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Abnormal Pap Tests: What They Mean & What Happens Next

An abnormal Pap doesn’t necessarily mean HPV or cancer. Here’s what a Pap can detect and what the next steps are depending on your results.

Cervical screening through routine Pap tests can yield various results. If you’ve never received an abnormal test result before, it can come as a scare — but abnormal results are a lot more common than you might think.

To understand what can cause abnormal results, and what the next steps are after receiving one, we sat down with two of Jefferson Health’s women’s health nurse practitioners, Maureen Hughes-Brown, APN, and Ashley Ferris, APN.

How does a Pap test work?

A Papanicolaou test, commonly known as a Pap test, looks for signs of precancer and cellular change on the cervix, as these changes can become cervical cancer. Pap tests can be coupled with HPV (human papillomavirus) tests when appropriate.

It’s recommended that women — and others assigned female at birth* — between the ages of 21 and 29 have a Pap done by their gynecologist every three years, explains Hughes-Brown. After this age, Paps are performed every five years, as long as the results are normal. The test may be repeated or done more frequently depending on an individual’s health history or risk factors. Test results usually take about a week to come back.

*Read more on how gynecological cancer screenings work for transgender individuals and others in the LGBTQ+ community.

What Is HPV and its link to cancer?

HPV is the most common sexually transmitted infection (STI) — said to afflict nearly 85% of individuals in the U.S. at some point in their life — and is one of the primary causes of cervical cancer. It can also increase the risk for other cancers, including vulvar, vaginal, anal, penile, and head and neck cancers.

HPV is what usually causes an abnormal Pap test result, says Ferris. However, those within the 21-29 age bracket are not tested for HPV unless their Pap finds atypical cells that may indicate HPV.

“HPV can get into cells, causing them to change,” continued Ferris. “This can lead to increased activity of cancer-causing genes and can also suppress the tumor-suppressing genes — which are the genes we want to work. Essentially, HPV promotes cell mutation.”

“It’s important to remember that receiving abnormal Pap results is not something to be alarmed about right away,” explains Hughes-Brown. “We see abnormal pap tests often for different reasons.”

Other Common Reasons for Abnormal Paps

In the U.S., around 3 million Pap tests come back abnormal each year, but less than 1% are related to cervical cancer, Ferris explains. “Some people may have a yeast or bacterial infection, which can make cells appear reactive on the test.”

Other types of STIs can also lead to an abnormal test result, and sometimes just having sexual intercourse before your Pap test can affect the cells and hinder results.

What comes next?

What you do following an abnormal Pap largely depends on individualized factors, such as your age, whether you’re menopausal or not, and if HPV was or wasn’t detected. Hughes-Brown explains that more often than not, one of three things will follow:

  1. A follow up Pap test within 1 year to evaluate for further changes
  2. Treatment for any detected vaginal infections
  3. A colposcopy with a possible biopsy to make a definitive diagnosis.

How does a colposcopy work?

A Pap test is a screening tool — it identifies a problem before symptoms appear. However, a colposcopy, which may be performed after an abnormal Pap, is a diagnostic test.

Ferris explains that during a colposcopy, a special magnifying glass is used to examine the cervix and vagina. Acetic acid (like table vinegar) is used to identify any abnormal cells, which will absorb the acid and turn white. If any areas of suspicion are found, a biopsy will be done. It usually takes about 10-14 days for test results to come back.

One of the most common colposcopy findings is cervical dysplasia, or precancer. Cervical dysplasia is something that needs to be monitored closely, and decisions on follow-up care depend on age and the rating of precancerous cells, explains Ferris.

“If a patient is younger, we lean toward a more conservative, watchful-waiting approach, and will likely follow up with a repeat Pap. We avoid doing Loop Electrosurgical Excision Procedures (LEEPs) in younger patients, as it may hinder cervical competence and cause pregnancy issues,” explained Ferris. “For older patients, we are more likely to do a LEEP.” Regardless of age, precancerous cells of a high rating – or thus closer to developing into cancer — will need to be removed.

In more serious cases, when cancerous cells are found during a colposcopy, patients are referred for cancer care — which could mean surgical removal, chemotherapy and/or radiation. Cancer care is dependent on the stage of cancer — so, the earlier cancer is caught, the better.

Reducing your risk for HPV and cervical cancer

In general, the risk of contracting HPV increases with intercourse at a young age, high-risk sexual activity, and having many sexual partners. Those who are immunocompromised, such as organ transplant patients, are also at increased risk, as are smokers, points out Ferris. “Studies have shown that smokers are actually two times more likely to develop cervical cancer, because nicotine further damages the DNA of cervical cells and compromises the immune system, making it harder to clear an HPV infection.”

The FDA-approved HPV vaccine, GARDASIL®9, has been a gold standard for HPV and HPV-related cancer prevention for years. It protects against the nine most prominent strains of HPV and can be administered between the ages of nine to 45. (Editor’s Note: Read about the six most common vaccine misconceptions, debunked by Ferris and Hughes-Brown here.)

Abnormal or pre-cancerous cells typically do not cause symptoms, so having Pap tests done is important to detect these concerns as early as possible, reminds Hughes-Brown. It takes time for mutated cells to develop into cervical cancer. The best outcomes occur when abnormal cells are detected early.

Ferris and Hughes-Brown stress the importance of annual checkups with your gynecologist for preventative care. Be proactive about your health and stay on schedule for any screenings you may be due for.

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