Oftentimes, results from a Pap test to screen for cervical cancer will reach you through your patient portal account before your provider has even had a chance to review them. This can cause confusion and even anxiety if the result isn’t “normal” or “negative.”

It can be easy to jump to the conclusion that something really awful is going on—cancer, an inability to have children or other scary scenarios. By the way, that’s almost never the case! Here are some common Pap test results and advice on how to put them into perspective until you hear from your provider’s office. But first…

What is a Pap test, and who needs one? 

A Pap test, or Pap smear, involves a healthcare provider swabbing cells from the cervix and sending them in a special liquid to a lab for testing. The cells are evaluated for changes that could (but probably won’t) lead to cervical cancer.

Pap smears are recommended for all people with cervixes between the ages of 21 and 65. Between age 21 and 29, recommendations are to test every three years if results are normal. Once you turn 30, you can continue this regimen of Pap tests every three years, or you have the option of choosing an HPV (human papilloma virus) test alone or together with a Pap test (called “co-testing”). Both options involving HPV testing may allow you to decrease cervical cancer screening frequency to every five years if all looks good. Many people can discontinue cervical cancer screening at age 65 if they have had normal results in the previous 10 years. Screening for sexually transmitted infections in individuals who have new partners or concerns about exposure should be done at least yearly.

What are the most common Pap smear results?

Negative for intraepithelial lesions and malignancy (NILM):

This means your test was “normal,” or “negative.” That’s great news! You’ll be advised on how often to have Pap tests over the next several years. That can mean you might not need another one for three to five years, depending on your age, the cervical cancer screening you’ve opted for and your unique situation.

Low-grade Intraepithelial Lesion (LSIL):

This is what it sounds like—the test showed mildly abnormal changes. In many cases, it’s best to do a colposcopy to make sure the changes to your cervix are just mild in nature.

Atypical Squamous Cells of Undetermined Significance (ASCUS):

This is not awful news. It just means “unclear.” Looking at the cells from your cervix, the pathologist did not think your cells were abnormal or scary-looking. However, some subtle change(s) were noted that mean the Pap test couldn’t be called “normal.”

If you didn’t have an HPV test as part of your initial screening, one will be ordered automatically with a Pap result of ASCUS. This is called “reflex” testing and you shouldn’t have to come back in; it can usually be performed using the cells your provider has already collected. The results of the HPV test will provide additional information your provider needs to make treatment or enhanced screening recommendations.

Don’t jump to conclusions with an ASCUS result–there may not be anything wrong with your cervix. And very likely, any abnormality that might be present is probably mild.

Atypical Squamous Cells, can’t rule out high-grade abnormalities (ASC-H):

Again, this is essentially “unclear.” It means the pathologist could not be certain while looking under the microscope that your cervical cells were definitely normal. However, some cells made the pathologist think there could be some moderate or severe abnormalities of the cervix.

Your provider may recommend a colposcopy following this type of result to help figure out if anything further needs to be done.

High-grade Intraepithelial Lesion (HSIL):

This means that cells were showing moderate or severe changes noted under the microscope. Further evaluation (a colposcopy) is important here. Please remember that this HSIL result on your Pap test does not mean you have cervical cancer. In fact, it’s still very unlikely.

Atypical Glandular Cells of Undetermined Significance (AGUS):

This is another “unclear” result, and this result isn’t very common. Your provider will want to do further testing to get a clear diagnosis.

Cervical cancer cells are present.

This is quite uncommon. Your provider will call you and help you get in to see the right specialist.

What is a colposcopy?

If your Pap test comes back with a result other than NILM or ASCUS, or an HPV co-test or reflex test indicates the presence of a high-risk variety of HPV, your provider may recommend a colposcopy as the next step.

During a colposcopy, the gynecologist will put a speculum in the vagina to see the cervix, just like during a Pap test. They’ll put vinegar on your cervix with cotton-tipped swabs, which can make an abnormal area turn white. Since the cervix is ordinarily pink, being able to see the possibly abnormal area(s) can really be helpful—and the vinegar doesn’t hurt.

After looking at the area, the provider may decide to take a tiny sample–or biopsy–from the area of the cervix that turned white. While some may feel no pain when a biopsy is done, others report varying degrees of pain. Ask your provider about your pain management options when discussing your procedure.

A biopsy isn’t always necessary with a colposcopy. But if a biopsy is done, you’ll get a phone call in a few days with the final result and your doctor’s recommendation for a follow-up.

When should I be concerned about my Pap smear results?

Hopefully, sharing more details about common Pap smear results helps ease anxiety. But never hesitate to ask your provider questions about your Pap test results. If you’re not sure you know what a particular result means, please call us! If you’re worried and wonder “just how bad is this?”—call us! Your provider’s job is to help you understand what the result means and what you should do next.

If you have not been seeing a healthcare specialist regularly, contact one of WHA’s offices to schedule an annual exam today. Your provider will talk about your Pap test history and help you decide how to proceed.