Pap Smear

The Pap smear, which is also called a Pap test, screens for abnormal cells on the cervix that could indicate an infection, unhealthy cells, or cervical cancer. The Pap smear can find the earliest signs of cervical cancer, which can most often be cured if caught early.

Women should have a Pap smear along with a pelvic exam starting as a young adult as part of their routine healthcare. The frequency with which you have a Pap test depends on what is best for you, so ask your provider. We generally recommend:

  • Age 21 and older – Pap smear every two to three years.
  • Age 30 and older, with three normal Pap tests for three years in a row, you may only need a Pap test every two or three years.
  • Over age 65 – ask your provider if you can stop having Pap tests, as the occurrence of cervical cancer is very low at this time in your life.

You may need a Pap smear more frequently if:

  • You have a weakened immune system because of an organ transplant or you are undergoing chemotherapy or steroid treatments.
  • Your mother was exposed to diethylstilbestrol (DES) while she was pregnant with you.
  • Over age 65 – ask your provider if you can stop having Pap tests, as the occurrence of cervical cancer is very low at this time in your life.
  • You are HIV-positive.
  • You have had abnormal Pap smears in the past.

Your provider at Cheyenne Women’s Clinic will be happy to talk with you and recommend the best test schedule for you based on your current health and your health history. Call us for an appointment, 307.637.7700.

What Do Pap Test Results Mean?

The good news is most Pap test results are normal. And an abnormal test result doesn’t necessarily mean anything is wrong. It means that some of the cells on your cervix don’t look normal, signaling your provider to take another look.

Keep in mind this is only a guide. Talk to your provider about your specific results and what he or she recommends as a follow-up to anything abnormal.

Abnormal Pap Test Results

Normal is what we like to see and what we usually see. But in case your results aren’t normal, this is what those results mean:

ASC-US: Atypical squamous cells of undetermined significance. Squamous cells are those that make up the tissue that covers the cervix. This result indicates that there are changes on the cervix cells, which are almost always the sign of an HPV (Human Papillomavirus) infection. (Certain types of HPV have been linked to cervical cancer.) ASC-US is the most common result of an abnormal Pap test.

LSIL: Low-grade squamous intraepithelial lesion. Cervical cells show changes that are mildly abnormal. These changes are generally caused by an HPV infection that usually goes away on its own.

HSIL: High-grade squamous intraepithelial lesion. This is more serious than LSIL and is more likely to be associated with precancerous or cancerous cells.

ASC-H: Atypical squamous cells, cannot exclude HSIL. There are changes in the cervical cells that may signal the presence of HSIL.

AGC: Atypical glandular cells. Glandular cells are another type of cell (in addition to squamous) found in the cervix and also in the uterus. An AGC result means there are changes in the glandular cells that might raise concern for the presence of precancerous or cancerous cells.

What Happens After Abnormal Pap Test Results?

If you receive abnormal Pap test results, what your provider may have you do next depends on your age and other test results. Options may include:

Repeat Pap test or co-test: Sometimes the best approach is just to wait, then have another Pap test or Pap test along with an HPV test to see if the results have changed.

HPV test: An HPV test looks for the types of HPV that are most closely linked to cervical cancer. The reflex HPV test uses the same cells used for the initial Pap test. Another test, HPV typing, looks specifically for type 16 and type 18 cells, the two types of HPV that are the source of most cases of cervical cancer.

Colposcopy: An examination of the cervix with a magnifying device. If your provider sees an area that doesn’t look normal, he or she may decide to do a biopsy to get a better look.

Biopsy: Removing a small sample of tissue from the cervix and sending it to a lab for testing. That testing can determine exactly what actual changes there are in the cervical cells. Changes are rated according to three levels of CIN (cervical intraepithelial lesion). CIN 1 is mild changes that usually go away on their own without additional treatment. CIN 2 is moderate changes and CIN 3 is more severe changes. CIN 2 and 3 can progress to cancer, so they are often described as precancerous.

Endocervical sampling: Taking a tissue sample from the cervical canal using a small brush or other instrument.

Endometrial sampling: Taking a tissue sample from the lining of the uterus (endometrium). If you have an AGC result, your provider may recommend this follow-up test.

Recommended Follow Up

These are the follow-ups recommended by the American Congress of Obstetricians and Gynecologists (ACOG) if you have not had any abnormal Pap tests before. But everyone is different, and your provider may recommend a different course of treatment for you.

Normal Pap Test Results:

  • Ages 21-24: Routine screening, which is a Pap test every 3 years
  • Ages 25-29: Routine screening, which is a Pap test every 3 years
  • Ages 30 and older, HPV negative: co-testing (Pap and HPV) every 5 years or Pap test alone every 3 years
  • Ages 30 and older, HPV positive: co-testing every 12 months or HPV typing

ASC-US:

  • Ages 21-24: Repeat Pap test in 12 months or reflex HPV test
  • Ages 25-29: Reflex HPV test or repeat Pap test in 12 months
  • Ages 30 and older, HPV negative: co-testing (Pap and HPV) every 5 years or Pap test alone every 3 years
  • Ages 30 and older, HPV positive: co-testing every 12 months or HPV typing

LSIL:

  • Ages 21-24: Repeat Pap test in 12 months
  • Ages 25-29: Colposcopy
  • Ages 30 and older, HPV negative: Repeat Pap test in 12 months or colposcopy
  • Ages 30 and older, HPV positive: Colposcopy

ASC-H:

  • Ages 21-24: Colposcopy
  • Ages 25-29: Colposcopy
  • Ages 30 and older, HPV negative: Colposcopy
  • Ages 30 and older, HPV positive: Colposcopy

HSIL:

  • Ages 21-24: Colposcopy
  • Ages 25-29: Immediate removal of abnormal cells or colposcopy
  • Ages 30 and older, HPV negative: Immediate removal of abnormal cells or colposcopy
  • Ages 30 and older, HPV positive: Immediate removal of abnormal cells or colposcopy

AGC:

AGC has several subcategories. The follow-up tests recommended depend on the AGC subcategory, and include colposcopy, endocervical sampling, and endometrial sampling.

Again, this is only a guide. Your provider knows you and your medical history and will make the recommendations best for your situation.

Scroll to Top