I Have an Abnormal Pap Test – What Happens Now?

pug worried about your abnormal pap test

When you get that call or letter from your doctor with abnormal pap test results, it’s normal to panic. Especially if this is the first abnormal result you’ve had. Let me reassure you – you likely do NOT have cancer. Most women will have at least one abnormal pap in their lifetime. And most of the time, with monitoring and sometimes treatment, the funky cells don’t turn into anything serious. That’s what paps were designed to do – pick up cervical weirdness BEFORE it becomes problematic.

After an abnormal pap, what happens next depends on your individual risk for cervical cancer. And THAT risk depends on 4 things:

  • What your pap test showed (how abnormal the cells on your cervix looked)
  • What your HPV test showed, if it was done (if you are positive for “high risk” HPV)
  • What your medical history is
  • How old you are

Your clinician is going to take all these things into account in figuring out the next step.

possible treatment plans

The most recent guidelines for abnormal pap management are really complicated. So complicated, in fact, that the recommendation is to use an app to look at these factors and come up with a plan. (So your doc isn’t cheating if they pull out their phone when talking to you!) And the plan could include any of the following:

  • Routine screening, in 3 or 5 years
  • Repeat pap test in 1 year
  • Colposcopy, a special exam of the cervix that often involves biopsies
  • Treatment by removal of the abnormal cells

Abnormal pap tests are most often reported as one of three things:

  1. Atypical cells of undetermined significance, or ASCUS
  2. Low grade squamous intraepithelial lesion, or LSIL
  3. High grade squamous intraepithelial lesion, or HSIL. 

ASCUS is a strange-sounding name for “well, it looks abnormal, but we can’t tell HOW abnormal.” If your HPV test was negative, you’ll likely just have a follow-up pap in 3 years.

LSIL is your typical abnormal pap result. The next steps are determined by your age and HPV result. If you’re under age 25 and negative, you’ll go back to routine screening. Positive, you’ll repeat your pap in a year. If you’re 25-60 and negative, you’ll come back for a pap in a year. Positive, you’ll have a colposcopy.

HSIL is the riskiest result–so no matter what your age or HPV results, you’re going for a colposcopy. And your doctor may recommend treatment at that time, depending on your pap and medical history.

special situations

These recommendations may be different based on your medical history. People who are living with HIV or are immunosuppressed are at greater risk of developing cervical cancer. That’s because they’re less likely to clear an HPV infection (it’s more likely to persist). And the longer HPV hangs around, the more likely the cervical changes will progress to cancer. People who are considered immunocompromised include:

  • Those who have received a solid organ or stem cell transplant,
  • Those with inflammatory bowel disease (ulcerative colitis or Crohn’s) on immunosuppressant treatment,
  • Those with lupus,
  • Those with rheumatoid arthritis on immunosuppressant treatment, and
  • Those without a spleen.

If you’re pregnant, or if you’ve had your uterus removed in the past (hysterectomy), the recommendations may also be a bit different.

Make sure your doctor takes all the time you need to explain to you what your test results mean, and what the follow-up should be for you. As long as you get the recommended follow-up, you’re likely to remain cancer-free.