What Do Your Pap Smear Results Mean?

How to Decode an Abnormal Test Result

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A Pap smear can reveal the presence of suspicious cells on the cervix that need further testing or treatment, which is why it's recommended that women have the test done by their physician regularly.

What Is a Pap Smear?

A Pap smear, also called a Pap test, is a procedure to test for cervical cancer. It involves collecting cells from the vagina and cervix—the lower, narrow end of the uterus that's at the top of the vagina.

The Pap smear is usually done in conjunction with a pelvic exam. In women 30 or older, a Pap smear may be combined with a test for human papillomavirus (HPV)—a common sexually transmitted infection that can cause cervical cancer in some women.

Normal Pap Smear Results

If only normal cervical cells were discovered during your Pap smear, you're said to have a negative result. You won't need any further treatment or testing until you're due for your next Pap smear and pelvic exam.

Abnormal Pap Smear Results

If abnormal or unusual cells were discovered during your Pap smear, you're said to have a positive result.

A positive result doesn't mean you have cervical cancer. What a positive result means depends on the type of cells discovered in your test.

Here are some terms your doctor might use and what your next course of action might be:

Atypical Squamous Cells of Undetermined Significance

One abnormal result you may receive is called Atypical Squamous Cells of Undetermined Significance, or ASCUS. Squamous cells are thin and flat and grow on the surface of a healthy cervix.

In the case of ASCUS, the Pap smear reveals slightly abnormal squamous cells, but the changes don't clearly suggest that precancerous cells are present.

In fact, while an ASCUS Pap smear result may sound alarming, it's considered only mildly abnormal and is actually the most common abnormal Pap smear result you can receive. There may, in fact, be no immediate cervical cancer risk associated with your ASCUS Pap smear result.

The most common causes of ASCUS Pap smear results are noncancerous (benign) conditions, such as infections or inflammation. These conditions can cause cervical cells to appear abnormal. Eventually, however, most cells return to a normal appearance with time.

For some women, an ASCUS result is due to changes in the cervical cells caused by HPV infection. With the liquid-based Pap smear test, your doctor can reanalyze the sample to check for the presence of certain high-risk types of HPV virus known to promote the development of cancers like cervical cancer.

If no high-risk viruses are present, the abnormal cells found as a result of the test aren't of great concern. If worrisome viruses are present, you'll need further testing.

That being said, in most cases, these cervical changes do not progress to cervical cancer but do require further monitoring and possible treatment to prevent an increased risk of cervical cancer.

Squamous Intraepithelial Lesion

This term indicates that the cells collected from the Pap smear may be precancerous.

If the changes are low grade, it means the size, shape, and other characteristics of the cells suggest that if a precancerous lesion is present, it's likely to be years away from becoming cancer.

If the changes are high grade, there's a greater chance that the lesion may develop into cancer much sooner. In this instance, additional diagnostic testing is necessary.

Atypical Glandular Cells

Glandular cells produce mucus and grow in the opening of your cervix and within your uterus. Atypical glandular cells may appear to be abnormal, which raises a worry for the presence of precancer or cancer.

Further testing is needed to determine the source of the abnormal cells and their significance.

Squamous Cell Cancer or Adenocarcinoma Cells

This result means the cells collected for the Pap smear appear so abnormal that the pathologist is almost certain a cancer is present.

"Squamous cell cancer" refers to cancers arising in the flat surface cells of the vagina or cervix. "Adenocarcinoma" refers to cancers arising in glandular cells. If such cells are found, your doctor will recommend a prompt evaluation.

Follow-Up After an Abnormal Pap Smear

Follow-up depends on the type of abnormality seen. Sometimes, only repeat testing is needed. In other instances, your doctor may perform a procedure called colposcopy using a special magnifying instrument (colposcope) to examine the tissues of the cervix, vagina, and vulva

Cervical Cancer Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

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Your doctor also may take a tissue sample (biopsy) from any areas that appear abnormal. The tissue sample is then sent to a laboratory for analysis and a definitive diagnosis. Based on these results, you may need treatment to remove any abnormal cells. After treatment, you will need to continue follow-up for cervical cancer screenings. 

A Word From Verywell

Detecting cervical cancer early with a Pap smear gives you a greater chance at a cure. Remain educated about your cervical health and keep up with your pap smears. Another tidbit is to remember not to have sex, douche, or use tampons or other vaginal hygiene products 48 hours prior to your Pap smear test, as these can give false results. 

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Article Sources
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  1. American College of Obstetrics and Gynecology. Frequently asked questions: abnormal cervical cancer screening tests. 2016.

  2. Karimi-zarchi M, Tabatabaie A, Dehghani-firoozabadi A, et al. The most common type of HPV in women with Atypical Squamous Cell of Undetermined Significance (ASCUS) in pap smear in Iran-Yazd. Int J Biomed Sci. 2015;11(4):173-5.

  3. American Cancer Society. The Pap (Papanicolaou) test. Updated December 9, 2016.