Understanding abnormal cervical cancer screening test results

understand hpv

What's next if you've had an abnormal test result? 

Many women have abnormal cervical cancer screening results. An abnormal result does not mean that you have cancer. Remember that cervical cell changes often go back to normal on their own. If they do not, it often takes several years for even high-grade changes to become cancer.

If you have an abnormal screening test result, additional testing is needed to find out whether high-grade changes or cancer actually is present. If results of follow-up tests indicate high-grade changes, you may need treatment to remove the abnormal cells. Your health care provider will thoroughly explain your test results to you and guide you through next steps for care, if needed. It’s important not to panic if your learn that your Pap test results are abnormal. This just means there are cells on your cervix that don't look like normal healthy cells. Just how abnormal they are varies a lot.

The American College of Obstetricians and Gynecologists (ACOG) shares everything you should know about abnormal cervical cancer screening test results. Learn more in the answers below. 

What causes abnormal results?

The main cause of cervical cancer is infection with HPV. There are many types of HPV. Some types have been linked to cancer of the cervix, , and . Some also can cause cancer of the head and neck. These types of HPV are known as “high-risk” types.

Most cases of cervical cancer are caused by just two high-risk types of HPV—type 16 and type 18. Cells that are infected with HPV appear different from normal cells under a microscope. Abnormal changes can be mild, or they can be more serious. The more serious changes can lead to cancer if not treated..

How are HPV test results described?

HPV test results show whether you have a high-risk type of HPV infection. Results are negative or positive:

  • A negative HPV test means that you do not have an HPV type that is linked to cancer.

  • A positive HPV test means that you have an HPV infection. This does not mean that you have cancer now, but it may be a sign that cancer could develop later. You may need follow-up testing

How are abnormal Pap test results described?

  • ASC-US—This means that changes in the cervical cells have been found. The changes are almost always a sign of an HPV infection. ASC-US is the most common abnormal Pap test result. ASC-US stands for atypical squamous cells of undetermined significance. “Squamous” refers to the type of cells that make up the tissue that covers the cervix.

  • LSIL—This means that the cervical cells show changes that are mildly abnormal. LSIL usually is caused by an HPV infection that often goes away on its own. LSIL stands for low-grade squamous intraepithelial lesion.

  • HSIL—This suggests more serious changes in the cervix than LSIL. It is more likely than LSIL to be linked to precancer and cancer. HSIL stands for high-grade squamous intraepithelial lesion.

  • ASC-H—ASC-H means that changes in the cervical cells have been found that raise concern for the presence of HSIL. ASC-H stands for atypical squamous cells, cannot exclude HSIL.

  • AGC—This means that changes have been found in glandular cells that raise concern for the presence of precancer or cancer. Glandular cells are another type of cell that make up the tissue that covers the inner canal of the cervix. Glandular cells also are present inside the uterus. AGC stands for atypical glandular cells.

What follow up testing may be needed? 

If you have a positive HPV test or an abnormal Pap test result, you may need further testing. The following tests may be done depending on your risk for cervical cancer. Testing is based on your age, initial screening test result, and any previous test results. Types of follow-up testing include the following:

  • Reflex testing—If you had an HPV test, a Pap test may be done on the same cells used for the HPV test. If you had a Pap test, an HPV test may be done on the same cells used for the Pap test. This is called reflex testing.

  • HPV typing—There is another kind of HPV test that looks specifically for HPV type 16 and HPV type 18. These two types cause the most cases of cervical cancer. This kind of HPV test is called HPV typing.

  • Repeat testing—For patients under 25, a repeat Pap test may be done in 6 months or 1 year. For patients 25 or older, repeat HPV testing or co-testing (having the HPV test and Pap test done at the same time) is recommended as a follow-up to some abnormal test results. Repeat HPV testing or co-testing may be done in 1 year or 3 years depending on your initial test result, your age, and the results of previous tests.

  • , and endocervical sampling—Colposcopy is an exam of the cervix with a magnifying device. If an area of abnormal cells is seen, you may need a cervical biopsy. For a biopsy, a small sample of tissue is removed and sent to a lab for testing. The lab testing can determine how severe the cell changes are. Endocervical sampling also may be done. This sampling uses a small brush or other instrument to take a tissue sample from the cervical canal.

  • Endometrial sampling—A sample of the endometrium (the lining of the uterus) is collected for study. Some women with an AGC result need to have this follow-up test.

If your initial test results show you have a very high risk of developing cervical cancer, you may consider treatment without additional testing. If your  recommends this option, you should talk together about the risks and benefits.

What does CIN mean on a biopsy report? 

Cervical intraepithelial neoplasia (CIN) is used to report cervical biopsy results. CIN describes the actual changes in cervical cells. CIN is graded as 1, 2, or 3:

  • CIN 1 is used for mild (low-grade) changes in the cells that usually go away on their own without treatment.

  • CIN 2 is used for moderate changes.

  • CIN 3 is used for more severe (high-grade) changes.

Moderate and high-grade changes can progress to cancer.

How are abnormal cervical cells treated? 

In general, there are two ways to treat abnormal cervical cells:

  1. Excisional treatment—Tissue is removed from the cervix and sent to a laboratory to be studied. Results can tell whether CIN actually is present and, if so, how severe it is.

  2. Ablative treatment—Abnormal cervical tissue is destroyed, and there is no tissue to send to a laboratory for study.

What type of excisional treatments? 

Excisional treatments include the following:

What are the type of ablative treatments?

Ablative treatments include the following:

  • —An instrument is used to freeze abnormal cervical tissue, which then sloughs off.

  • Laser therapy—A focused beam of light is used to destroy abnormal cervical tissue.

Will I need more cervical cancer screening after treatment? 

Yes, you should continue with routine cervical cancer screening. More frequent screening may be needed, depending on what type of abnormal cell changes you had. Talk with your ob-gyn about the screening you need.

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