If you’re following the recommended cervical cancer screening schedule—and hopefully you are—you’ll have a lot of Pap tests in your life.
Sometimes, you may get an abnormal result. This can feel alarming, but rest assured that this is exactly what the test is designed to do: Find abnormal changes early, before they progress into cancer.
“I know an abnormal result can be difficult, but we are here because we care, to answer your questions and to help you remain healthy,” says UNC Health OB-GYN Lisa Rahangdale, MD, MPH.
Here’s what you need to know about abnormal pap results and what to do next.
Cervical Cancer Screening Schedule
First, it’s important to understand what cervical cancer screening is and how often you need to go.
From the ages of 21 to 29, you should have a Pap test as part of a well-woman exam every three years. During a Pap, your provider uses a small brush to take cells from your cervix that are examined under a microscope.
At the age of 30, you’ll start having HPV tests, which also use a small sample of cells from the cervix to look for the strains of human papillomavirus that lead to cervical cancer. For women of average risk, it’s recommended to have an HPV test every five years, or both a Pap and an HPV test every five years. An alternative is to have a Pap every three years, and there is even an option to have an HPV test that you can self-collect every three years. Your provider will help you understand the best screening option for you.
These tests, along with the HPV vaccine, which protects against strains of HPV that lead to cancer, save lives. While cervical cancer was once the leading cause of cancer-related death for women in the United States, rates of cervical cancer cases and deaths decreased by more than half from the mid-1970s to the mid-2000s.
That’s because these tests can flag abnormalities for treatment before they become cancer.
Understanding Abnormal Cervical Cancer Screening Results
Pap test results are typically described as normal, meaning that no abnormal cervical cells were seen; unsatisfactory, meaning there either weren’t enough cells or the cells couldn’t be seen under the microscope, which will typically require a repeat test; or abnormal, which means that some cells looked different than normal, healthy cells.
Abnormal could mean a variety of things. The most common abnormal Pap finding is atypical squamous cells of undetermined significance (ASC-US). That means you have some abnormal cells, but it’s not clear if it’s because of an HPV infection or something else, like irritation, a yeast infection or hormonal changes. If you also had an HPV test, those results can help determine whether the changes are related to HPV and whether you need additional procedures.
The other common results you might see are low-grade squamous intraepithelial lesions (LSIL), which most likely means there are mild changes to the cells, likely caused by HPV, and high-grade squamous intraepithelial lesions (HSIL), which means the changes may be more pronounced.
HPV tests are more straightforward; you either receive a result of negative or positive for HPV. Sometimes you may find out the type of HPV, like 16 or 18, but next steps after both a Pap test and an HPV test will vary person to person.
“People will need different things, as we take into account your age, background, medical history, HPV test results and desire for future children,” Dr. Rahangdale says.
No matter what, you shouldn’t ignore an abnormal finding, even if you’re feeling scared.
“If you avoid following up, you could put yourself at more risk instead of taking the steps to prevent cancer,” Dr. Rahangdale says. “It is important to learn what needs to be done to help you take best care of yourself.”
Possible Next Step: Watch and Wait
In some cases, your doctor may recommend following up in 12 months to see if abnormalities persist.
“Sometimes, the body can clear the infection itself,” Dr. Rahangdale says. “Though most people exposed to HPV don’t get cervical cancer, we are unable to tell who will get better and who will persist or progress. This is why follow-up is important”
Ask your provider when you need another Pap or HPV test.
Possible Next Step: Colposcopy and Biopsy
For most, the next step after an abnormal Pap test or positive HPV test will be a colposcopy.
“With this test, we use a microscope to look at your cervix for any abnormal changes. That shows us where to take a biopsy if needed,” Dr. Rahangdale says.
This procedure starts like any pelvic exam: You’ll lie on an exam table and your doctor will use a speculum to hold your vagina open just like when you have a Pap test. Your doctor will swab your cervix with a liquid that turns abnormal cells a different color, which might cause slight burning or tingling. The microscope, formally known as a colposcope, has a bright light on it that allows your provider to see your cervix, but it doesn’t enter your body. If your doctor sees abnormal cells, they will perform a biopsy, using a small instrument to take samples. The entire test takes about 15 minutes.
You may have mild bleeding and discharge in the day or two after the procedure, and some women report discomfort. However, everyone’s experience is different.
“For some, a colposcopy is well-tolerated, but for others, it’s painful,” Dr. Rahangdale says. “Talk to your provider about pain management or if there is something we can do to help you with your worries or anxiety. We want to have the conversation so we can help you feel empowered and safe.”
If you have a biopsy, you’ll receive results about how much cervical dysplasia, or precancerous change to the cervix, is found. These results may be CIN 1, 2 or 3; CIN stands for cervical intraepithelial neoplasia.
“With CIN 1, there’s been exposure to HPV. The majority of people can suppress the infection on their own,” Dr. Rahangdale says. “CIN 2 and 3 are precancer, so you might get a recommendation for treatment or much closer follow-up depending on your age, childbearing plans or other factors. There are good treatments for CIN 2 and 3 to prevent cervical cancer.”
Possible Next Step: LEEP
If you have a Pap test showing high-grade changes, or if your biopsy shows CIN 2 or 3, your next step might be a loop electrosurgical excision procedure, or LEEP.
“A LEEP is treatment for precancerous cells,” Dr. Rahangdale says. “It’s an office procedure. Using a thin loop of wire, we remove part of the cervix to get rid of those abnormal cells.”
Before the procedure, you’ll typically receive local anesthesia to numb your cervix, but let your doctor know if you’re worried about pain. As with pelvic exams and colposcopies, women report varying levels of discomfort.
If you desire children in the future, talk to your doctor.
“There is evidence that multiple LEEPs can increase the risk of premature labor, so we want to understand your needs,” Dr. Rahangdale says.
LEEPs are very effective at preventing cervical cancer, though after you’ll continue to need more frequent Pap and/or HPV tests and follow-ups with your provider.
“In about 90 percent of women, this treatment gets rid of disease,” Dr. Rahangdale says; for the people who have recurrence of cervical dysplasia, it tends to show up in the first few years after your LEEP, which is why regular follow-ups are so important.
If you have any questions or concerns about these procedures, don’t be afraid to talk to your doctor, Dr. Rahangdale says.
“Ask your questions so that we can help you make good decisions for your health, have a better experience and prevent cancer.”
If you have questions about your test results, talk to your doctor or find one near you.