Cervical Cancer Prevention and Early Detection

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Work-up of abnormal Pap test results

If your Pap test results are abnormal, your doctor may recommend testing again (with the Pap test and/or the HPV test), colposcopy, or a loop electrosurgical procedure (LEEP or LLETZ). What tests (or treatment) you need depend upon the results of the tests you had.

Atypical squamous cells (ASC-US and ASC-H)

If the Pap results show atypical squamous cells of uncertain significance (ASC-US), some doctors will repeat the Pap test in 12 months. Another option is to use the HPV DNA test to decide whether or not to do a colposcopy. If the human papilloma virus (HPV) is detected, the doctor is likely to order a colposcopy. If HPV is not detected, then the doctor will recommend that both the Pap test and the HPV test be repeated in 3 years.

If the results of a Pap test are labeled atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion (ASC-H), it means that a high grade SIL is suspected. The doctor will recommend colposcopy.

Squamous intraepithelial lesions (SILs)

These abnormalities are divided into low-grade SIL (LSIL) and high-grade SIL (HSIL).

For LSIL, further testing depends upon HPV testing:

  • If the HPV test result was negative (meaning the virus wasn’t detected), then repeating the Pap test and HPV test in one year is recommended.
  • If HPV was found, then colposcopy is recommended.
  • If no HPV test was done and the woman is at least 25 years old, colposcopy is recommended.
  • If the woman is under 25, she should have a repeat Pap test in a year.
  • Pregnant women with LSIL should have colposcopy.

For HSIL, either colposcopy or a loop electrosurgical procedure is recommended for women 25 and older. For women under 25, colposcopy is recommended.

Atypical glandular cells and adenocarcinoma in situ (on a Pap test)

If the Pap results read atypical glandular cells or adenocarcinoma but the report says that the abnormal cells do not seem to be from the lining of the uterus (the endometrium), guidelines recommend colposcopy with the biopsy type called endocervical curettage (endocervical scraping). The doctor may also biopsy the endometrium (this can be done at the same time as the colposcopy). For information about endometrial biopsy, see our document Endometrial (Uterine) Cancer.

If the atypical glandular or adenocarcinoma cells look like they are from the endometrium (based on how they look under the microscope), experts recommend a biopsy of the endometrium along with an endocervical curettage, but a colposcopy isn’t needed.

Last Medical Review: 05/02/2013
Last Revised: 02/04/2014