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Abnormal Pap Smear: Causes and Next Steps

A Pap smear is a procedure that looks for abnormal changes in the cells of your cervix. Getting an abnormal Pap smear result is not as bad as it sounds. It might be the chance to take action to prevent bigger problems! Read on to learn about abnormal cells on a Pap smear, how to interpret abnormal Pap smear results, and what to do next.
A doctor and his patient are discussing abnormal Pap smear result

What is a Pap test and how is it done?

A Pap test is a procedure to screen women for cancer of the cervix. During the test, your doctor will collect cells from your cervix — the lowest portion of your uterus situated at the top of your vagina. 

During the Pap test, you lie on a table with your feet resting in stirrups. Your doctor will use a speculum to gently open your vagina. They will use a soft brush to collect a sample of cells from your cervix. After placing these cells on a glass slide or in a container, they will send the sample to a lab for testing. 

You may find the Pap test to be slightly uncomfortable, but it is usually painless. The test takes just a few minutes and is usually done in your doctor’s office. 

When should you go?

Pap tests are generally done along with a pelvic examination. For women older than 30, Pap smears may be done in association with a test to detect human papillomavirus (HPV). HPV is a commonly occurring sexually transmitted infection that can cause cervical cancer. 

In general, physicians recommend that women begin to have Pap tests when they turn 21. Doctors generally recommend that women between 21 and 65 years old repeat the Pap test every three years. Women 30 years and older can consider having a Pap test every five years if they get an HPV test at the same time. 

With these risk factors, your physician may recommend getting a Pap test more frequently, regardless of your age:

  • If you have HIV 
  • If your mother was exposed to diethylstilbestrol while pregnant 
  • If you have a prior diagnosis of cervical cancer or an abnormal Pap smear with precancerous cells 
  • If your immune system has become weak because of chemotherapy, chronic use of corticosteroids, or an organ transplant
  • If you smoke

Abnormal cells on a Pap smear: 5 main types 

The results of your Pap smear will either show normal or abnormal cells. If normal cells are present, your test is “negative.” If there are abnormal cells, the test is an abnormal or “positive” Pap smear. But a positive test or abnormal result doesn’t necessarily mean that you have cervical cancer. A positive result just means that there are abnormal cells, and further testing will determine what type. 

1. Atypical glandular cells

Glandular cells form the thin layer that lines the inner cervical canal. The uterus also contains glandular cells. Abnormal Pap smear results in the form of atypical glandular cells imply that the glandular cells have changed, raising the possibility of precancerous or cancerous changes.

2. Atypical squamous cells — can’t exclude HSIL (ASC-H)

Another possible abnormal Pap test result may say “atypical squamous cells — can’t exclude HSIL,” often shortened to ASC-H. This result indicates that the changes in the cervical cells raise concern about the presence of high-grade squamous intraepithelial lesion (HSIL). 

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3. Atypical squamous cells of undetermined significance (ASC-US)

This abnormal Pap smear result implies that changes are present in the cells of the cervix. In most cases, these changes are a sign of HPV. ASC-US is the most common abnormal Pap test result.

4. Squamous intraepithelial lesion

This abnormal Pap smear result indicates that the cervical cells may be precancerous. 

Low-grade squamous intraepithelial lesion (LSIL/CIN 1)

Low-grade squamous intraepithelial lesion (LSIL) on a Pap smear indicates that the changes present in the cells of the cervix are of low grade. This means that if there are precancerous changes, they may take several years to become cancer. 

High-grade squamous intraepithelial lesion (HSIL/CIN 2–3)

High-grade squamous intraepithelial lesion (HSIL) indicates more severe changes in the cervical cells than LSIL. This abnormal Pap smear result implies that there are higher chances of the precancerous changes progressing to cancer sooner. 

5. Squamous cell cancer or adenocarcinoma cells

This abnormal Pap smear result indicates that the cervical cells look so abnormal to the pathologist that they are almost certain about a diagnosis of cancer. Squamous cell cancer arises in the cells lining the cavity of the cervix and vagina. Adenocarcinoma arises in the glandular cells. 

What can cause an abnormal Pap smear besides HPV? 

Apart from HPV, abnormal Pap smear results may occur due to other infections. In some cases, inflammation in the vagina can also cause abnormal Pap smear results. An abnormal Pap smear may indicate herpes or trichomoniasis. Having sex in the days before getting a Pap smear may also cause abnormal cells to appear.

Abnormal Pap smear: what to do next 

A Pap smear test

If the results of your Pap smear are abnormal, further testing might be needed. Your doctor may recommend these tests depending on your abnormal Pap smear results and your age:

Repeat Pap smear or co-test — Your doctor may recommend either a repeat Pap smear or a co-test. The co-test is a combined Pap smear and HPV test. 

Repeated Pap smear is usually recommended for women aged 21 to 24 who have atypical squamous cells of undetermined significance (ASC-US) or squamous intraepithelial lesion (LSIL). Those with LSIL may get a recommendation for a repeated test if they are older than 30 years and are HPV negative. Repeated co-test is recommended for women older than 30 with ASC-US if they are HPV negative.

HPV test — An HPV test that is done on the cervical cells that were used for the initial Pap smear is known as reflex HPV testing. Another type of HPV test, which tests specifically HPV type 18 and HPV type 16, is known as HPV typing. These two kinds of HPV cause most cases of cervical cancer. 

That test is recommended for women aged 21 to 29 with ASC-US.

Colposcopy — During a colposcopy, your doctor will use a magnifying device to look closely at your cervix. If they notice an abnormal area, they may perform a biopsy and send the tissue sample to a laboratory for testing. 

Doctors usually recommend colposcopy for women with LSIL who are between 25 and 29 years old. That procedure is also recommended for those who tested positive for HPV and have LSIL, or have ASC-US (and are older than 30), and for every woman who has ASC-H. Finally, those of 21 to 24 years of age with HSIL usually should do the colposcopy, too.

How to prevent abnormal Pap smear results 

While the test doesn’t require any preparation, certain things can affect the results. For accurate Pap test results, avoid the following things for at least two to three days before the test:

  • Tampons
  • Sexual intercourse
  • Sprays, powders, or other feminine hygiene deodorizers
  • Vaginal creams, medicines, douches, suppositories, and spermicidal creams, jellies, or foams

Try not to schedule a Pap test for when you’ll be on your period

A Pap test is a procedure that screens women for signs of cervical cancer. An abnormal Pap smear doesn’t always mean cervical cancer, though. In fact, most women who get abnormal Pap smear results don’t have cancer of the cervix. Other causes of an abnormal Pap smear include infection, inflammation, and HPV. The result of your Pap test may show normal or abnormal cells. Abnormal cells on a Pap smear may either be high grade or low grade. You may need further testing depending on your abnormal Pap smear results and your age. 

https://www.mayoclinic.org/tests-procedures/pap-smear/about/pac-20394841

https://www.acog.org/Patients/FAQs/Abnormal-Cervical-Cancer-Screening-Test-Results

https://www.healthline.com/health/womens-health/abnormal-pap-smear-test

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