Abnormal Pap Smear

An abnormal Pap smear result can naturally cause anxiety, but it is important to remember that an abnormal reading is a screening finding, not a definitive diagnosis of cervical cancer. In the vast majority of cases, abnormal results simply indicate minor, temporary cellular changes triggered by routine tissue irritation, benign inflammation, or transient human papillomavirus (HPV) infections that the immune system frequently clears on its own.

Understanding Your Pap Smear Results

When laboratory professionals evaluate a Pap sample under a microscope, they examine the structure of both surface (squamous) cells and inner (glandular) cells. Results are reported using standardized Bethesda system terminology to help your physician determine the appropriate next step:

• Unsatisfactory: The collected sample lacked sufficient clear cells or was obscured (e.g., by blood or severe inflammation) and must be repeated.
• Negative for Intraepithelial Lesion or Malignancy (NILM): No cancerous or precancerous cells were identified. This standard baseline result includes normal findings as well as non-cancerous benign or reactive changes, such as those caused by routine tissue irritation or inflammation.
• ASC-US (Atypical Squamous Cells of Undetermined Significance): Mildly atypical surface cells detected; may be associated with temporary tissue irritation, benign inflammation, or an underlying HPV infection.
• ASC-H (Atypical Squamous Cells, Cannot Exclude HSIL): Atypical surface cells that carry a substantially higher risk of underlying high-grade precancer, typically requiring prompt colposcopic evaluation.
• LSIL (Low-Grade Squamous Intraepithelial Lesion): Early, mild cellular changes commonly associated with HPV, which the body’s immune system frequently clears over time.
• HSIL (High-Grade Squamous Intraepithelial Lesion): Significant cellular changes (often categorized medically as cervical dysplasia) that strongly suggest higher-grade precancerous changes and warrant prompt diagnostic follow-up.
• AGC (Atypical Glandular Cells): Abnormalities detected in mucus-producing glandular cells, which may originate from the endocervical canal, the endometrial lining of the uterus, or other pelvic structures, requiring comprehensive evaluation.
• Findings Suggestive of Malignancy (or Carcinoma): Cytological evidence suggesting invasive cancer; requires urgent diagnostic evaluation, including a colposcopy and tissue biopsy, as a biopsy is required to definitively diagnose cervical cancer.

Next Steps and Follow-Up Care

Receiving an abnormal Pap result does not mean you immediately need invasive procedures. Because cervical cell changes typically progress very slowly over several years, physicians recommend follow-up based on your age, medical history, HPV status, and specific cytological finding.

Depending on whether your cell changes are minor or higher-risk, your physician may recommend:

• Monitoring and co-testing: For lower-risk findings like ASC-US or LSIL, guidelines often suggest repeat Pap screening combined with HPV testing in 6 to 12 months to see if your body clears the altered cells naturally.
• Diagnostic colposcopy and biopsy: If your report shows higher-risk changes (such as ASC-H, HSIL, or AGC), a specialist will perform a colposcopy - a brief, in-office examination using a magnifying instrument to inspect the cervix and collect tissue samples (cervical biopsies) for definitive diagnosis.
• Excisional treatment: If high-grade precancerous tissue is confirmed by biopsy, minor outpatient procedures, such as a LEEP (Loop Electrosurgical Excision Procedure) or a cone biopsy, can safely remove the affected cell layer before it can progress.

Specialized Cervical Evaluation at Moffitt Cancer Center

At Moffitt Cancer Center, we offer Pap smears and follow-up testing as part of our commitment to early diagnosis and prevention. If you’ve recently received abnormal Pap smear results and have been instructed to pursue additional diagnostic tests, you can call 1-888-663-3488 or submit a new patient registration form online to request an appointment with one of Moffitt’s experienced gynecologic oncologists.

Our team specializes in diagnosing and treating cervical cancer and can schedule any appropriate tests with or without a physician’s referral. Virtual care appointments are sometimes available, but usually, an in-person exam and evaluation are necessary.