Abnormal smear test: what does it mean?
An abnormal smear test does not mean you have cancer. It means that cells were found that look different than normal. Here you can read what it entails and what the next steps are.
If your general practitioner (GP) calls with the message that your smear test is abnormal, your first thought might be: 'Do I have cancer?' Let us reassure you immediately: an abnormal smear test does not mean you have cancer.
It means that cells have been found that look different than normal. In the vast majority of cases, this is caused by an HPV infection. In many women, these abnormalities recover spontaneously.
What is a smear test?
A smear test (also called cervical cytology or PAP test) is an examination in which cells are taken from the cervix. In the Netherlands, women between the ages of 30 and 60 are invited every 5 years for the cervical cancer screening program.
In 2018, 799,173 women were invited and 460,518 women participated in this screening. Since 2017, testing for HPV is done first, and only in the case of an HPV-positive result are the cells evaluated.
The PAP results explained
The cells from the smear test are evaluated and classified according to the PAP system. Below you can see what each result means:
| Result | Meaning | Severity | Next step |
|---|---|---|---|
| PAP 1 | Normal | No abnormalities | Regular check-up in 5 years |
| PAP 2 | Slight abnormality | Usually inflammation | Repeat smear test |
| PAP 3a1 | Slight abnormalities | Mild | Often repeat or referral to gynecologist |
| PAP 3a2 | Moderate abnormalities | Mild-moderate | Referral to gynecologist |
| PAP 3b | More serious abnormalities | Moderate-severe | Referral to gynecologist |
| PAP 4 | Possible carcinoma in situ | Severe | Treatment by gynecologist |
| PAP 5 | Almost certainly cervical cancer | Very severe | Treatment by gynecologist |
What is the next step?
Depending on your PAP result, your GP will refer you to the gynecologist. the examination at the gynecologist proceeds as follows:
Referral to the gynecologist
Your GP refers you based on the PAP result.
Colposcopy
The gynecologist examines the cervix with a special camera and stains the cells.
Biopsy
Small pieces of tissue are taken for laboratory examination.
CIN result
The biopsy gives a CIN classification indicating how deep the abnormalities are.
Treatment plan
Based on the CIN result, the gynecologist advises observation, follow-up, or treatment.
Click on your result for more information
Each result has its own page with detailed information