What Are the Next Steps After an Abnormal Cervical Cancer Screening Test?
About 11,500 new cases of cervical cancer are reported each year in the United States. Yet, individuals who get regular cervical cancer screening, such as the Pap test, rarely experience this type of cancer. In other words, it matters more than you may think to attend your regular check-ups and routine exams.
And while the c-word sounds scary, abnormal cervical cancer screening test results don’t often mean cancer. So, what do they mean?
Well, the short answer is that these results frequently indicate the presence of the human papillomavirus (HPV) or early cellular changes that may lead to cancer (and can, thus, be monitored and treated accordingly). Below, we dig into these test results even further, helping you understand exactly what the next step is for your situation.
HPV Test Results
Surprisingly, HPV testing only began to be recommended fairly recently. As of 2003, the American Cancer Society started to advise physicians and other experts to use HPV testing as a screening option for cervical cancer.
An HPV test is usually recommended when you’ve had an abnormal Pap test result or if you’re over the age of 30. This test indicates if high-risk HPV types are present in the cervical cells, indicating either a positive or negative result. So, what do these results mean exactly?
What Does a Positive HPV Test Result Mean?
A positive HPV test result means a high-risk HPV type is present. Depending on the type you have, your doctor will recommend the next steps. Sometimes, this only means undergoing additional testing within a shorter amount of time, such as a year rather than five years.
It’s also important to note that if you’ve had HPV in the past, the infection can re-activate. In turn, you could have negative HPV test results after a positive result but then another positive result in the future.
What Does a Negative HPV Test Result Mean?
A negative HPV test result means you do not have a high-risk HPV type. This means that you don’t need to undergo additional testing. Instead, you will undergo your next test in the recommended five years. However, if you previously had abnormal results, this may differ; your healthcare provider will provide you with the next steps.
Pap Test Results
The Pap test indicates the presence of abnormal cervical cells or not. Results are either normal, abnormal, or unsatisfactory. So, what do each of these mean exactly?
What Does a Normal Pap Test Result Mean?
A normal Pap test result means there were no abnormal cells present. This is also called a “negative” test and means you don’t need further testing until your next routine test.
What Does an Abnormal Pap Test Result Mean?
Abnormal Pap test results or “positive” results indicate that there are cervical cells that don’t look normal. It’s important to note that this doesn’t mean cancer is present. Rather, it may indicate a higher risk of cancer developing. Thus, your physician will recommend further testing or monitoring.
What Does an Unsatisfactory Pap Test Result Mean?
If your test comes back as unsatisfactory, this indicates that the test will need to be redone. Not enough cells were collected, they were too clumped, or mucus and blood interfered with the test. Your doctor will, thus, recommend you redo the Pap test in two to four months.
What Follow-up Tests Are Involved After an Abnormal Pap Test or HPV Test?
Your doctor may recommend further testing or monitoring after an abnormal Pap or HPV test. These may include a colposcopy or a cervical biopsy—both of which we look at in more detail below.
Colposcopy
Sometimes, your doctor may refer you to a specialist for this brief procedure. During a colposcopy:
- Your doctor inserts a speculum into the vagina; this allows them to view the cervix easier.
- They will then place a vinegar solution on the cervix, which helps highlight abnormal areas.
- A colposcope is then used to close the vagina. From here, a light is used to allow a closer look at the vagina and cervix, allowing for the identification of any abnormalities.
This process also usually includes a biopsy after this last step. This allows your doctor to retrieve cells and have them examined microscopically in a laboratory.
Cervical biopsy
A biopsy involves the removal of cervical tissue. This is then examined under a microscope to detect abnormalities, such as those leading to cancer. In some cases, this process may also involve the removal of abnormal cells. During the entire process, your doctor will talk you through the procedure, ensuring you know what they are doing and when.
Bleeding is normal after a biopsy or colposcopy. Some individuals may also experience slight cramping. This should subside in a day or so.
Results from a biopsy indicate how much of the cervical tissue is affected by abnormalities. In cases of low-grade abnormalities, these may be monitored and left to go away on their own. With moderate CIN 2 changes and above, treatment is usually necessary. This may include:
- Removal of abnormal cells
- Laser therapy
- Loop electrosurgical excision procedure (LEEP)
- Cryotherapy
- Hysterectomy (for severe cases or cases that don’t respond to other treatments)
Your doctor will discuss the exact next steps specific to your situation and guide you through them. In many cases, with routine screening, cervical cancer is caught early enough that it isn’t life-threatening and is treatable. Thus, ensure you schedule your testing at regular intervals—it could very well save your life!
References
- Cervical Cancer Statistics | CDC. (n.d.). https://www.cdc.gov/cancer/cervical/statistics/index.htm
- Saraiya, M., Steben, M., Watson, M., & Markowitz, L. (2013). Evolution of cervical cancer screening and prevention in United States and Canada: implications for public health practitioners and clinicians. Preventive medicine, 57(5), 426–433. https://doi.org/10.1016/j.ypmed.2013.01.020
- HPV test – Mayo Clinic. (2023, October 28). https://www.mayoclinic.org/tests-procedures/hpv-test/about/pac-20394355
- Brown, D. R., & Weaver, B. (2013). Human papillomavirus in older women: new infection or reactivation?. The Journal of infectious diseases, 207(2), 211–212. https://doi.org/10.1093/infdis/jis662
- Pap smear – Mayo Clinic. (2022, June 18). https://www.mayoclinic.org/tests-procedures/pap-smear/about/pac-20394841
- Website, N. (2022, May 26). What happens on the day. nhs.uk. https://www.nhs.uk/conditions/colposcopy/what-happens/
