Getting a phone call that your Pap smear came back “abnormal” can be alarming. Your first thought might be, “Do I have cancer?”
The truth is, abnormal Pap smear results are common, and in most cases, they don’t mean cancer at all. Instead, they usually point to minor cell changes that may clear on their own or need only simple follow-up.
Let’s clarify what “abnormal” really means, why it happens, and what the next steps usually look like.
What a Pap Smear Actually Tests For
A Pap smear, sometimes called a Pap test, is a screening tool used to detect changes in the cells of the cervix—the lower part of the uterus that opens into the vagina.
The main goal is to catch abnormal cell changes early, before they turn into something more serious like cervical cancer. The test can also show signs of infections or inflammation.
Pap smears are closely linked to HPV (human papillomavirus), the most common sexually transmitted infection. Most abnormal Pap results are related to HPV, especially the high-risk strains that can cause cervical cancer.
What Does “Abnormal” Mean?
When doctors say your Pap smear is “abnormal,” it doesn’t mean they’ve found cancer. It means some of the cells in your cervix look a little different under the microscope.
These changes can be very mild, like irritation or inflammation, or they can suggest precancerous changes that need closer attention. In other words, “abnormal” is not a final diagnosis. This is why your doctor will recommend follow-up tests to examine the cells and find the root of the problem.
Types of Abnormal Pap Smear Results
Not all abnormal results are the same. Some are so mild that doctors simply watch and wait, while others may need further testing.
| Result | What It Means | Next Steps |
|---|---|---|
| ASC-US (Atypical Squamous Cells of Undetermined Significance) | The most common finding. Cells look slightly off, but it’s not clear why. | Often followed by an HPV test or repeat Pap in 6–12 months. |
| LSIL (Low-grade Squamous Intraepithelial Lesion) | Mild changes, usually linked to HPV. May clear on their own. | Doctors may recommend repeat testing or colposcopy. |
| HSIL (High-grade Squamous Intraepithelial Lesion) | More serious changes that could become precancerous if untreated. | Colposcopy and biopsy are usually recommended. |
| ASC-H (Atypical Squamous Cells—cannot rule out HSIL) | Uncertain changes but possibly high-grade. | Further testing with colposcopy. |
| AGC (Atypical Glandular Cells) | Less common, but can be linked to more serious issues. | Usually requires colposcopy and sometimes more advanced testing. |
Why Do Pap Smears Show Abnormal Results?
Several things can cause abnormal results, and most of them are not cancer. Common reasons include:
- HPV infection: The leading cause of abnormal Pap results.
- Other infections or inflammation: Yeast infections, bacterial vaginosis, or STIs can affect cervical cells.
- Hormonal changes: Pregnancy and menopause can change the way cervical cells look, which may ultimately be harmless.
- Recent sexual activity or products: Using tampons, lubricants, or spermicides shortly before the test can sometimes interfere with results.
When your doctor says your test came back “abnormal,” it might simply mean your cervix was a little irritated on test day.
Follow-Up Procedures After an Abnormal Pap Smear
After your Pap smear results, the next steps aren’t the same for everyone. Your doctor will suggest the follow-up based on several factors: your age, the type of cell change spotted, and whether you also tested positive for high-risk HPV.
1. Repeat Pap Smear
If your results show only minor changes, such as ASC-US (atypical squamous cells of undetermined significance), your doctor may simply recommend repeating the Pap test in 6–12 months.
Why wait? Because in many cases, these minor cell changes clear up on their own, especially in younger women. The immune system can often fight off HPV naturally, and your cervix may return to normal without any treatment.
2. HPV Testing
Since HPV is behind nearly all cervical cancers, testing for it is often the next step. If your abnormal Pap result comes with a positive test for high-risk HPV strains (like HPV-16 or HPV-18), your doctor will likely want to investigate further.
On the other hand, if you’re HPV-negative, that’s good news. It often means your risk is low, and you may not need immediate procedures beyond routine monitoring.
3. Colposcopy
This is the most common next step if the Pap results look more concerning or if you tested positive for high-risk HPV. A colposcopy is a closer examination of your cervix using a special magnifying device (like a microscope on a stand). It allows your doctor to see details that the naked eye would miss.
During the exam:
- A solution is applied to your cervix, which makes abnormal cells stand out.
- If any suspicious areas appear, your doctor may take a biopsy for lab testing.
It may sound intimidating, but most women describe colposcopy as slightly uncomfortable rather than painful. Some cramping (like a period) and light spotting afterward are normal.
4. Biopsy
A biopsy is when your doctor removes a small piece of cervical tissue for closer examination. The results show whether the abnormal cells are:
- Low-grade (mild changes): These often go away without treatment.
- High-grade (more serious changes): These may need to be removed before they develop further.
A biopsy provides clarity. While Pap smears and colposcopies are screening tools, a biopsy is the step that gives a more definite answer.
Treatment Options After Confirmation of Abnormal Cells
If a biopsy confirms precancerous cells, treatment is usually straightforward and highly effective. The goal is to remove the abnormal tissue before it has a chance to turn into cancer. Common treatment options include:
Cryotherapy: Freezing the abnormal cells with liquid nitrogen. It’s quick, usually done in-office, and has minimal recovery time.
LEEP (Loop Electrosurgical Excision Procedure): Uses a thin, heated wire loop to remove abnormal cells. It’s one of the most common treatments and typically takes only a few minutes.
Cone biopsy: Removes a cone-shaped piece of cervical tissue that includes the abnormal area. This is usually done in more complex cases or if the abnormality extends deeper into the cervix.
These treatments are highly successful. Studies show that they can prevent most cases of cervical cancer when done promptly.
Women’s Health Clinic di Cheras, KL
Get Your Pap Smear Results with Klinik Azurose
Hearing that your Pap smear results are abnormal can seem scary, but in most cases, it simply means your doctor needs a closer look. With routine screening, follow-up, and treatments if needed, abnormal results rarely lead to serious disease. Our doctors can ensure you’re thoroughly tested, advise you on what to do next and recommend you to the specialists you need for treatment.
