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Abnormal Pap Test
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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.
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.
Evaluation of minor cell changes (ASC-US and LSIL)
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.
If your Pap test shows that a vaginal infection or a treatable sexually transmitted infection (STI) is present, you can be treated with medicine.
Evaluation of ASC-US. If you have had a Pap test only and your test results show atypical squamous cells of undetermined significance (ASC-US), you can:
- Choose watchful waiting, which includes repeat Pap tests every 4 to 6 months. Watchful waiting will not be harmful if the abnormal tissue is not visible on the cervix or a type that is not likely to progress to cancer and you do not have an impaired immune system.
- Have a test for high-risk human papillomavirus (HPV) types. The natural course of most types of HPV is to resolve on their own within 18 months. HPV in women younger than 30 usually goes away on its own. HPV in women older than 30 is more likely to persist. Minor cell changes not related to high-risk HPV may not be significant and often go away. Even if you have a high-risk HPV type, more severe cell changes may never develop because high-risk HPV infections can also go away on their own. But if testing shows a high-risk HPV, your doctor will probably recommend a colposcopy and possibly cervical biopsy to look at the abnormal cells. If you do not test positive for a high-risk HPV, you can return to a normal screening schedule.2
- Have a colposcopy so your doctor can look at the abnormal cells. A cervical biopsy may be done at the same time to confirm the colposcopy findings. Women with HIV infection will most likely be evaluated with colposcopy and then treated for any abnormal cervical cells.
Evaluation of LSIL. If the results of your Pap test show the minor cell changes called low-grade squamous intraepithelial lesions (LSIL), your doctor may recommend a colposcopy to evaluate the cell changes. Some women, especially those who have already gone through menopause, may be treated for atrophy with estrogen cream and then have a repeat Pap test. Colposcopy is needed only if the repeat test shows cell changes.
For more information, see:
Treatment for moderate to severe cell changes (HSIL, ASC-H, or AGC)
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 beam; or cone biopsy (conization), in which a cone-shaped piece of abnormal tissue is removed from the cervix.
For cervical cancer, treatment will focus on destroying or removing the cancerous tissue. For more information, see the topic Cervical Cancer.
Treatment for an abnormal Pap during pregnancy
A 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.
| By: | Healthwise Staff | Last Revised: December 28, 2010 |
| Medical Review: | Sarah Marshall, MD - Family Medicine Kirtly Jones, MD - Obstetrics and Gynecology | |
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