a patient sits on an exam table and listens to her gynecologist

Abnormal Pap Tests Are Common, So What Do They Mean?

May 12, 2023

No one looks forward to a Pap test, but it’s one of the most important screenings that happen during visits to the gynecologist.

“Most cancers of the cervix can be identified early if you have regular pelvic exams and Pap smears,” says Reyna Payero, MD, an obstetrician-gynecologist (OBGYN) who focuses on health care across the continuum of a woman's  lifespan. “Pap screening has been one of the most successful preventive care measures undertaken in medical history.”

Regular Pap testing reduces cancer rates by 80%, according to the National Cancer Institute. Because cervical cancer usually takes many years to develop, screening identifies abnormal cells before they become cancer. Regular screening allows earlier detection and treatment of precancerous lesions.

Payero recommends patients age 21 to 65 have a Pap test every three to five years if the tests are normal and every 12 months if not. 

In countries where Pap screening has not been implemented due to lack of resources, cervical cancer is the second most common cancer in women and third most common cause of cancer-related mortality. Payero says education about screening methods is the best prevention in decreasing cervical cancer.

Here’s what she told us about abnormal Pap results.

What is a Pap smear?

A Pap smear (also called a Pap test) is a screening test performed by a gynecologist during a regular exam. It’s the best way to check for abnormal cells in the cervix (the neck or opening of the uterus) and can be further utilized to identify the risks for cervical cancer.

This is not the test for HPV (human papilloma virus, the virus that causes cervical cancer), though the two tests may be performed at the same time during a pelvic exam.   

What does it mean when a Pap test is abnormal?  

An abnormal Pap test result rarely means cancer is present, especially in someone who has regular, annual Pap tests. An abnormal result means there are cells in the cervix that look unusual, which can be caused by yeast or bacterial infection, irritation, benign growths, hormonal changes, or pre-cancer.

It is also possible to have a false abnormal if vaginal medicine, cream, gels, or douches have been used within 48 hours of a screening test, or if you had sex, or are menstruating. Talk to your doctor about these possible interferences.  

How common is an abnormal Pap smear result?  

Abnormal Pap smear results are common. According to the National Institutes of Health, 3.8% of Pap tests come back abnormal.

Most of the abnormal cells found during a Pap test are the result of a cervical or vaginal infection and are not cancerous.

What should you do if you have an abnormal Pap?

If your Pap test is abnormal, follow up with your gynecologist immediately to discuss next steps.

If the second, follow-up Pap test result is also abnormal, you might have a cervical biopsy, also known as a colposcopy. A biopsy removes cells or tissue so they can be checked under a microscope for further examination and/or as a treatment to remove abnormal cells, lesions, or tissue.

If high grade cells are noted on the biopsy, procedures such as LEEP or cone biopsy are considered.

Cells from a Pap test

Is there a relationship between an abnormal Pap today and something more serious in five or 10 years? 

An abnormal Pap test today may reveal pre-cancerous cells that could develop into cervical cancer later in life unless treated.

Development of cancer is a random process, requiring enough of the "right" mutations to cause a cell to replicate uncontrollably. A cell might look like it is in the beginning stages of that process, but might not fully progress to cancer. 

If a Pap test indicates pre-cancer, there will be regular and close follow-up to combat further development into cervical cancer.

If you have an abnormal Pap, should you get a vaccine to prevent cervical cancer?

According to the CDC, up to 93% of cervical cancers can be prevented by screening and with HPV vaccination. All patients should receive the vaccine. It is protective against nine strains of HPV.

Even if your Pap smear is abnormal, it may be due to only one strain, so you benefit from receiving the vaccine while undergoing treatment for the abnormal Pap.

Vaccination is definitely an important tool in our armament in preventing cervical cancer; however, the importance of routine screening is also vital in prevention.

What do all patients ask about Pap tests, and what do you tell them?  

Will the Pap smear be painful? No, it is not a painful procedure. However, it can be uncomfortable for some women. Fortunately, it’s quick.

Some patients might experience some light bleeding after the Pap smear, which should go away in a day or so.


Reyna Payero, MD, is an obstetrician and gynecologist (OBGYN) at ColumbiaDoctors and assistant professor of obstetrics & gynecology at Columbia University Vagelos College of Physicians and Surgeons. She also has a master's degree in public health policy and management from the Mailman School of Public Health at Columbia University.