What happens if the Pap test results are abnormal?

An abnormal Pap test may not mean that cancer cells were found during the examination. There are many causes for abnormal Pap test results.

Your healthcare provider will evaluate the results to determine if you should have:

  • A repeat Pap test.
  • A colposcopy.
  • An HPV test.
  • A combination of the above.

Based on the results of these procedures and tests, you might need additional treatment.

Why would a repeat Pap test be necessary?

A repeat Pap test might be necessary if you had an infection at the time of the Pap test or if there weren't enough cells collected during the Pap test. Since decreased levels of estrogen can lead to vaginal atrophy (gradual decline in size and function) and also influence Pap test results, menopausal women might need to take estrogen before the repeat Pap test.

If the results of the repeat Pap test are still abnormal, your healthcare provider might recommend that you have a colposcopy to further evaluate the problem.

What is colposcopy?

Colposcopy is a closer examination of the cervix and the walls of the vagina. During the examination, a speculum is inserted into the vagina (as done in a Pap test). A doctor looks through a magnifying instrument called a colposcope to detect cervical problems that cannot be seen by the eye alone. Acetic acid (vinegar) is often used on the cervix to help visualize abnormal cells. During the colposcopy, the colposcope remains outside the vagina. Biopsies (tissue samples) of the abnormal cervical area might be taken. You should feel only minimal discomfort during this procedure.

Colposcopy is not always necessary immediately after an abnormal Pap test. Your healthcare provider will follow national guideline recommendations to determine best follow-up depending on your type of abnormal Pap result.

Based on new follow-up guidelines for minimally abnormal Pap tests (ASCUS-atypical squamous cells of undetermined significance), colposcopy is recommended as a follow-up option only when the HPV test is positive. Colposcopy is not recommended as the first option for evaluation unless the Pap test results indicate a definite and more severe abnormality.

What do the results of the HPV test indicate?

The HPV test results can accurately distinguish women who are at higher risk to have cervical abnormalities from those who do not. When compared to a Pap follow-up only, this test reduces the risk of delayed detection of high-grade disease or cervical cancer. In addition, the HPV test is a less expensive alternative to colposcopy. Colposcopy is often unnecessary when performed as the first follow-up option for minimal abnormalities indicated by a Pap test if they are negative for HPV.

What follow-up is needed if the Pap shows atypical squamous cells of undetermined significance (ASCUS)?

Pap results showing ASCUS cells are one of the most common abnormalities seen. If the HPV test results are negative, and a patient has a Pap abnormality showing ASCUS cells, a follow-up Pap test is usually recommended in three years. If the hybrid capture test results are positive, with ASCUS, a colposcopy is recommended. Recommendations for subsequent repeat Pap tests will be made by your healthcare provider after the colposcopy.

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