Getting a call that your Pap smear results are abnormal is an unsettling experience that many people face. Of course, it’s normal to feel instant anxiety and jump to worst-case conclusions. If you receive a call regarding an abnormal Pap screening result, it's crucial to remain calm. Take a moment to pause and remember to breathe.

Generally, an "abnormal" result does not mean "serious." In fact, millions of women receive abnormal results each year, with a prevalence of about 4% for all Pap tests in the U.S. And it rarely means cancer is present, especially in individuals who get regular Pap tests. So, let’s spend some time breaking down what an abnormal Pap test result does mean while also exploring what causes an abnormal Pap test and what to do if you get unexpected news about a recent Pap smear that feels confusing and possibly even catastrophic.

What’s a Pap smear and why does it matter?

A Pap Smear is a screening test invented by Dr. George Papanicolaou, a Greek physician and pioneer of cytopathology (diagnosing disease by looking at cells), used to detect abnormal cells in the cervix that could potentially develop into cervical cancer. During the test, your healthcare provider gently removes cells from the cervix and looks at them under a microscope. The cervix is the lower part of the uterus that connects to the vagina.

Today, cervical cancer screening may include Pap tests, HPV (human papillomavirus) testing, or both. An HPV test detects the types of HPV that are associated with cervical cancer.

The CDC states that cervical screening and HPV vaccination can prevent up to 93% of cervical cancers. That’s a huge number but not necessarily a surprising one. Why? Because Pap testing is one of the most predictive and preventive screening programs undertaken in medical history.

The simple truth is: Most precancerous cervical lesions (areas of abnormal growth) can be identified early and treated successfully with regular Pap screening. And because cancer of the cervix takes many years to develop, this type of preventive testing can pinpoint abnormal cells long before they grow into cancer.

What does an abnormal Pap test mean?

An abnormal Pap smear result means the lab has found some cells on your cervix that don’t look completely normal. These cellular changes can be minor (low-grade), more significant (high-grade), or even of undetermined significance.

Unusual test results and cell changes may seem scary, but they are frequently discovered. These findings are fairly common and do not necessarily indicate cancer. Consulting a healthcare professional for further evaluation and guidance is important. Here are a few abnormal results you might hear:

• ASC-US (Atypical Squamous Cells of Undetermined Significance): This is the most common abnormal result and, as the name implies, there are some unusual cells- even if it’s unclear what those changes mean.
• LSIL (Low-grade Squamous Intraepithelial Lesions): These are low-grade changes often linked to an HPV infection. These lesions often resolve on their own, but your healthcare provider might ask you to undergo additional testing to make sure there aren’t any more serious changes.
• HSIL (High-grade Squamous Intraepithelial Lesions): This finding suggests more significant changes that can potentially lead to cancer without treatment. Your healthcare provider will likely ask you to come back for a colposcopy, which is a way of getting a closer look at the cervix through a special magnifying device.
• AGC (Atypical Glandular Cells): This result means abnormal glandular cells were seen under the microscope, which usually warrants further testing and a colposcopy, since these cells can suggest more significant issues.
• AIS (Adenocarcinoma in Situ): This is an advanced lesion in the glandular tissue of the cervix and may be referred to as pre-cancer. It’s not cancer, but can become cancer if untreated.
• Squamous Cell Carcinoma or Adenocarcinoma: This means cancer cells were found, but it’s a very rare finding for people who have been screened at regular intervals.

Causes of Abnormal Pap Smears

HPV, a common infection that’s passed through sexual contact, plays a role in causing most cervical cancers. When exposed to HPV, the body’s immune system typically prevents the virus from causing harm. But in a small number of people, HPV survives and contributes to cellular changes that can cause cancer.

But there are many other reasons for an abnormal Pap test result that are unrelated to HPV or cellular changes:

• Irritation
• Yeast or bacterial infections
• Benign growths, such as polyps in the uterus
• Hormonal changes that occur during menopause or pregnancy
• Using vaginal medicines, creams, gels, or douches within 48 hours of a screening test
• Having sex prior to a screening test
• Menstruation

What are the next steps after getting an abnormal Pap test result?

If you have an abnormal Pap test result, the most important piece of advice is to get the follow-up care your healthcare provider recommends. Updated guidelines advise a tailored approach to follow-up care, which means your healthcare provider will consider several factors when recommending next steps, including previous screening results, previous treatments for precancerous cell changes, and personal health factors like your age. Some possible follow-up recommendations:

• Repeat Testing: Getting a repeat Pap smear, an HPV test, or both.
• HPV Typing: This is a type of HPV test that looks for HPV 16 and 18, the types that cause the most cases of cervical cancer.
• Colposcopy/Biopsy: Your doctor might recommend a colposcopy. During the procedure, your doctor might also take a biopsy of the cervix or endometrium (the lining of the uterus) for further examination.
• Treatment of Abnormal Cells: If a biopsy finds precancerous cells, you may undergo treatment to remove or destroy the abnormal cells before they can become cancer. These options include the LEEP procedure (an electrical current removes tissue), cryotherapy (freezing abnormal cells), or laser therapy.

Being Proactive, Not Reactive

While an abnormal Pap smear result can be worrisome, it’s rarely a diagnosis of something severe. Medicine has made amazing efforts over the years, and the outlook for managing and treating abnormal cervical cells is truly positive.

Screening tests, like the Pap test, can prevent most cases of cervical cancer by detecting abnormal cervical cell changes and treating them before they ever become pre-cancer or cancer. Most cervical cancers are found in women who have never had a Pap test or have fallen far behind in their screening regimen.

So, stay proactive, stay on-schedule with your recommended cervical cancer screenings, and stay calm if you get an abnormal Pap smear result. Usually, it’s nothing more than a yellow light or yield sign giving you an early warning about possible danger ahead; danger that can almost always be avoided by paying a little more attention to your health and following the routines that will keep you safe and sound for years to come.