ADVICE: My pap test is abnormal. Is that bad?

The immune system is usually able to clear HPV on its own, but follow-up testing is important.

Maja Begovic 4 minute read December 4, 2020
pap test HPV

Dear Asking For a Friend,

My Pap test came back abnormal. My doctor thinks it could be the Human Papilloma Virus (HPV), which sounds scary, but he says it’s a wait-and-see thing. Should I be worried?

Signed, In Limbo

Dear In Limbo,

An abnormal Pap test doesn’t mean it’s cancer, so take a deep breath and try not to panic.

Pap tests, also called Pap smears, is a routine procedure to screen for cervical cancer during which a doctor collects a sample of cells from the cervix with a small brush.

According to research, the majority of Pap test samples that contain atypical cervical cells are not cancerous. Human papillomavirus (HPV) diagnosis can feel scary, but most infections can actually clear up on their own.

“The body’s immune system is able to help clear the changes in the cervical cells caused by HPV in many cases, explains Dr. Ashley Waddington, obstetrician and gynecologist, assistant professor and co-director of contraception, advice, research and education (CARE) fellowship at the Department of Obstetrics and Gynecology at Queen’s University. “This is why it is safe to take a “watch and wait” approach. But, it is important to go for any follow up testing — like a repeat Pap test — that is recommended.”

Usually, patients are reassessed six months after cervical changes are detected, she says.

It’s important for you to know that HPV is the most common sexually transmitted disease in the world today, according to the Society of Obstetricians and Gynaecologists of Canada (SOGC). Both men and women can be infected, and about 75 per cent of sexually active Canadians will have at least one HPV infection in their lifetime, with the highest rates occurring in young people aged 15 to 24.

There are over 200 different types of HPV, the SOGC’s website reports, with approximately 40 types that infect the genital tract. While many low-risk HPV types will simply clear up on their own, types 6 and 11 may cause genital warts, and at least 15 high-risk HPV types may cause cancer.

In women, HPV has been linked to cancer of the cervix, vulva, and vagina and in men, to cancer of the penis — in both women and men, it has been linked to cancer of the anus, and mouth and throat, according to the SOGC.

There are many misconceptions about HPV, but one of the most common myths is that only promiscuous people get HPV. According to the Canadian Cancer Society website, anyone who has ever had sex may have been exposed to the HPV virus. It typically presents with no symptoms, and spreads rapidly by skin-to-skin contact in the genital area (penetration is not required) or during genital, anal or oral sex.

In women, HPV has been linked to cancer of the cervix, vulva, and vagina and in men, to cancer of the penis

Waddington says that while exposure to HPV is the biggest risk factor for cervical cancer, not getting screened can also contribute to the disease, and negatively affect outcomes.

“It is true that the majority of people who are diagnosed with advanced cervical cancer have slipped through the cracks in terms of getting their regular Pap screening,” she says.

Waddington insists that an abnormal Pap test doesn’t automatically imply cancer.

Sometimes, less worrisome cervical changes — clinically referred to as “low grade” or “atypical cells of undetermined significance”— can be attributed to HPV or to other factors, such low levels of estrogen or menopause, she says. Whatever the cause, it may require closer follow up to ensure it doesn’t progress to pre-cancerous changes.

On the other hand, if the cervix doesn’t look healthy, if the changes don’t go away on their own, if they are persistent or develop into more worrying changes, it may signal a higher risk for pre-cancerous changes in the cells and you may be referred to a colposcopy clinic for further evaluation or treatment, suggests Waddington.

Signs of cervical cancer can include bleeding between periods, increased discharge, painful intercourse, loss of appetite, weight loss, fatigue, and pelvic pain, among others. If you experience these symptoms, tell your doctor.

Waiting to be in the clear is never easy, but the good news is that regular Pap testing and following up on any abnormal results, as directed by your health care provider, will mean it is likely that any concerning changes will be caught before progressing to cancer. If you’re still worried or you feel like your concerns are being dismissed by your primary doctor, don’t hesitate to get a second opinion.

Maja Begovic is a writer with

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