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abnormal pap smear|gynecologic|women's health

Understanding Abnormal Cervical Cancer Screening Results

Last Updated September 2023 | This article was created by editorial staff and reviewed by Leisa Bailey, MD

Cervical cancer screening is an important part of preventing cancer or detecting it early. Two tests are used for screenings: the Pap test (or smear) and the HPV test. The Pap test checks for cell changes on a woman’s cervix that could turn into cancer if they are not treated. The HPV test looks for human papillomavirus (HPV). The virus can cause cell changes that lead to cervical cancer.

Path to improved health

Your Pap test will come back with one of three results:

Normal (or negative). This means no cell changes were found.

Unclear (or inconclusive). This result is common. It means it looks like your cells could be abnormal. This could be because of an infection, such as a yeast infection or the herpes virus. Hormone changes from pregnancy or menopause can also affect test results.

Abnormal (or positive). This means cell changes were found. In most cases, it does not mean you have cervical cancer. There are different abnormal test results. These are the most common.

  • ASC-US – Atypical squamous cells of undetermined significance
    This is the most common abnormal finding. It is sometimes considered an unclear result rather than abnormal. Squamous cells form the surface of your cervix. This result means the squamous cells don’t look normal. This could be because of an infection, including HPV.
  • AGC – Atypical glandular cells
    Glandular cells produce mucus in your cervix and uterus. This result means some glandular cells don’t look normal. These cell changes are usually more serious than ASC (atypical squamous cells). This means there is a greater risk that precancer or cancer is present.
  • LSIL – Low-grade squamous intraepithelial lesions
    This result is sometimes called mild dysplasia. It indicates low-grade changes that are usually caused by an HPV infection. Changes may go away on their own.
  • HSIL – High-grade squamous intraepithelial lesions
    This result is also called moderate or severe dysplasia. It indicates that HPV is present and is causing more serious changes. These could turn into cancer if left untreated.
  • ASC-H – Atypical squamous cells, cannot exclude HSIL
    Some cells are not normal, and there is a possibility that HSIL is also present.
  • AIS – Adenocarcinoma in situ
    An advanced lesion was found in the glandular tissue. It could turn into cancer if left untreated.
  • Cervical cancer cells (squamous cell carcinoma or adenocarcinoma)
    Pap tests can detect cancer cells, but it is rare. Cancer usually does not have time to develop in women who get regular cancer screenings.

Most women with abnormal cervical cancer screening results do not have cancer.

If your screening found ASC-US, your doctor will probably order an HPV test. He or she may also have you come back in 6 to 12 months for another Pap test. If the HPV test is positive and you are older than 25, your doctor will order a colposcopy. During this test, he or she will use a magnifying lens to look more closely at your cervix. They can also take a sample of tissue (biopsy) to test for cancer.

Cells of the cervix go through many changes before they turn into cancer. A Pap test can show if your cells are going through these changes. If caught and treated early, cervical cancer is not life threatening. Talk to your doctor to see how often he or she recommends you receive Pap tests. You may need them or less often, depending on your age and overall health.

Cervical cancer screening results can sometimes be wrong. This means you may have to undergo unnecessary follow-up tests. However, screening has saved lives. Discuss your risk for cervical cancer, the pros and cons of screening, at what age to start screening, and how often to be screened.

Things to consider

Abnormal or precancerous cells are often found before cancer develops. If further testing shows that you have precancerous cells, your doctor will want to remove them. They will help you decide which treatment is best for you. Sometimes, they will recommend watchful waiting. This could include more frequent Pap tests. Other common treatments include:

  • Cryotherapy– Abnormal tissue is frozen off.
  • Laser therapy– A focused beam of light destroys abnormal tissue.
  • Loop electrosurgical excision procedure (LEEP)– A thin metal loop with an electric current removes abnormal tissue.
  • Conization– Abnormal tissue is removed with a scalpel in a cone-shaped piece.

Your doctor can perform some of these treatments in their office. They usually take only a few minutes. Other treatments require anesthesia, so you go to a hospital for those.

If the tests find invasive cancer, treatment will depend on how far the cancer has spread. The most common treatments include:

  • Surgery– The cancerous tissue is removed in an operation.
  • Radiation– High-energy rays like X-rays shrink or kill the cancerous cells.
  • Chemotherapy– Powerful medicines, in pill form or injected into the veins, shrink or kill the cancer.

Treatment of invasive cancer often involves a team of specialists. This could include your family doctor, a gynecologist, and an oncologist (cancer specialist). You will all work together to develop the best treatment plan for you.

If you have any questions about your cervical cancer screening results, call your doctor.

Questions to ask your doctor

  • What do these results mean?
  • Do I need a follow-up Pap test or an HPV test?
  • Will I need a colposcopy or a biopsy?
  • Do I need any treatment?
  • Am I at risk for cervical cancer?
  • Is it safe for me to have sex?
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