Abnormal Pap Smear

Abnormal Pap Smear

The Pap test is a quick and simple test that checks for particular changes to the cells of a woman’s cervix (the neck of the womb). These changes may lead to cervical cancer if left untreated. In Australia, regular Pap tests save more than 1,200 women each year from cervical cancer. Around 8 in 10 women who develop cervical cancer either have not had a Pap test or have not had them regularly.

Cervical screening by PAP smear became available for Australian women in the mid-1960s. A two-yearly cervical screening interval was introduced for the target population aged 20–69 years.

About two million Australian women have a PAP test for cervical cancer screening each year. Australia has the second lowest incidence of cervical cancer in the world among countries with comparable cancer registration systems. Cervical cancer incidence and mortality have declined in the target age group by 56.9% and 57.7%, respectively, over the past decade. 

PAP smear can be slide or liquid based. Liquid-based systems provide greater specimen adequacy, particularly for women with cervical bleeding or inflammation. Liquid based PAP smear is not Medicare funded so is an out of pocket expense.

Cervical cancer and Human Papillomavirus (HPV)

Cervical dysplasia is an infective process caused by HPV which is spread through genital-skin to genital-skin contact during sexual activity. The point prevalence of HPV among sexually active young women is high at around 20% to 25%. Most HPV infections acquired by women resolve without medical intervention. HPV is necessary for development of cancer of the cervix. Types 16 and 18 are responsible for about 70% of cervical cancer. Cigarette smoking increases the risk of cervical cancer up to fourfold.

There are two main types of cervical cancer: squamous cell carcinoma and adenocarcinoma. Squamous cell carcinoma of the cervix is more prevalent than adenocarcinoma. Screening can detect precursors and early-stage disease for both types. Treatment of precursors and early-stage disease can prevent the development of invasive cervical cancer.

Further investigation with a colposcopy is indicated with an abnormal Pap smear result.

Indications for Colposcopy are;

1. Repeat Pap smear showing LSIL or HSIL

2. HSIL (possible or definite) on the index smear

3. Signs or symptoms of cervical disease (eg, abnormality on visualization or palpation of the cervix)

4  Pap test report of adenocarcinoma

5. Postcoital bleeding (non-menstrual bleeding that occurs immediately after sexual intercourse) with normal Pap Smear

6. DES-exposed women should be offered annual cytological screening and colposcopic examination of both the cervix and vagina.

Women with a histological diagnosis of CIN 2 or CIN 3 should be treated by local ablative or excisional treatments in order to reduce the risk of developing invasive cervical carcinoma.

Please read further below on Colposcopy and LLETZ procedures. 


If you have been advised by your GP that your Pap Smear has returned back abnormal you will be referred to a gynaecologist to have a Colposcopy. A Colposcopy can be treated in rooms and we can advise you of the costs associated with this treatment.

The information we provide to our patient's is contained in the following PDF link;

Colposcopy Information Sheet (PDF 468KB)



A Large Loop Excision of the Transformation Zone ( LLETZ ) procedure is performed in hospital and only required should your biopsy from your Colposcopy come back abnormal.

The information we provide to our patients is contained in the following PDF link;

LLETZ information (PDF 382KB)

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