Abnormal Pap Test
Treatment Overview
Even though most abnormal Pap tests are caused by an HPV infection that will go away or an inflammation that can be treated, you will need a follow-up evaluation to make sure your abnormal cell changes have resolved. Your need for treatment will vary depending on whether your abnormal cell changes are mild, moderate, or severe. Abnormal Pap test results may show minor cell changes (most common), moderate to severe cell changes (less common), or cervical cancer (rare). Depending upon the cause and severity of the cervical cell changes, treatment may be necessary.
Human papillomavirus (HPV) infection is the most common cause of an abnormal Pap test. There are many types of HPV; high-risk types can cause cell changes that could develop into cancer.
Evaluation of minor cell changes (ASC-US and LSIL)
An abnormal Pap test result is not uncommon because HPV infection is very common. About 5% to 10% of women who have a yearly Pap test will have an abnormal Pap result, but only a small percentage of these abnormal results indicate changes that may progress to cervical cancer. If your abnormal Pap test shows minor cell changes, you may have several choices of what to do next.
If your Pap test shows that a vaginal infection or a treatable sexually transmitted infection (STI) is present, you can be treated with medicine. STIs are also called sexually transmitted diseases (STDs).
Evaluation of ASC-US. If you have had a Pap test only and your test results show atypical squamous cells of undetermined significance (ASC-US), your doctor will repeat your Pap tests every 4 to 6 months. This is called watchful waiting and may be a good option if the abnormal tissue is not visible on the cervix or a type that is not likely to progress to cancer and you do not have an impaired immune system. Regular use of condoms during this time will increase the chance that abnormal cells will go away on their own.2
In some areas, you may be able to have a test for high-risk human papillomavirus (HPV) types. The natural course of most types of HPV is to resolve on their own within 18 months. HPV in women younger than 30 usually goes away on its own. HPV in women older than 30 is more likely to persist. Minor cell changes not related to high-risk HPV may not be significant and often go away. Even if you have a high-risk HPV type, more severe cell changes may never develop because high-risk HPV infections can also go away on their own. But if testing shows a high-risk HPV, your doctor will probably recommend a colposcopy and possibly cervical biopsy to look at the abnormal cells. If you do not test positive for a high-risk HPV, you can return to a normal screening schedule.7
HPV testing may be included in a watchful waiting period of time because it is a diagnostic test, not treatment. Watchful waiting is usually recommended only for women who will follow through with repeat Pap tests every 4 to 6 months.
Evaluation of LSIL. If the results of your Pap test show the minor cell changes called low-grade squamous intraepithelial lesions (LSIL), your doctor may recommend a colposcopy to evaluate the cell changes. Some women, especially those who have already gone through menopause, may be treated for atrophy with estrogen cream and then have a repeat Pap test. Colposcopy is needed only if the repeat test shows cell changes.
Adolescent girls with high-risk HPV, whether their Pap test shows ASC-US or LSIL, will usually have either a repeat Pap test at 6 to 12 months or a repeat HPV test at 12 months. This is because girls this age are extremely unlikely to develop cervical cancer, and HPV is likely to go away on its own. But if either of the follow-up tests are positive, colposcopy is usually the next recommended test.8
It is very unlikely that minor cervical cell changes would progress to cancer in a short period of watchful waiting. Atypical squamous cells of undetermined significance (ASC-US) cell changes usually remain the same or return to normal after the first abnormal result. Low-grade squamous intraepithelial lesions (LSIL) cell changes may be more likely to progress to more severe cell changes over time, but most LSIL cell changes return to normal or are not identified as more severe cell changes.1, 9
Minor changes found by a repeat Pap test and confirmed by colposcopy or biopsy can remain under observation (watchful waiting) or be treated to destroy or remove the abnormal tissue.
For more information, see:
Treatment for moderate to severe cell changes (HSIL)
Treatment decisions for an abnormal Pap test that shows moderate to severe cell changes are based on the Pap test results, colposcopy, and cervical biopsy. A larger tissue sample may be removed by a cone biopsy. In some cases, this procedure may serve as treatment so you are cured. Follow-up to evaluate and treat moderate to severe cervical cell changes is recommended sooner than for minor cell changes. If not treated, about 40% of women with untreated high-grade squamous intraepithelial lesions (HSIL) will progress to invasive cancer over a period of 10 years.10
- For moderate or severe precancerous cell changes confirmed by biopsy, treatment will focus on destroying or removing the abnormal tissue. Treatment choices include LEEP, a surgery that uses a thin wire loop to remove the abnormal tissue; cryotherapy, which destroys tissue by freezing it; laser therapy, which destroys tissue with a laser beam; or cone biopsy (conization), in which a cone-shaped piece of abnormal tissue is removed from the cervix.
- For cervical cancer, treatment will focus on destroying or removing the cancerous tissue. Treatment choices include a hysterectomy, radiation therapy, chemotherapy, or a combination of these therapies.
Treatment for an abnormal Pap during pregnancy
A Pap test may be done during pregnancy if a woman is due for her regular screening test. A pregnant woman with an abnormal Pap test is monitored closely throughout her pregnancy. Monitoring may include evaluation by colposcopy. The goal of evaluation is to rule out cervical cancer, a rare diagnosis. Treatment for abnormalities other than cancer is done after delivery.
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| Author: | Shannon Erstad, MBA/MPH Carrie Henley | Last Updated: April 10, 2007 |
| Medical Review: | Joy Melnikow, MD, MPH - Family Medicine Anne C. Poinier, MD - Internal Medicine Barbara S. Apgar, MD, MS - Family Medicine, Women's Health Ross Berkowitz, MD - Obstetrics and Gynecology Deborah A. Penava, BA, MD, FRCSC, MPH - Obstetrics and Gynecology | |
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