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doctor says that your Pap test, or Pap smear, was abnormal, it means that the test found
some cells on your cervix that do not look normal.
A Pap test may be done as part of a woman's routine physical exam, because it's the best way to prevent cervical cancer. But having an abnormal test result doesn't mean you
have cancer. In fact, the chances that you have cancer are very small.
Most of the
time, the abnormal cell changes are caused by certain types of
human papillomavirus, or HPV. HPV is a
sexually transmitted infection.
Usually these cell changes go away on their own. But certain types of HPV have been linked to
cervical cancer. That's why regular Pap tests are so important.
Sometimes the changed cells are due to other types of infection,
such as those caused by bacteria or yeast. These infections can
In women who have been through menopause, a Pap test may find cell
changes that are just the result of getting older.
Certain sexual behaviors, like having sex without condoms and having more
than one sex partner (or having a sex partner who has other partners), can increase your risk for getting HPV. And HPV raises your risk for having an abnormal pap test.
HPV can stay in your body for many years without your knowing it. So even
if you now have just one partner and practice safer sex, you could still have an
abnormal Pap test if you were exposed to HPV in the past.
or having an
impaired immune system also raises your chances of
having cell changes in your cervix.
changes themselves don't cause symptoms. HPV, which causes most abnormal Pap
tests, usually doesn't cause symptoms either.
If a different sexually transmitted infection is the cause of your abnormal test, you may have symptoms such as:
You may need more tests to find out if you have an
infection or to find out how severe the cell changes are. For example, you may need:
A colposcopy is usually done before any treatment is
given. During a colposcopy, the doctor also takes a small sample of tissue from
the cervix so that it can be looked at under a microscope. This is called a
Treatment, if any, will depend on whether your abnormal
cell changes are mild, moderate, or severe. In moderate to severe cases, you
may have treatment to destroy or remove the abnormal cells.
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abnormal Pap tests are caused by
Other types of
infection—such as those caused by bacteria, yeast, or protozoa
(Trichomonas)—sometimes lead to minor changes on a Pap
test called atypical squamous cells.
Natural cell changes that may happen during and after menopause can also cause an abnormal Pap test.
Certain sexual behaviors—such as having sex without condoms and having more
than one sex partner—increase your risk of getting an HPV infection. And an HPV infection raises your risk for having abnormal test results.
things that may also play a role in increasing your risk include:
If you have had one abnormal Pap test result, you're more likely to have another in the future.
Lab specialists label abnormal cells according to how abnormal they are—how different they are from normal cells. Knowing what type of abnormal cells you have helps your doctor decide on treatment.
Minor cell changes may disappear without treatment. But sometimes they turn into more serious cell changes. Types of minor cell changes are:
Moderate to severe cell changes—HSIL and AGC—are more likely to be precancerous and turn into cervical cancer if left untreated.
In some countries, other labeling systems are used. These systems may use the term dysplasia to describe cervical cell
changes. Or they may simply describe the changes as mild, moderate, or severe.
When your Pap test result is abnormal, you always need to follow up with your doctor. Often this just means having regular checkups and Pap tests. But sometimes it means more tests or treatment.
It's very important to complete any further testing
that your doctor recommends.
Most women won't need special testing or treatment. Instead, they'll follow a schedule of regular Pap tests to watch for cell changes. This is called watchful waiting. It may be recommended when:
It's okay to do nothing but watch and wait, because minor cell changes such as ASC-US or LSIL don't usually become more severe during a short period of watchful waiting.
Watchful waiting may not be a good choice if you don't think you'll be able to follow your doctor's recommendations about having regular Pap tests. Talk with your doctor about your testing choices.
After an abnormal Pap test, you may need more tests to look for infection or to find out more about your cell changes. These
The type of treatment you have will depend on what caused the abnormal test results.
Infection: If your abnormal test results were caused by a vaginal infection or a sexually transmitted infection, you can
be treated with medicine.
Menopause: Women near
menopause may have abnormal results because
of normal body changes during menopause. These minor cell changes may improve with the use of estrogen
Moderate or severe cell changes, such as HSIL. Your treatment will focus on destroying or removing the
abnormal tissue. Treatment choices include:
cervical cancer, treatment will focus on destroying or
removing the cancer. To learn more, see the topic
pregnant woman with an abnormal Pap test is monitored
closely throughout her pregnancy. Monitoring may include a
colposcopy. The goal is to rule out
cervical cancer, a rare diagnosis. If cancer is ruled out, treatment for abnormal cell changes is done after delivery.
The National Cancer Institute (NCI) is a U.S. government
agency that provides up-to-date information about the prevention, detection,
and treatment of cancer. NCI also offers supportive care to people who have cancer
and to their families. NCI information is also available to doctors, nurses,
and other health professionals. NCI provides the latest information about
clinical trials. The Cancer Information Service, a service of NCI, has trained
staff members available to answer questions and send free publications.
Spanish-speaking staff members are also available.
Other Works Consulted
American College of Obstetricians and Gynecologists
(2010). Management of abnormal cervical cytology and histology. ACOG Practice
Bulletin No. 99. Obstetrics and Gynecology, 112(6):
American College of Obstetricians and Gynecologists
(2012). Screening for cervical cancer. ACOG Practice Bulletin
No. 131. Obstetrics and Gynecology, 120(5):
Wright TC, et al. (2007). 2006 consensus guidelines
for the management of women with abnormal cervical cancer screening tests.
American Journal of Obstetrics and Gynecology, 197(4):
December 12, 2012
Sarah Marshall, MD - Family Medicine & Kirtly Jones, MD - Obstetrics and Gynecology
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