Pap Test Abnormalities: What They Mean and What Happens Next

A pap test is one of the most important tools available for preventing cervical cancer. Every year, thousands of women receive a phone call informing them that their pap test was "abnormal." While this news can be concerning, most abnormal pap test results do not mean cancer is present. In fact, many abnormalities are mild, temporary, and easily managed with appropriate follow-up care.

At Complete Healthcare in Richland, Washington, we believe that understanding your results can help reduce anxiety and empower you to make informed decisions about your health.

What Is a Pap Test?

A pap test, also called a Pap smear, is a screening test used to detect abnormal cells on the cervix. The cervix is the lower portion of the uterus that opens into the vagina.

The purpose of cervical cancer screening is to identify precancerous changes before they become cancer. Modern screening often includes testing for the human papillomavirus (HPV), which is responsible for the vast majority of cervical cancer cases.

By detecting abnormalities early, treatment can be performed long before cancer develops.

What Causes an Abnormal Pap Test?

An abnormal pap test means that some cervical cells appear different from normal under a microscope.

Common reasons include:

• HPV infection

• Inflammation

• Vaginal infections

• Hormonal changes

• Recent sexual activity

• Cervical polyps

• Precancerous cervical changes

• Rarely, cervical cancer

Most abnormalities are related to HPV infection and are not cancer.

Understanding HPV

HPV is one of the most common sexually transmitted infections in the world.

Important facts about HPV include:

• Most sexually active adults are exposed at some point.

• Many infections clear naturally within one to two years.

• Certain high-risk HPV types are associated with cervical cancer.

• HPV often causes no symptoms.

A positive HPV test does not mean someone has cancer. It simply identifies women who may require closer surveillance.

Common Pap Test Results Explained

Normal Pap Test

A normal result means no abnormal cervical cells were detected.

Women should continue routine screening based on age and risk factors.

ASC-US (Atypical Squamous Cells of Undetermined Significance)

ASC-US is the most common abnormal pap test result.

This means:

• A few cervical cells appear slightly abnormal.

• The changes are often minor.

• HPV testing helps determine whether further evaluation is needed.

If HPV testing is negative, many women can simply return to routine screening.

If HPV testing is positive, additional evaluation such as colposcopy may be recommended.

LSIL (Low-Grade Squamous Intraepithelial Lesion)

LSIL represents mild cellular changes usually caused by HPV.

Characteristics include:

• Often temporary

• Frequently resolves without treatment

• Common in younger women

• Usually associated with low-grade cervical dysplasia

Depending on age and HPV status, your provider may recommend repeat testing or colposcopy.

HSIL (High-Grade Squamous Intraepithelial Lesion)

HSIL indicates more significant cervical abnormalities.

This result suggests:

• Higher risk of precancerous changes

• Increased likelihood of cervical dysplasia

• Need for prompt evaluation

Most patients with HSIL require colposcopy and biopsy to determine the severity of the abnormal cells.

Early treatment of HSIL can prevent progression to cervical cancer.

ASC-H (Atypical Squamous Cells, Cannot Exclude HSIL)

This result means abnormal cells are present and a high-grade lesion cannot be ruled out.

Because of the increased risk of significant cervical abnormalities, colposcopy is generally recommended.

AGC (Atypical Glandular Cells)

Glandular cells originate from the cervical canal and uterine lining.

An AGC result is less common but requires careful evaluation because it may be associated with:

• Cervical precancer

• Endometrial abnormalities

• Cervical cancer

• Endometrial cancer

Further testing often includes colposcopy, cervical sampling, and sometimes endometrial biopsy.

What Is Cervical Dysplasia?

Cervical dysplasia refers to abnormal growth of cervical cells.

Biopsy results may be reported as:

CIN 1 (Mild Dysplasia)

• Mild abnormal changes

• Frequently resolves on its own

• Often monitored without treatment

CIN 2 (Moderate Dysplasia)

• Greater risk of progression

• May require treatment depending on age and circumstances

CIN 3 (Severe Dysplasia)

• Considered a high-grade precancerous lesion

• Usually treated to prevent cervical cancer

Importantly, dysplasia is not cancer. It represents cellular changes that can often be successfully treated before cancer develops.

What Is a Colposcopy?

A colposcopy is a specialized office procedure used to examine the cervix more closely.

During the procedure:

• A microscope remains outside the body.

• The cervix is visualized using magnification.

• Special solutions help identify abnormal areas.

• Small biopsies may be obtained.

Most patients tolerate colposcopy well and can return to normal activities afterward.

When Is Treatment Necessary?

Not every abnormal pap test requires treatment.

Treatment decisions depend on:

• Age

• HPV status

• Biopsy findings

• Degree of cervical dysplasia

• Future fertility desires

When treatment is indicated, options may include:

LEEP Procedure

Loop Electrosurgical Excision Procedure (LEEP) removes abnormal cervical tissue using a thin wire loop.

Benefits include:

• High success rates

• Outpatient treatment

• Preservation of fertility in most women

Can Abnormal Pap Tests Return to Normal?

Yes.

Many mild abnormalities improve naturally as the immune system clears HPV.

Factors that support cervical health include:

• Avoiding smoking

• Maintaining a healthy immune system

• Following recommended screening schedules

• Completing HPV vaccination when appropriate

Regular follow-up is critical because even mild abnormalities require monitoring to ensure they resolve.

The Importance of Routine Screening

One of the greatest successes in women's healthcare has been the reduction in cervical cancer through routine screening.

Women who skip regular pap tests are at greater risk for developing advanced cervical disease because abnormalities may go undetected for years.

Routine screening allows providers to identify and treat problems before they become serious.

When Should You Contact Your Provider?

You should contact your provider if:

• You receive an abnormal pap test result and have questions.

• You are unsure when your next screening is due.

• You experience abnormal bleeding.

• You have bleeding after intercourse.

• You develop persistent pelvic pain.

Prompt evaluation helps ensure the most appropriate treatment plan.

Expert Cervical Cancer Screening in Richland, WA

At Complete Healthcare, Dr. Richard Lorenzo and Kortney Jones ARNP provide comprehensive women's healthcare, including pap tests, HPV screening, colposcopy, cervical biopsies, and treatment of cervical dysplasia. Our goal is to detect abnormalities early, provide clear explanations, and develop individualized care plans that protect your long-term health.

If you have questions about an abnormal pap test or are due for cervical cancer screening, our team is here to help.

Complete Healthcare - Obstetrics and Gynecology

509-392-6700

Richard Lorenzo, D.O.

Kortney Jones ARNP