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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 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.

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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.