What Do Abnormal Pap Test Results Mean?

At least half of all women (50 to 80 percent) whose Pap smears are classified as abnormal

• don't have cervical cancer

• don't have a condition that will become cervical cancer

For a woman who has regular Pap smears, abnormalities detected by the test are most apt to be very early precancers. It can take as long as 10 years for these conditions to become cancerous.

The Pap smear is a screening procedure. It is used to detect cervical abnormalities in women who do not have any symptoms. It is not a diagnostic test. Diagnostic tests are performed to identify the cause of symptoms a woman is experiencing. The Pap smear can indicate the presence of abnormal cells but cannot indicate what conditions those abnormalities represent.

Abnormal Pap smear results do not

• identify the abnormality

• indicate whether treatment is necessary

• indicate what treatment is most appropriate

Abnormal Pap smear results do indicate the need for

• repeat screening

• diagnostic testing

What Happens If A Second Pap Smear Shows Abnormal Results?

If the second screening indicates that abnormalities are still present, the woman's doctor may perform one of the following diagnostic procedures.

• Colposcopy

• Colposcopic biopsy

• Cone biopsy

• Endocervical curettage

Colposcopy. After applying a vinegar-like solution that causes the outermost cells of the cervix to swell and become opaque, the doctor examines the cervix with a lighted magnifying instrument called a colposcope. This painless office procedure has no side effects and can be safely performed during pregnancy. If colposcopy reveals abnormal areas on the cervix, the doctor performs a biopsy to determine whether the condition is cancerous, precancerous, or noncancerous (benign).

Colposcopic biopsy. The doctor uses forceps to remove about 1/8 inch of tissue from an area of the cervix where abnormal cells have been detected. The doctor may use local anesthetic to numb the cervix, and a woman who undergoes this office procedure may briefly experience pain, mild cramping, or light bleeding.

Cone biopsy. This procedure consists of removing a cone-shaped piece of cervical tissue from the border between the ectocervix and the endocervix. Called the transformation zone, this is the area where cancerous or precancerous conditions most often originate.

Endocervical curettage. Also called endocervical scraping, this procedure is used to remove cells from the endocervix. After using local anesthetic to numb the cervix, the doctor inserts a narrow instrument called a curette into the passage between the outer part of the cervix and the inner part of the uterus.

Generally performed at the same time as colposcopic biopsy, this procedure removes cells from the part of the uterus the colposcope cannot see. A woman who has endocervical curettage may experience menstrual-type cramping or light bleeding for a short time afterward.

What Happens If A Biopsy Shows Abnormal Results?

If biopsy indicates that a woman has cervical cancer, her family doctor or gynecologist will refer her to a cancer specialist called an oncologist. This cancer specialist will initiate appropriate treatment.