What should I do if I have an abnormal Pap (Papanicolau) smear result?

Management of Abnormal Pap Smear Results

If you have an abnormal Pap smear, you should promptly follow up with colposcopy or repeat testing as recommended by your healthcare provider, as proper follow-up is critical for preventing cervical cancer. 1

Understanding Abnormal Pap Smear Results

Abnormal Pap smear results vary in severity and require different management approaches:

• Atypical Squamous Cells of Undetermined Significance (ASC-US)

  • HPV testing is the preferred next step
  • If HPV positive: Colposcopy is recommended
  • If HPV testing unavailable: Repeat Pap testing at 6 and 12 months 1

• Low-Grade Squamous Intraepithelial Lesion (LSIL)

  • Colposcopy is generally recommended
  • For women under 21: Repeat Pap testing at 12 and 24 months (due to high spontaneous clearance rates) 1

• High-Grade Abnormalities

  • High-grade squamous intraepithelial lesions (HSIL)
  • Atypical squamous cells, cannot exclude HSIL (ASC-H)
  • Atypical glandular cells (AGC)
  • Squamous cell carcinoma
  • All require immediate referral for colposcopy and directed biopsy 1

Follow-Up Protocol

1. Initial Follow-Up

   • If your Pap shows severe inflammation with reactive cellular changes:
     • Return for repeat Pap smear within 3 months
     • Any underlying infection should be treated before repeat testing 2

2. Colposcopy Procedure

   • Examination of cervix with special microscope
   • Directed biopsies of suspicious areas
   • Usually performed by gynecologist or specially trained provider 1

3. Post-Treatment Surveillance

   • After treatment for high-grade precancer:
     • HPV test or cotest at 6,18, and 30 months
     • Long-term surveillance for at least 25 years 1

Common Pitfalls to Avoid

1. Misunderstanding Follow-Up Instructions

   • Research shows 15-35% inconsistency between what patients recall and actual recommendations 3
   • Women with history of abnormal results and more severe abnormalities are at higher risk of misreporting recommendations 3
   • Solution: Ask for written instructions about your follow-up plan

2. Missing Follow-Up Appointments

   • Only about 50-60% of women adequately follow up on abnormal results 4, 5
   • Solution: Set reminders, ask for appointment reminder calls/texts

3. Barriers to Follow-Up

   • Financial concerns: Women who perceive costs as inexpensive have better follow-up rates 4
   • Lack of understanding about the importance of follow-up 6
   • Fear and anxiety about potential results 6
   • Solution: Discuss financial assistance options and ask questions to ensure understanding

Special Considerations

• Pregnancy: Pap smears are part of routine prenatal care; colposcopy can be safely performed during pregnancy 2

• HIV Infection: More frequent screening is recommended due to increased risk of cervical abnormalities and potentially faster progression 2

• Previous Abnormal Results: May require more vigilant follow-up and surveillance 1

Remember that proper follow-up of abnormal Pap smear results is essential for preventing cervical cancer. Multiple reminder attempts (up to 3) have been shown to significantly improve follow-up rates 5.