Abnormal Pap smear: What happens next?

It’s time for your annual gynecologic exam and are due for a Pap smear and HPV test. You’ve had this routine screening for years, so you may be surprised when your doctor calls with different results. More than 50 million Pap smears are performed in the US each year. About 5% are abnormal, and of the 3 million women with abnormal results each year, less than 1% will be diagnosed with cervical cancer. 

“Cervical cancer is one of the most preventable types of cancer and getting a routine Pap smear helps find that,” says Mali K. Schneiter, DO, gynecologic oncologist at The Women’s Comprehensive Cancer Center at Ascension Saint Thomas. 

That's why it's so important to have your annual check ups with your OB-GYN.

Dr. Schneiteranswers common questions women have after receiving an abnormal Pap smear result.

What is a Pap smear?

A Pap smear, also called a Pap test, is a routine cervical cancer screening that checks your cervical and vaginal cells for changes. 

An abnormal Pap result means that some cervical cells look irregular and may need additional testing or follow-up. It doesn’t automatically mean cervical cancer. “Most routine pap smears are done with an HPV test,” shares Dr. Schneiter.“This HPV test helps to triage which Pap smear results may be more concerning for pre-cancerous changes and which can be followed with another Pap smear.” 

Many abnormal cervical cell changes are linked to human papillomavirus, or HPV, a sexually transmitted infection that can cause cervical cancer. While HPV is common and most infections clear on their own, some can last longer and cause changes in cervical cells.

“An abnormal Pap smear or HPV result tells us that additional evaluation or follow-up may be needed. That’s why making another appointment with your OB-GYN is important,” says Dr. Schneiter. 

Is a Pap smear different from a pelvic exam?

“Yes,” says Dr. Schneiter. “Both are important, but they serve different purposes.”

A Pap smear and HPV test are both screening tests. Your doctor uses a small brush to collect cells from your cervix and checks them for changes that could lead to cervical cancer.

A pelvic exam is a broader physical exam. Your OB-GYN examines the pelvic organs, including the vulva, vagina, cervix, uterus and ovaries, and checks for signs of other health concerns.

A Pap smear is often performed during a pelvic exam, but they are not the same thing. Your provider can explain which exams or screenings you need based on your age, symptoms, medical history and current health.

What happens after an abnormal Pap test?

Typically, your doctor’s office will call you if you have abnormal Pap results. If you receive notification before your doctor’s office gets in touch, a good next step is to contact the provider who ordered your test. They can explain your results and recommend the next step.

“The first step is to understand exactly what the results say and how they compare with your previous screening results, and if the HPV test is positive,” says Dr. Schneiter.

Cervical cell changes often don’t cause symptoms. That’s why, even if you feel fine, it’s important to complete the follow-up your gynecologist recommends. 

When are more gynecologic tests needed?

“A Pap smear is essentially a screening test that helps determine whether additional gynecologic tests are needed,” says Dr. Schneiter.

It’s also important to know that a Pap smear by itself does not screen for sexually transmitted infections (STIs), including HPV, gonorrhea or chlamydia. An HPV test may be performed at the same time as a Pap smear, because certain types of HPV can cause abnormal cervical cell changes, both tests may be important. If you have concerns about gonorrhea, chlamydia or another STI, ask your doctor about separate testing.

Depending on your Pap results and medical history, your doctor may recommend one or more additional tests.

Repeat Pap or HPV testing

If your Pap results are considered lower risk, your gynecologist may recommend repeating the Pap or HPV test after a certain amount of time. The timing depends on your results and previous screening history.

Ask your OB-GYN when you should be tested next.

Colposcopy

A colposcopy is a minor, nonsurgical procedure that gives your OB-GYN a closer look at your cervix. During the exam, your OB-GYN uses a speculum and magnifying instrument to find any abnormal areas in your cervix. A solution may also be applied to help identify areas that need further evaluation.

Your gynecologist may also take a small tissue sample from the cervical canal, called endocervical sampling, to check for abnormal cells that may not be visible during the exam.

“It's natural to be anxious before getting a colposcopy," says Dr. Schneiter. "It is a longer pelvic exam and the biopsies can be uncomfortable, however, it is an office-based procedure that doesn’t require anesthesia and that's typically well-tolerated. What's most important is that it will identify if there are cancerous cells." 

Tell your care team if you’re pregnant, may be pregnant or are trying to become pregnant, as this information can affect the timing and type of follow-up you’ll need.

Cervical biopsy

During a cervical biopsy, your doctor removes a small sample of tissue that will be sent to a pathologist to examine. Results may show normal tissue, pre-cancerous cells or cancer.

If pre-cancerous cells are found, your gynecologist may recommend further treatment, such as a loop electrosurgical excision procedure, also called LEEP, or a cone biopsy.

When should you see a gynecologic oncologist?

Most abnormal Pap results can be managed by your OB-GYN or women’s health provider. In some cases, your doctor may refer you to a gynecologic oncologist for additional evaluation.

This may happen if:

• A biopsy shows high-grade precancerous changes or cancer
• Your Pap results suggest a significant abnormality
• Cervical cancer is suspected or confirmed
• Imaging shows a pelvic mass or another concerning finding
• You’d like a second opinion
• Your symptoms, results or medical history require specialized evaluation

Take the next step for gynecologic care

An abnormal Pap result can leave you with questions, but you don’t have to figure out what comes next on your own. Start by reviewing your results with your OB-GYN and following through with any additional testing or next steps they recommend.

Your next step depends on your specific result, HPV status, age, previous screening history, medical history and other risk factors. If cancer is found, The Women’s Comprehensive Cancer Center at Ascension Saint Thomas can help connect you with the right care team when advanced gynecologic care is needed. 

If you need additional evaluation or a gynecologic specialist, Ascension Saint Thomas can help connect you with the right care team.

Next steps and helpful resources 

Learn about the Women’s Comprehensive Cancer Center at Ascension Saint Thomas 

Read how Dolores overcame stage 3 ovarian cancer

This blog is intended for general informational use. Any health-related information shared is not meant to provide or replace professional medical advice and does not establish a patient-provider relationship. If you are experiencing a medical emergency, call 911 or go to the nearest emergency room.