Cervical Cancer Series 04 Does an Abnormal Pap Test Mean Cancer?
“My Pap test result came back abnormal.”
When people receive this news, cervical cancer is often the first thing that comes to mind. Unfamiliar terms such as ASC-US, LSIL, or HSIL on the report can make the result feel even more frightening.
However, an abnormal Pap test result does not necessarily mean that you have cervical cancer.
A Pap test is a screening test, not a test that can confirm cervical cancer. An abnormal result means that some of the cells collected from the cervix look different from normal cells. The degree of change and the need for further evaluation must then be determined.
You should not assume that an abnormal result means cancer, but you should not ignore it either. It is important to understand the exact result, review any HPV test findings and previous screening history, and complete the recommended follow-up care.
What Does a Pap Test Look For?
A Pap test involves collecting cells from the surface of the cervix and examining their appearance under a microscope.
Its main purpose is to detect abnormal cervical cell changes, including changes that could potentially develop into cancer, at an early stage.
However, a Pap test examines only the appearance of the cells that were collected. It does not directly examine the entire cervical tissue, so a Pap test result alone cannot confirm a diagnosis of cervical cancer.
The roles of the different tests can be summarized as follows:
A Pap test is a screening test used to detect abnormal cervical cells.
A colposcopy uses a magnifying instrument to closely examine areas of the cervix that may look abnormal.
During a biopsy, a small tissue sample is removed and examined by a pathologist to determine whether precancerous changes or cancer are present.
In other words, an abnormal Pap test result is not the end of the diagnostic process. It is the starting point for deciding whether further evaluation is needed.
Why Can a Pap Test Result Be Abnormal?
HPV infection is the most common cause of abnormal cervical cell changes.
In particular, persistent infection with certain high-risk HPV types can cause changes in cervical cells. However, detecting HPV or abnormal cells does not mean that cervical cancer is already present.
Abnormal results may also occur because of inflammation of the cervix or vagina, temporary irritation, certain infections, or hormonal changes associated with pregnancy or menopause.
For this reason, the word “abnormal” alone cannot reveal the cause or level of risk. The specific type of cellular change, the high-risk HPV test result, and whether similar changes appeared on previous tests must all be considered.
What Does ASC-US Mean?
ASC-US stands for “atypical squamous cells of undetermined significance.”
It means that some squamous cells from the cervix do not look completely normal, but it is unclear whether the changes are related to HPV or to another cause, such as inflammation or irritation.
ASC-US is a relatively common abnormal Pap test result. It does not, by itself, indicate a precancerous lesion or cancer. The high-risk HPV test result is an important factor in deciding what should happen next.
If high-risk HPV is not detected, immediate colposcopy or biopsy may not be necessary. Instead, repeat testing may be recommended after a specified interval.
If high-risk HPV is detected, additional information—such as whether HPV 16 or 18 is present and previous screening results—may be used to determine whether further evaluation, including colposcopy, is needed.
If you receive an ASC-US result, check whether an HPV test was performed and whether high-risk HPV was detected.
What Does LSIL Mean?
LSIL stands for “low-grade squamous intraepithelial lesion.”
It means that relatively mild cellular changes, usually associated with HPV infection, were observed. Particularly in younger patients, these cell changes often return to normal as the immune system clears or controls the HPV infection.
However, an LSIL result should not be ignored without appropriate follow-up.
Because a Pap test examines sampled cells rather than the cervical tissue itself, the result cannot completely rule out more significant changes elsewhere in the cervix.
Depending on age, HPV test results, and previous screening history, repeat HPV or Pap testing after a specified interval may be recommended. In other cases, colposcopy may be needed.
Even when two people receive the same LSIL result, their follow-up plans may differ depending on whether high-risk HPV was detected and whether abnormal findings have appeared on previous tests.
Does HSIL Mean Cervical Cancer?
HSIL stands for “high-grade squamous intraepithelial lesion.”
It means that more significant cellular changes are suspected than with ASC-US or LSIL. These changes may be associated with a high-grade precancerous lesion that could progress to cervical cancer if left untreated, so prompt evaluation is important.
However, HSIL is still not a confirmed diagnosis of cervical cancer.
Colposcopy and biopsy are commonly performed to determine the actual severity of the lesion. The biopsy result helps establish whether a precancerous lesion is present, how advanced it is, and whether treatment is needed.
Not everyone follows exactly the same pathway.
For some nonpregnant patients aged 25 or older whose combined results indicate a very high immediate risk of CIN3 or a more serious lesion, excisional treatment may be considered without first obtaining a confirming biopsy. Colposcopy is still performed at the time of treatment to guide the procedure.
This decision should be made through shared decision-making after discussing the benefits and risks of treatment, including its possible effects on future pregnancy outcomes.
An HSIL result should not be interpreted as proof of cervical cancer. Nevertheless, because it requires more urgent evaluation than ASC-US or LSIL, the recommended follow-up should not be delayed even if you have no symptoms.
There Are Other Types of Abnormal Pap Results
Abnormal Pap test results are not limited to ASC-US, LSIL, and HSIL.
A report may also include terms such as ASC-H, AGC, or AIS.
ASC-H means that atypical squamous cells were found and that a high-grade lesion cannot be excluded. AGC refers to abnormal changes in glandular cells, which may come from the inner cervical canal or the lining of the uterus. AIS, or adenocarcinoma in situ, is a high-grade glandular cell abnormality that has not invaded deeper cervical tissue.
Each of these findings has a different meaning and may require a different follow-up approach. It is therefore important to identify the exact term on the report and complete any additional evaluation recommended by your healthcare professional.
Why Can the Follow-Up Plan Differ for the Same Result?
Current cervical cancer screening guidelines do not determine follow-up care from a single Pap result alone.
Instead, healthcare professionals assess the overall risk that a high-grade cervical lesion is currently present or could develop in the future by considering both current results and previous medical history.
The assessment may include:
Your current Pap test result
Your high-risk HPV test result
Any available HPV type information, including HPV 16 or 18
Previous Pap and HPV test results
Previous colposcopy or biopsy findings
Any history of treatment for cervical precancer
Your age and pregnancy status
Your immune status
This is why two people with the same ASC-US or LSIL result may receive different recommendations. One may be advised to repeat testing after a certain period, while the other may need a colposcopy.
It is also why comparing your result directly with someone else’s experience online can be misleading.
Rather than deciding what to do based only on the name of the result, follow the recommendation of a healthcare professional who has reviewed both your current findings and previous screening history.
What Tests May Follow an Abnormal Result?
Not everyone with an abnormal Pap test result needs an immediate biopsy.
The next step depends on the estimated individual risk based on the severity of the cell changes, the HPV test result, and previous screening history.
If the risk is considered low, repeat HPV testing or Pap testing after a specified interval may be recommended to determine whether the infection or cellular changes persist.
If further evaluation is needed, a colposcopy may be performed.
During a colposcopy, a healthcare professional applies special solutions to the cervix and examines it through a magnifying instrument to identify areas that differ in color or appearance.
If a suspicious area is found, a small tissue sample may be removed for a biopsy.
Colposcopy and biopsy may be recommended when high-grade cellular changes are suspected or when the combination of current HPV and Pap results and previous screening history indicates that the risk of a high-grade lesion exceeds a certain threshold.
A biopsy may show normal tissue or inflammation. It may also show cervical intraepithelial neoplasia (CIN) or, less commonly, invasive cervical cancer.
What CIN1, CIN2, and CIN3 mean—and when observation or treatment may be needed—will be discussed in the next article.
What Should You Check on Your Test Report?
If you are told that your Pap test result is abnormal, first confirm the exact name of the result.
Being told only that “something abnormal was found” does not provide enough information to understand the severity of the changes or what follow-up is needed.
It may help to ask your healthcare professional the following questions:
What is the exact name of my Pap test result?
Was a high-risk HPV test performed?
Was high-risk HPV detected?
Does the report provide HPV type information, such as whether HPV 16 or 18 was found?
What test or evaluation do I need next?
When should I complete the follow-up?
Is this a new change compared with my previous results?
Has the same abnormality appeared before?
Keeping a copy of your report and providing records of previous Pap tests, HPV tests, colposcopies, or biopsies performed at other medical facilities can help your healthcare professional assess your individual risk and determine the appropriate next step.
Do Not Panic, but Do Not Delay Follow-Up Care
An abnormal Pap test result does not mean that cervical cancer has been diagnosed.
Many abnormal results are related to HPV infection or mild cellular changes and may return to normal over time. When necessary, follow-up testing and treatment can identify and manage lesions before they progress to cancer.
However, you should not assume that no further action is needed simply because the result is not a cancer diagnosis.
The purpose of Pap screening is to detect cellular changes before symptoms develop and to ensure that people who need additional evaluation or treatment receive it at the appropriate time.
Rather than drawing conclusions from the name of the result alone, review your HPV test findings and previous screening history with a healthcare professional and complete the recommended follow-up on schedule.
Key Takeaways
An abnormal Pap test result does not confirm cervical cancer.
ASC-US refers to atypical cells whose cause is unclear. LSIL indicates relatively mild, low-grade cellular changes. HSIL indicates high-grade changes that require prompt and thorough evaluation.
Other terms, including ASC-H, AGC, and AIS, may also appear on a Pap report, so it is important to confirm the exact result.
Even when two people receive the same result, their follow-up plans may differ depending on HPV test findings, previous screening history, age, pregnancy status, and other health factors.
When necessary, colposcopy allows the cervix to be examined more closely, and a biopsy can determine the actual severity of the lesion.
There is no need to assume the worst. However, completing the recommended follow-up on time is an important step in identifying changes that may require treatment and preventing their progression to cervical cancer.
References
National Cancer Institute. HPV and Pap Test Results: Next Steps After an Abnormal Test
National Cancer Institute. Cervical Cancer Screening
Perkins RB, Guido RS, Castle PE, et al. 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. Journal of Lower Genital Tract Disease. 2020;24(2):102–131.
American Society for Colposcopy and Cervical Pathology. Tips for Best Practice on the Role of Expedited Treatment
World Health Organization. Cervical Cancer
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