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Abnormal Pap Test — What should you do?

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contributed by Annette Schork, R.N., BSN, OCN, CBCN, Cancer AnswerLine

Your health care provider tells you that you have an abnormal Pap test. It is difficult not to panic when you hear this information. Maybe you're worried and wondering what this means and how it will affect you. It's important to keep in mind the majority of abnormal Pap tests do not mean you have cancer. The most common reason for an abnormal Pap test is a vaginal or cervical infection that causes changes in the cells of your cervix. Most of these changes can be followed closely until they return to normal.

Pap tests can detect precancerous and cancerous conditions by collecting cells from the surface of the cervix. The pathologist will look at the cervical cells under a microscope. Sometimes these cells appear abnormal, but they are not completely cancerous. These are called precancerous cells, which means they might turn into cancer if not found and treated early enough.

What are the different types of abnormal Pap test results?

    Atypical squamous cells of undetermined significance (ASC-US)
    ASC-US means that changes in the cervical cells have been found. The changes are almost always a sign of an HPV infection. ASC-US is the most common abnormal Pap test result.

    Low-grade squamous intraepithelial lesion (LSIL)
    LSIL means that the cervical cells show changes that are mildly abnormal. LSIL usually is caused by an HPV infection that often goes away on its own.

    High-grade squamous intraepithelial lesion (HSIL)
    HSIL suggests more serious changes in the cervix than LSIL. It is more likely than LSIL to be associated with pre-cancer and cancer.

    Atypical squamous cells, cannot exclude HSIL (ASC-H)
    ASC-H means that changes in the cervical cells have been found that raise concern for the presence of HSIL.

    Atypical glandular cells (AGC)
    Glandular cells are another type of cell that make up the thin layer of tissue that covers the inner canal of the cervix. Glandular cells also are present inside the uterus. An AGC result means that changes have been found in glandular cells that raise concern for the presence of pre-cancer or cancer.

    Squamous cell cancer or adenocarcinoma cells
    This result means the cells collected for the Pap smear appear so abnormal that the pathologist is almost certain a cancer is present. Squamous cell cancer refers to cancers arising in the flat surface cells of the vagina or cervix. Adenocarcinoma refers to cancers arising in glandular cells.

If you have an abnormal Pap test, you may need further testing. It is important to talk to your healthcare provider about your next steps. The following tests may be done depending on your age and your initial Pap test result.

    Repeat Pap test or co-test
    A repeat Pap test or a repeat co-test (Pap test and a test for high-risk types of HPV) is recommended as a follow-up to some abnormal test results. These repeat tests may be done in 1 year or in 3 years depending on your initial test result, your age, and the results of previous tests.

    HPV test
    An HPV test looks for the presence of the HPV types that have been linked to cervical cancer.

    Colposcopy, biopsy, and endocervical sampling
    Colposcopy is a procedure using a special magnifying instrument (colposcope) to examine the tissues of the cervix, vagina and vulva. For a biopsy, a small sample of tissue is sent to the lab for testing. Endocervical sampling takes a tissue sample from the cervical canal by using a small brush or other instrument.

    Endometrial sampling
    The removal of a small piece of tissue from the endometrium (the lining of the uterus).

Do you have questions/concerns about an abnormal pap test? Our Cancer AnswerLine™ nurses are experienced in oncology care, including helping patients and their families who have questions about cancer. These registered oncology nurses are available by calling 800-865-1125 Monday through Friday, 8 a.m. – 5 p.m. Your call is always free and confidential.

Continue learning about abnormal pap tests and the treatment options:

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