Home > Abnormal Pap Test
Pap test, or Pap smear, is part of a woman's routine
physical exam. It is the best way to prevent
cervical cancer, because it can find cells on your
cervix that could turn into cancer. The cervix is the
lower part of the uterus that opens into the vagina.
doctor says that your Pap test was "abnormal," it means that the test found
some cells on your cervix that do not look normal. It does not mean that you
have cancer. In fact, the chances that you have cancer are very small.
Most of the
time, abnormal cell changes on the cervix are caused by certain types of
human papillomavirus, or HPV. HPV is a
sexually transmitted infection. Usually these cell
changes go away on their own. But certain types of HPV have been linked to
cervical cancer. That’s why it’s important for women to have regular Pap tests.
It usually takes many years for cell changes in the cervix to turn into cancer.
Sometimes cell changes in the cervix are due to other types of infection,
such as infections caused by bacteria or yeast. These types of cell changes can
be treated. In women who have been through menopause, a Pap test may find cell
changes that are just the result of getting older.
High-risk sex raises your chances of getting HPV and having an abnormal
Pap test. High-risk sex includes having sex without condoms and having more
than one sex partner (or having a sex partner who has other partners).
HPV can stay in your body for many years without your knowing it. So even
if you now have just one partner and practice safe sex, you could still have an
abnormal Pap test if you were exposed to HPV in the past.
or having an
impaired immune system also may raise your chances of
having cell changes in your cervix.
changes themselves don't cause symptoms. HPV, which causes most abnormal Pap
tests, usually doesn't cause symptoms either. This is why regular Pap tests are
If a different sexually transmitted infection is the cause of your abnormal Pap test, you may have symptoms,
You will need more tests to find out if you have an
infection or to find out how severe the cell changes are. These tests may
A colposcopy is usually done before any treatment is
given. During a colposcopy, the doctor also takes a small sample of tissue from
the cervix so that it can be looked at under a microscope. This is called a
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.
Frequently Asked Questions
Learning about abnormal Pap tests:
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abnormal Pap tests are caused by
human papillomavirus (HPV) infections. Other types of
infection—such as those caused by bacteria, fungi (yeast), or protozoa
(Trichomonas)—sometimes lead to minor changes on a Pap
test called atypical squamous cells of undetermined significance (ASC-US). The most common cause is HPV infection.
Natural cervical cell changes (atrophic vaginitis) related to
menopause can also cause an abnormal Pap test.
cervical cell changes that can cause an
abnormal Pap test rarely cause symptoms, regular Pap
test screening to monitor cell changes is important.
Human papillomavirus (HPV) infection, which is the
most common cause of abnormal cervical cell changes, usually does not cause any
A number of
sexually transmitted infections (STIs) can cause an
abnormal Pap test. STIs can have a variety of symptoms, including:
Only a small percentage of abnormal Pap tests indicate
cervical cell changes that may progress to cervical cancer.
cervical cancer may include:
The cervix contains two kinds of cells:
rectangular-shaped columnar cells on the surface of the cervix and in the
cervical canal; and flat, scalelike squamous cells on the surface of the
cervix. Columnar cells are constantly changing into squamous cells
in an area of the cervix called the
Abnormal Pap test results can be caused by infection,
which leads to cell changes in the
transformation zone of the
cervix. Pap test results often return to normal when
the cells have returned to healthy growth or after an infection has been
treated or has resolved on its own.
In some cases, untreated
cervical cell changes that cause abnormal Pap tests may progress to
precancerous or cancerous stages. Certain high-risk types of the
human papillomavirus (HPV) have been linked to the
cervical cancer. But changes in cervical cells usually
progress slowly and take many years to become cancer cells. Treatment can
remove or destroy these cells before they become cancerous.
Regular Pap test screening can detect cervical cell changes
Cervical polyps are unrelated to cervical cancer, but
they may be found and removed at the time of a pelvic exam and Pap test.
Most cervical cell changes
that cause an
abnormal Pap test are the result of sexual
transmission of HPV disease. High-risk sexual behaviors by you or your partner
at some time, possibly even many years ago, may lead to HPV infection.
High-risk sexual behaviors increase your risk of infections and
sexually transmitted infections (STIs).
risk factors that may also play a role in increasing your risk for cervical
cell changes include:
If you have had one abnormal Pap test result, you may be at
higher risk for having another abnormal Pap test in the future.
Most problems that cause
abnormal Pap tests do not cause symptoms, so you won't
know you have cervical cell changes. Regular Pap testing is needed to detect
early cervical cell changes.
Call your doctor if:
If you think you may have
symptoms of a sexually transmitted infection (STI), call
your doctor for an appointment. Avoid sexual intercourse
until you have been treated for your symptoms and can no longer infect your
If your sex partner has symptoms of an STI, both of you
should be evaluated by a doctor. If you have been diagnosed with an STI, such
as genital warts, your
sex partner(s) may want to be evaluated.
If you have had an abnormal Pap test, be certain
to complete any additional testing or treatment that your doctor recommends.
You and your doctor can decide how often Pap test screening should continue or
whether other tests are needed.
Your family doctor or any of the following health
professionals can manage an abnormal Pap test:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
You may have a
Pap test as part of your routine gynecologic exam. A
Pap test is used to identify abnormal cell changes on your
cervix and to screen for
cervical cancer. Pap test screening is the most
effective way to detect early abnormal cervical cell changes.
Women older than age 30 may have a screening test for HPV infection at
the same time they have their Pap test.1
The recommended Pap test schedule is based on your age and on things that increase your risk. For most women, it is best to have a Pap test every 1 to 3 years. Talk to your doctor about when to have your first Pap test and how often to have this test.
If your Pap test result is abnormal, the lab will use
the Bethesda system (TBS) to describe how severe the problem is. Your doctor will use these results to decide how to treat the problem.
Following an abnormal Pap test
result, more tests may be needed to determine whether an infection is
present or to determine the severity of cervical cell changes. These additional
For more information, see:
For information on tests to diagnose a specific
infection, see the specific topic:
liquid-based collection, are being used in many areas
of the United States. Liquid-based collection methods allow testing for HPV at
the same time as a Pap test, but these methods may not be available everywhere and
may be more costly.
The terms used to report Pap test results vary
depending on which classification system is used. The Bethesda system (TBS) is
used by most labs in North America. Other classification systems are used
around the world.
Even though most
abnormal Pap tests are caused by an
HPV infection that will go away or by an inflammation
that can be treated, you will need a follow-up evaluation to make sure your
abnormal cell changes have resolved. Your need for treatment will vary
depending on whether your abnormal cell changes are mild, moderate, or severe.
Abnormal Pap test results may show minor cell changes (most common), moderate
to severe cell changes (less common), or
cervical cancer (rare). Depending upon the cause and
severity of the cervical cell changes,
you may need treatment.
If your Pap test shows that a vaginal infection or a treatable
sexually transmitted infection (STI) is present, you can
be treated with medicine.
Human papillomavirus (HPV) infection is the most
common cause of an abnormal Pap test. There are many types of HPV. High-risk
types can cause cell changes that could develop into cancer.
An abnormal Pap test result is not uncommon because HPV infection is
very common. Most cell changes seen in abnormal Pap test results will not
progress to cervical cancer. If your abnormal Pap test shows
minor cell changes, you may have several choices of what to do next.
Based on your age and the type of cell changes found, your doctor may recommend:
Treatment decisions for an abnormal Pap test that shows
moderate to severe cell changes are based on the Pap
test results, colposcopy, and cervical biopsy. A larger tissue sample may be
removed by a
cone biopsy. In some cases, this procedure may serve
as treatment so you are cured. Follow-up to evaluate and treat moderate to
severe cervical cell changes is recommended sooner than for minor cell changes.
For moderate or severe precancerous cell
changes confirmed by biopsy, treatment will focus on destroying or removing the
abnormal tissue. Treatment choices include
LEEP, a surgery that uses a thin wire loop to remove
the abnormal tissue;
cryotherapy, which destroys tissue by freezing it;
laser therapy, which destroys tissue with a laser
cone biopsy (conization), in which a cone-shaped piece
of abnormal tissue is removed from the cervix.
cervical cancer, treatment will focus on destroying or
removing the cancerous tissue. For more information, see the topic
Pap test may be done during pregnancy if a woman is due for her regular
screening test. A
pregnant woman with an abnormal Pap test is monitored
closely throughout her pregnancy. Monitoring may include evaluation by
colposcopy. The goal of evaluation is to rule out
cervical cancer, a rare diagnosis. Treatment for abnormalities other than
cancer is done after delivery.
You cannot prevent an
abnormal Pap test, but you can reduce your risk
The Pap test is
the most effective screening test to prevent the development of
cervical cancer. Pap tests done at regular intervals
almost always detect cervical cell changes before the changes become cancerous.
Regular screening for and treatment of cervical cell abnormalities can prevent
the abnormal cell changes from developing into cancer.
Women who smoke are at higher risk
for developing cervical cell changes that cause an abnormal Pap test. The
reason for this is not fully understood. Quitting smoking may decrease this
risk. Not smoking has many other health benefits. For example, nonsmokers have
a lower risk of other cancers and heart disease. For more information, see the
Sexually transmitted infections (STIs), especially
HPV infection, often cause abnormal Pap tests and can
lead to other serious health problems. Preventing an STI is easier than
treating an infection after it occurs.
Your risk for an STI increases if you have several sex
partners at the same time or if your sex partner has more than one
The vaccines Cervarix(What is a PDF document?) and Gardasil(What is a PDF document?) protect against two types of HPV that cause cervical cancer. Gardasil also protects against two types of HPV that cause genital warts. Three shots are given over 6 months. It is recommended for children age 11 or 12 but can be given as early as age 9. For girls who have not already gotten the vaccine, it is recommended up to age 26. For boys who have not already gotten the shot, the vaccine is recommended up to age 21. Gardasil is used for males. Females can get either vaccine. For more information,
see the topic
For more information on
getting your child vaccinated, see:
abnormal Pap tests require follow-up. In some cases,
you may need further testing or treatment. In other cases, your doctor may
recommend a period of
watchful waiting that includes repeat Pap
To reduce your risk of cervical problems:
Medicines may cure a bacterial, fungal,
or protozoal infection and allow
minor cell changes called atypical squamous cells of undetermined significance
(ASC-US) that have caused an
abnormal Pap test to return to normal. HPV infection
cannot be treated with medicine. The infection or inflammation changes of
cervical cells are monitored in the following sequence:
Estrogen cream. Women near
menopause may have abnormal Pap test results because
of normal body changes during menopause, such as cervical cell atrophy and
estrogen loss. These minor cell changes may improve with the use of estrogen
If you have had an
abnormal Pap test, surgery may be an option. Surgical
treatment may be recommended if:
Surgery may be done to destroy or remove the abnormal cells
on your cervix, or confirm or rule out the possibility that you have cervical
Abnormal tissue that can be seen through the magnifying
viewing instrument (colposcope) can often be destroyed or removed with
cryotherapy, a cone biopsy, a carbon dioxide (CO2) laser, or the loop
electrosurgical excision procedure (LEEP).
Abnormal cervical cells
that are detected by a Pap test but cannot be seen by colposcopy may be high in
the cervix (cervical canal). Before treatment is recommended, the location and
type of cell change must be confirmed by a cervical biopsy. Depending on the
results of the colposcopy and cervical biopsy, a
cone biopsy may be done as the next step.
Surgical choices for abnormal cervical cell changes
include the following:
If the results of a Pap test, colposcopy, and
cervical or cone biopsy point to invasive cervical cancer, then surgery,
radiation, chemotherapy, or a combination of treatments will be needed to
destroy or remove the cancerous tissue.
For more information, see the topic
Minor cell changes may not need
to be treated with surgery. When deciding on treatment for minor cell changes,
consider the following:
Treatment choices for moderate to severe cell changes are
more likely to include surgery to specifically destroy or remove the abnormal
Removal of the uterus (hysterectomy) may be a treatment choice for some women
who have had an
abnormal Pap test if both of the following are
American Congress of Obstetricians and Gynecologists
(ACOG) is a nonprofit organization of professionals who provide health care for
women, including teens. The ACOG Resource Center publishes manuals and patient
education materials. The Web publications section of the site has patient
education pamphlets on many women's health topics, including reproductive
health, breast-feeding, violence, and quitting smoking.
This organization of health professionals provides education and
information on reproductive health matters such as sexual health, sexually
transmitted diseases (STDs), family planning, contraception, and
The National Center for HIV/AIDS, Viral Hepatitis, STD,
and TB Prevention is a branch of the Centers for Disease Control and Prevention
(CDC). Its website provides information and updates on sexually transmitted
diseases (STDs), human immunodeficiency virus (HIV), and tuberculosis (TB). You
can also find fact sheets on these health topics.
This nonprofit advocacy group includes consumers, health
centers, and organizations. The National Women's Health Network monitors
federal health policy and operates an information clearinghouse.
American College of Obstetricians and Gynecologists
(2005, reaffirmed 2009). Human papillomavirus. ACOG Practice Bulletin No. 61.
Obstetrics and Gynecology, 104(4): 905–918.
Winer RL, et al. (2006). Condom use and the risk of genital human papillomavirus infection in young women. New England Journal of Medicine, 354(25): 2645–2654.
Other Works Consulted
American College of Obstetricians and Gynecologists
(2012). Screening for cervical cancer. ACOG Practice Bulletin
No. 131. Obstetrics and Gynecology, 120(5):
ASCUS–LSIL Triage Study (ALTS) Group (2003). A
randomized trial on the management of low-grade squamous intraepithelial lesion
cytology interpretations. American Journal of Obstetrics and Gynecology, 188(6): 1393–1400.
Cox JT, et al. (2003). Prospective follow-up suggests
similar risk of subsequent cervical intraepithelial neoplasia grade 2 or 3
among women with cervical intraepithelial neoplasia grade 1 or negative
colposcopy and directed biopsy. American Journal of Obstetrics and Gynecology, 188(6): 1406–1412.
Cuzick J, et al. (2003). Management of women who test
positive for high-risk types of human papillomavirus: The HART study.
Lancet, 362 (9399): 1871–1876.
Guido R, et al. (2003). Postcolposcopy management
strategies for women referred with low-grade squamous intraepithelial lesions
or human papillomavirus DNA–positive atypical squamous cells of undetermined
significance: A two-year prospective study. American Journal of Obstetrics and Gynecology, 188(6): 1401–1405.
Wright TC, et al. (2003). 2001 consensus guidelines
for the management of women with cervical intraepithelial neoplasia.
American Journal of Obstetrics and Gynecology, 189(1):
Wright TC, et al. (2007). 2006 consensus guidelines
for the management of women with abnormal cervical cancer screening tests.
American Journal of Obstetrics and Gynecology, 197(4):
February 9, 2012
Sarah Marshall, MD - Family Medicine & Kirtly Jones, MD - Obstetrics and Gynecology
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