What Do Your Pap Smear Results Mean?

A Pap smear, also simply known as a Pap or Pap test, screens for cervical cancer and any abnormal cell changes on the cervix that might lead to cervical cancer. It does not screen for any other gynecological cancer like endometrial or ovarian cancer. Depending on the findings and the grade of any lesions, you may need additional testing, more frequent monitoring, or treatment.

Read on to find out more information about Pap smear results and what comes next.

What Is a Pap Smear?

A Pap smear involves collecting cells from the vagina and cervix—the lower, narrow end of the uterus, at the top of the vagina. It's usually done in conjunction with a pelvic exam. Pap smears look for abnormal cell changes that may lead to cancer and they also test for precancers. These precancers are often caused by human papillomavirus (HPV).

An HPV test is a test for high-risk, cancer-causing strains of HPV that can be done at the same time as a Pap test. It may also be performed on a Pap sample after it has been sent to a lab.

What Is HPV?

Human papillomavirus is a very common sexually transmitted infection (STI) that can lead to cervical cancer in some women. While there are many strains of HPV, only certain strains are linked to cervical cancer. The HPV test is designed to look specifically for these strains.

Normal Results

If your Pap smear is read as normal, your healthcare provider will also consider the results of your HPV test or recommend an HPV test on the same sample if it was not previously done.

If both your Pap smear and HPV test are normal—and if you do not have a history of abnormal Pap smears/HPV tests, you likely won't need any further testing or treatment until your next screening test is recommended. This is usually five years for HPV testing or co-testing.

Normal Pap But Positive HPV Test

If your Pap smear is normal but your HPV test is positive, your healthcare provider will talk to you about possible recommendations. Most commonly, this combination of results means that an HPV infection is present but not causing any abnormalities in the cervical cells at the time. Most HPV infections clear without causing abnormalities or cancer.

Sometimes, these results could be a false negative (a test result that incorrectly indicates a condition is not present) if the Pap smear sample did not pick up an area of abnormal cells.

According to the American Society for Colposcopy and Cervical Pathology (ASCCP), for women aged 30 years or older who are HPV-positive with a normal Pap smear, repeat testing can be done in one year. If any repeat HPV test is positive or a Pap smear shows a significant abnormality, colposcopy (a procedure that closely examines the cervix, vagina, and vulva) is recommended.

Abnormal Results

If abnormal or unusual cells were discovered during your Pap smear, this is said to be a positive result. Keep in mind that a positive result doesn't mean you have cervical cancer. 

There are five categories of abnormal Pap smear results, which are:

• Atypical squamous cells of undetermined significance (ASC-US): This term is used to describe changes in cervical cells, and it is the most common abnormal Pap smear result. It's possible to tell if the changes are caused by HPV infection, irritation, or precancer.
• Squamous intraepithelial lesion (SIL): These abnormal changes may signal precancer. The changes can be described as low grade (LSIL) or high grade (HSIL). LSIL is very common and typically goes away on its own without treatment. HSIL can lead to cancer if left untreated.
• Atypical squamous cells (ASC-H): These may or may not be HSIL.
• Atypical glandular cells (AGC): These results suggest there may be a precancer of the upper part of the cervix or uterus.
  
• Cancer: This means that abnormal cells have spread deeper into the cervix or to other tissues.
  

Follow-Up Testing

The recommended follow-up after an abnormal Pap smear depends on the findings, any treatment you receive, your age, your history of Pap smears and HPV testing in the past, and more. Follow-up usually includes more frequent screening, such as HPV/Pap testing and colposcopy.

It's important to note that for people who have significantly abnormal Pap smears (such as those that are HSIL or precancerous) and after the initial period of increased screening, HPV testing or HPV testing plus a Pap smear will be required every three years for a full 25 years. The reason for this is that the risk of cervical cancer with these findings persists for at least 25 years.

Reflex Testing

Reflex testing is when you have a Pap smear and those same cells are also tested for HPV, or if you have an HPV test and a Pap test may be performed on those same cells.

HPV Typing

HPV typing is an HPV test that looks for the two main HPV strains that cause cervical cancer. These are types 16 and 18. If you test positive for HPV, this typing may be done.

Repeat Testing

For people under 25 years of age, a repeat Pap may be done in six months to a year, depending on the results. For those over 25, a repeat Pap may be done or both a repeat Pap and HPV testing may be recommended. The specific time period when this is done depends on your age, your medical history, your previous Pap results, and your abnormal results.

Colposcopy, Biopsy, and Endocervical Sampling

Those who are at high risk for high-grade abnormal cells may be referred for a colposcopy, biopsy, and endocervical sampling. A colposcopy uses a special magnifying device to examine the cervix and any abnormal areas.

A biopsy involves removing sample tissue of the cervix for further examination in a lab. Enndocervical sampling involves scraping and collecting cells from the endocervical canal (the passageway from the uterus to the vagina) to be examined in a lab.

Endometrial Sampling

If glandular cells show up on the Pap, this can be concerning. When these cells show up on a Pap, endometrial sampling may be done. This is when a small piece of tissue from the uterine lining, or endometrium, is biopsied so it can be sent to a lab for further testing.

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Prevention

If you've had an abnormal Pap smear or HPV test, careful follow-up and lifestyle measures may reduce your risk of developing cervical cancer. For example, while smoking does not cause cervical cancer, it appears to increase the chance that people who develop high-risk HPV infections (the cause of most cervical cancers) will go on to develop the disease.

In addition, HPV vaccination (Gardasil 9) is recommended for all people between the ages of 9 and 26 whether or not they have been sexually active. If you were not vaccinated within this window of time, you can still get the vaccine up until age 45. Your physician can help you evaluate if it makes sense in your case.

A Swedish study found that among women vaccinated under the age of 17, the incidence of cervical cancer was 88% lower than those who were not vaccinated. For those vaccinated later (between the ages of 17 and 30), the incidence was 53% lower.

Summary

A Pap test is a procedure that screens for cervical cancer. It takes samples of cervical cells that are sent to a lab for testing. Depending on your Pap test result, follow-up testing may be necessary. This depends on the type of changes, your HPV test results, and your medical history.

A Word From Verywell

Detecting cervical cancer early with a Pap smear gives you a greater chance of a cure. This test can even detect abnormal changes before they have an opportunity to progress to cervical cancer. It's important to keep up with your pap smears.