What does an abnormal Pap smear mean?

Medically reviewed by Neka Miller, PhD on February 11, 2021. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.


Pap tests are an important part of many women’s health preventative screenings and can help detect abnormalities and potentially cancerous cells on the cervix. But what does having an abnormal Pap smear mean?

We break down what an abnormal Pap smear means, if it’s related to HPV infection, and more—so read on.


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What does an abnormal Pap smear indicate?

If your Pap smear results come back abnormal, this means that the test detected abnormally shaped cells in your sample. Abnormal Pap smears are often the result of a cervical or vaginal infection, not cancer. Depending on your case, your healthcare provider may order additional testing to collect more cells or tissue samples from your cervix to further screen for cervical cancer.

If cancerous or precancerous cells are found in your sample, your physician may recommend a treatment plan based on your age and the degree of abnormality.

Are abnormal Pap smears common?

If you’ve recently had your Pap smear and the results came back abnormal, this isn’t necessarily cause for alarm—it’s more common than you may think. According to the cancer clinic Roswell Park, of the 3 million women with abnormal Pap tests each year, less than 1% (13,240 cases) will be diagnosed with cervical cancer. In fact, most of the abnormal cells found during a Pap test are the result of a cervical or vaginal infection, which are treatable conditions.

What is the next step after an abnormal Pap smear result?

If your Pap smear results are abnormal (remember, this is quite common), your healthcare provider may order additional testing to confirm the possibility of cervical cancer or remove cancerous cells. These additional tests may include the following:

Reflex testing

This refers to using an HPV test after an abnormal Pap smear result (or vice versa). An HPV test checks for the presence of human papillomavirus (HPV), which is a kind of sexually transmitted infection (STI or STD); certain types of HPV are associated with a high risk of cervical cancer. (Note that you can take an HPV test at home.)

Colposcopy

A minimally invasive procedure where the healthcare provider administering the test uses a magnifying device (colposcope) to take a closer look at your cervix. If abnormal cells are found during a colposcopy, then a biopsy can be performed to determine whether these cells are cancerous or precancerous.

Biopsy

A small sample of tissue is removed from the cervix. A pathologist then checks this tissue under a microscope to rule out the possibility of cancer.

Conization

Cone biopsy or cold knife biopsy and LEEP (loop electrosurgical excision procedure) are procedures that remove abnormal tissue from the cervix. They help ensure that no cancerous cells are in the cervix while removing any precancerous cells that are found.

Does an abnormal Pap smear mean you have HPV?

If you’re wondering if an abnormal Pap means you definitely have HPV, the short answer is “no.” But an abnormal Pap smear could lead you to follow up with an HPV test.

Here’s why: it’s very common that in addition to a Pap test, your healthcare provider may also collect an additional sample for an HPV test. Although the two samples are collected in much the same way, what they measure is significantly different:

  • A Pap test checks your cervical cells to see if they look normal
  • An HPV test assesses cervical cells to check for human papillomavirus (HPV) using DNA sequencing technology; if high-risk HPV types are discovered by the test, this means a significantly higher risk of cervical cancer

An abnormal Pap test result could also indicate that you may have HPV, which is a sexually transmitted infection (STI or STD). A Pap smear checks for signs of precancerous tissue growths by looking for abnormal cell changes in the cervix (these precancerous growths might develop into cervical cancer if they are not treated appropriately). Abnormal cell changes are often caused by HPV infection. So, while Pap tests do not directly test for HPV, if you have abnormal pap test results your healthcare provider may follow up with an HPV test to confirm whether you have this STD.


If you want to check for HPV without the waiting rooms or clinic visits, you can now screen for this STD from the comfort of your home. The Everlywell HPV Test allows you to collect your sample at home, send it to a CLIA-certified lab for testing, and receive your digital results in days. From there, you can choose to share your results with your healthcare provider to follow up and discuss next steps.


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References

1. Pap smear. Mayo Clinic. URL. Accessed February 11, 2021.

2. What Do My Cervical Cancer Screening Test Results Mean?. Centers for Disease Control and Prevention. URL. Accessed February 11, 2021.

3. Abnormal Pap Smear Follow-up. Roswell Park. URL. Accessed February 11, 2021.

4. Abnormal Cervical Cancer Screening Test Results. American College of Obstetricians and Gynecologists. URL. Accessed February 11, 2021.

5. Colposcopy. Mayo Clinic. URL. Accessed February 11, 2021.

6. Do Pap tests screen for sexually transmitted infections? Planned Parenthood. URL. Accessed February 11, 2021.

7. Pap and HPV tests. Office on Women's Health. URL. Accessed February 11, 2021.

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