirm if there is cancer or not. Even if you aren't HPV positive, if the Pap smear is abnormal enough the next step is still colposcopy.

An abnormal result does not mean you have HPV or cervical cancer. Other reasons for an abnormal Pap test result include yeast infections, irritation and hormone changes.

If your Pap test is abnormal, your doctor may do the test again. You may also have an HPV test or these tests:

  • Colposcopy. A device is used to look closely at your cervix. It lets the doctor look at any abnormal areas.
  • Schiller test. The test involves coating the cervix with an iodine solution. Healthy cells turn brown and abnormal cells turn white or yellow.
  • Biopsy. A small amount of cervical tissue is taken out and looked at under a microscope. This way the doctor can tell if the abnormal cells are cancer.

This answer is based on source information from the National Women's Health Information Center.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.