Topic Overview

What is an abnormal Pap test?

A Pap test, or Pap smear, is done to look for changes in the cells of the cervix. If your test is abnormal, it means it found some cells on your cervix that don't look normal. Having an abnormal test doesn't mean you have cancer. The chances that you have cancer are very small.

What causes an abnormal Pap test?

Most abnormal Pap tests are caused by HPV infections. Other types of infection—such as those caused by bacteria, yeast, or protozoa (Trichomonas)—sometimes lead to minor changes on a Pap test called atypical squamous cells. Natural cell changes that may happen during and after menopause can also cause an abnormal Pap test.

What increases your risk for an abnormal Pap test?

Human papillomavirus (HPV) can raise your risk for having an abnormal Pap test. Certain sexual behaviours, like having sex without condoms and having more than one sex partner, can put you at risk for getting HPV. Smoking and having an impaired immune system can also increase your risk for having an abnormal Pap test.

Do abnormal cell changes cause symptoms?

HPV, which causes most cervical cell changes, usually doesn't cause symptoms. But some people with cell changes may have abnormal vaginal bleeding. This may include bleeding between periods, heavy periods, or bleeding after sex. If another vaginal condition is the cause, you may have other symptoms, such as vaginal pain, itching, or discharge.

What will you need to do if you have an abnormal Pap test?

You may need more tests to find out if you have an infection or to find out how severe the cell changes are. For example, you may need:

• Colposcopy, a test to look at the vagina and cervix through a lighted magnifying tool.
• An HPV test. Like a Pap test, an HPV test is done on a sample of cells taken from the cervix.
• Another Pap or HPV test in about 6 to 12 months.

A colposcopy is usually done before any treatment is given. During a colposcopy, the doctor also may take a small sample of tissue from the cervix so that it can be looked at under a microscope. This is called a biopsy.

Treatment, if any, will depend on whether your abnormal cell changes are mild, moderate, or severe. In moderate to severe cases, you may have treatment to destroy or remove the abnormal cells.

Cause

Most of the time, the abnormal cell changes are caused by certain types of human papillomavirus, or HPV. HPV is a sexually transmitted infection.

Sometimes the changed cells are due to other types of infection, such as those caused by bacteria or yeast. These infections can be treated.

During or after menopause, a Pap test may also find cell changes that are caused by atrophic vaginitis.

What increases your risk of having an abnormal test result?

Certain sexual behaviours, like having sex without condoms and having more than one sex partner (or having a sex partner who has other partners), can increase your risk for getting HPV. And HPV raises your risk for having an abnormal pap test.

HPV can stay in your body for many years without your knowing it. You may not know you have it until you get an abnormal pap. So it can be hard to know when you were exposed.

Other things that may also play a role in increasing your risk include:

• Smoking.
• Having an impaired immune system.
• Having been exposed to the drug DES before you were born. But this is rare.

If you have had one abnormal Pap test result, you're more likely to have another in the future.

Types of Results

Lab specialists label abnormal cells according to how different they are from normal cells.

Minor cell changes

Minor cell changes may go away without treatment. But sometimes they turn into more serious cell changes. Types of minor cell changes are:

• ASC-US or ASC-H. These are changes for which the cause is unknown. ASC-US changes usually stay the same or return to normal. ASC-H changes are also minor. But they are more likely to become more serious.
• LSIL. These changes may be more likely to become more severe over time. But even when they do, they usually return to normal.

Moderate to severe cell changes

Moderate to severe cell changes—HSIL and AGC—are more likely to be precancerous and turn into cervical cancer if they aren't treated.

In some countries, other labelling systems are used. These systems may use the term dysplasia to describe cervical cell changes. Or they may just describe the changes as mild, moderate, or severe.

Follow-Up Tests

When your Pap test result is abnormal, you always need to follow up with your doctor. Often this just means having regular checkups and cervical cancer screening tests. But sometimes it means more tests or treatment.

It's very important to complete any further testing that your doctor recommends.

Active surveillance

Most people won't need special testing or treatment. Instead, they'll follow a schedule of regular Pap or HPV tests (cervical cancer screening tests). This is called active surveillance. It may be recommended when:

• You have a treatable infection in the vagina or cervix.
• You have an HPV infection. Most low-risk types of HPV go away on their own within 6 to 18 months.
• Your cell changes are minor.

It's okay to do nothing but watch and wait, because minor cell changes such as ASC-US or LSIL don't usually become more severe during a short period of watchful waiting.

Active surveillance may not be a good choice if you don't think you'll be able to follow your doctor's recommendations about having regular tests. Talk with your doctor about your testing choices.

More testing

After an abnormal Pap test, you may need more tests to look for infection or to find out more about your cell changes. These tests include:

HPV test.

This test looks for high-risk types of HPV (human papillomavirus). Knowing if you have a high-risk type of HPV can help guide your treatment decisions.

Colposcopy.

In this test, your doctor uses a magnifying tool to look at your vagina and cervix. The doctor may take a small sample of tissue so that it can be looked at under a microscope.

Cone biopsy.

A cone biopsy removes a little more tissue than a cervical biopsy. It may also serve as treatment by removing the abnormal cells.

Tests for other infections.

These can include other sexually transmitted infections, a yeast infection, or a bacterial infection.

Tests and Treatments

Not everyone needs treatment after an abnormal Pap test. Whether or not you need treatment can depend on the type of cell changes you have, your age and medical history, and the possible cause of the cell changes.

Mild cell changes.

For mild cell changes you probably will not need treatment. Mild changes often go away on their own. But if mild changes are caused by a treatable vaginal infection or atrophic vaginitis, you may be treated with medicine.

Moderate or severe cell changes.

For moderate or severe cell changes you may have treatment that focuses on destroying or removing abnormal tissue.

Treatment choices include:

• Cone biopsy, which removes a cone-shaped wedge of abnormal cells that are high in the cervical canal.
• Loop electrosurgical excision procedure (LEEP), which uses a thin, low-voltage electrified wire loop to cut out abnormal cervical cells.
• Cryotherapy, which destroys abnormal cervical cells by freezing them.
• Laser therapy, which uses a laser beam to destroy abnormal cervical cells.

If you're pregnant, you'll be monitored closely throughout your pregnancy. Most treatment for abnormal cell changes is done after delivery.