A person talking on their phone about their abnormal Pap smear results.

Abnormal pap smears: Everything you need to know

Getting notified that you had an abnormal Pap Smear can be worrisome. Let’s decode what these results mean and where to go from here.

Breaking down those abnormal pap smear test results

These things can be complicated, so it’s helpful to know the basics about pap smear results and what they mean. This way, if you receive abnormal results, you know exactly what comes next.

The basics

You might have some questions about the basic facts about pap smears.

  • What is a pap smear for? Human papillomavirus (HPV) is responsible for the majority of cases of cervical cancer, and cells that are infected look different than ones that aren’t infected. For this reason, providers collect and examine cervical cells to ensure that there aren’t any signs of a change in cell appearance. Your results from a pap smear can either be normal, unclear, or abnormal.
  • Is an abnormal pap smear serious? If you learn that a test came back abnormal, it’s completely normal for you to be startled or scared. But try not to worry — an abnormal pap smear only indicates that cervical cell appearance has changed. Typically, a change in cells is benign (noncancerous), and most abnormal test results don’t end in cervical cancer. The only way to know for sure is for your provider to do more tests.

What do my abnormal test results mean?

Results from pap smears aren’t black-and-white. There are a variety of ways that cells could appear to have changed. It’s helpful for providers to categorize abnormal results so that both of you know what’s going on and what it could mean. It’s also very important to remember that many abnormal results don’t result in anything serious. Here are the different types of abnormal pap smear test results.

  • ASC: (atypical squamous cells) means that the cells look different from ‘normal’ cells. There are two types of ASC:
    • ASC-US: (uncertain significance). This abbreviation represents changes that aren’t normal, but which usually don’t mean anything serious. These are the most common abnormal pap results. They could be a sign of HPV infection or another infection like yeast, a sign of inflammation, or even mean you have a benign cyst or polyp. If you’re healthy, you’ll need to have your HPV or HPV and pap test repeated within the year.
    • ASC-H: (possible high-grade squamous intraepithelial lesion). This means that there’s a possibility of cancerous development. It’s the more serious of the two, and your provider will want to do a colposcopy (more on what that means below).
  • LSIL: (low grade squamous intraepithelial lesions) Means that your provider noticed slightly abnormal changes in cell size or shape. These results are usually associated with HPV and they tend to go away on their own. If you get this as a result, your provider will factor in your HPV status to decide on a repeat pap smear or colposcopy for follow-up.
  • HSIL: (high-grade squamous intraepithelial lesions) Means that the cells look very different from how normal cells look, and it is more likely to indicate the potential for cervical cancer. This type of abnormal result basically means that without treatment, the patient could develop cancer. This is another instance in which a provider will want to perform a colposcopy.
  • AGC: (atypical glandular cells) Means that the changes a provider noticed aren’t normal but it’s unclear why. Glandular cells produce mucus in the opening of your cervix and your uterus, and changes in these cells are more serious and carry with them a higher risk of cervical cancer. In this case, a provider will most likely want to perform a colposcopy.

What are the different kinds of follow-up?

Again, it might be hard, but try not to worry about any results until you have any confirmation from a provider. Many times, a follow-up test can confirm that there’s nothing concerning about the cell changes. Depending on the results of your test and your healthcare provider’s opinion, you’ll have a different kind of follow-up appointment and test.

  • Watchful waiting: your provider might have you wait for a while before giving you another test.
  • Colposcopy: this involves your provider using a special lens to look at your cervix more closely.
  • Biopsy: to perform a biopsy, your provider will take a sample of your cervical tissue so that they can study it closely under a microscope.
  • Removing abnormal cells: this can be done right in your provider’s office.
  • Refer you to a specialist: this will probably be done if the condition is more serious.
  • A future routine appointment: Anyone with a cervix needs to get regular pap smears until they’re 65 years old, so the date of your next routine appointment depends on how old you are. Women who are 21-29 years old get a pap smear every 3 years, and women who are over 30 with three normal pap smear results can either go every 3 years or be tested for HPV with or without a pap smear every 5 years.

The bottom line on abnormal pap smears

It’s important to take your health seriously. But you can cause a lot of unpleasant stress for yourself if you immediately assume that an abnormal pap smear test result means ‘the worst.’ If your provider tells you that your pap smear results were abnormal, try to keep in mind the variety of things that this could mean, and then schedule whatever type of follow-up is recommended. When it comes to abnormal pap smear results, the best things you can do are to remain calm, educate yourself on what your results mean, and be proactive.

Reviewed by the Ovia Clinical Team


  • Mayo Clinic Staff. “Pap smear.” MayoClinic. Mayo Foundation for Medical Education and Research, March 15, 2018. Web. https://www.mayoclinic.org/tests-procedures/pap-smear/about/pac-20394841

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