Understanding Pap Test Results
(Updated August 2008; Also available in Spanish)
|
cer • vix, n. the lower, narrow portion of the uterus where it joins with the top end of the vagina. |
The Pap test (also known as the Pap smear) is a simple and effective way of checking for cells in your cervix that are not normal and potentially cancer-causing. Cervical cancer, most often caused by human papillomavirus (HPV), is preventable by early detection and treatment of worrisome or abnormal cells.
What Do My Pap Test Results Mean?
Your Pap test is reported as either normal or one of several abnormal results. After your Pap test, make sure you receive your results. Don’t rely on no news meaning good news—make sure you receive your actual results. Based on the results, your age, and the likelihood of cancer, your health care provider will advise you about the possible next steps (shown in the table below). If the results are abnormal, the three most likely next steps are a repeat Pap test, HPV test, or colposcopy.
A normal Pap test does not mean “no chance of cancer.” It means there is a very low chance that cervical cancer is present. Because the Pap test is not perfect and can sometimes miss irregularities, including cancer, you should have the test on a regular basis to decrease the chance of missing cervical cancer or dysplasia (dis-PLAY-zha). If you notice unusual vaginal symptoms, such as bleeding between periods or pain during intercourse, you should see your health care provider even if your last Pap test was normal.
Colposcopy is a procedure used after an abnormal Pap test result to get a closer look at the cervix. It is usually performed in a health care provider’s office. The woman is positioned on the examination table as if she were having a Pap test. The health care provider uses a large microscope with a bright light to look closely at the cervix. The provider may take a tissue sample (known as a biopsy), which feels like a cramp and may cause mild discomfort. The entire procedure takes about ten to fifteen minutes.
| Normal (no abnormal cells seen) |
No abnormal cells |
Pap test in 1 to 3 years, depending on age and other factors |
| ASC-US (atypical squamous cells of undetermined significance) |
Cells look unusual but don’t look exactly like dysplasia (75% of women with an ASC-US result have no abnormal cervical cells, but to be safe all women need additional testing or evaluation) |
One of the following:
- HPV test; if this is positive, then colposcopy; if negative, then Pap test in 1 year
- Pap test in 4 to 6 months
- Colposcopy
|
| LSIL (Low-grade squamous intra-epithelial lesions) |
Mildly abnormal cells (most women with a LSIL result have HPV infection, which will usually go away on its own, but to be safe all women need additional evaluation) |
Colposcopy |
| HSIL (High-grade squamous intra-epithelial lesions) |
Moderately to severely abnormal cells (all women need further evaluation) |
Colposcopy |
False Positives and False Negatives
The Pap test is not perfect. Sometimes, the Pap test gives a positive (abnormal) result when everything is actually normal—this is called a “false positive.” The Pap test can also give a “false negative” result—a negative result when abnormal cells are present.
In fact, the Pap test can miss abnormal cells as much as half the time it’s used. False negatives can happen because the sample didn’t pick up cells from an abnormal area, discharge hid abnormal cells in the sample, or other reasons. False negative results can be harmful if they delay treatment for abnormal cells or cervical cancer.
Repeating the Pap test on a regular basis can help find abnormal cells that were missed before. Using a new kind of Pap test, in which cells are placed in a bottle of liquid, rather than on a glass slide, can lower the number of false negatives. The liquid-based Pap test gives fewer false negatives than the older test, because the liquid washes away discharge and makes abnormal cells easier to see.
The Well-Woman Visit
Based on recent advances in screening for cervical cancer, it is no longer the case that all women need a Pap test every year. If your recent Pap tests have been normal, your health care provider can recommend a safe frequency for screening based on your age, previous Pap test results, and previous HPV test results.
No matter how often you have a Pap test, you should have a yearly “well-woman visit” to stay healthy. The well-woman visit is a chance to talk about any concerns regarding your menstrual cycle, birth control, sexuality, infertility, or menopause (the change of life). During this visit, your health care provider can answer questions, address any concerns, perform a breast exam, and check for some common diseases, such as high blood pressure. Your provider might also perform a pelvic exam. The well-woman visit is different for each woman and is based on her unique needs.
If I Have HPV or an Abnormal Pap Test, What Can I Do?
- Educate yourself. The following Web sites offer additional information:
- Follow-up as recommended by your health care provider.
- Stop smoking. Women who smoke are more likely to have abnormal Pap tests and more likely to develop cervical cancer than women who do not smoke.
- Continue (or start) healthy habits, such as eating a nutritious diet.
- Try to remain calm. HPV is very common; you are not alone. The majority of sexually active Americans get HPV at some time in their lives.
- Don’t assume your partner cheated on you. Genital HPV is not a sign that you or your partner had sex outside the relationship. A person can have HPV for a very long time before it is found.
- Learn more about the HPV vaccine.
