Abnormal Smear Result: What Happens Next

TL;DR: An abnormal smear result is very rarely cancer. It usually means the test found HPV, cell changes, or both, and that you need a closer look or a repeat test. The next step is often a colposcopy, a 15 to 20 minute examination of the cervix. If treatment is needed, it is usually a short procedure, followed by a check about six months later. Please go to the follow-up, because this is the stage where cervical cancer is prevented.

The letter or text arrives and the word "abnormal" is the only one you can see. January is Cervical Cancer Awareness Month, so we want to say this plainly: an abnormal result is the screening test doing its job. It has found something early, at the point where it can be watched or treated. Below we go through what your result means and what happens next, step by step.

If you want the background on the virus itself, the vaccine and how screening works, start with our guide to cervical cancer and HPV. This post picks up from the moment the result lands.

What does an abnormal smear result mean?

It means the test found high-risk HPV, changes in the cells of your cervix, or both. It does not mean you have cancer. The NHS explains that the cells found at this stage are not cancer, but could become cancer if left untreated, which is why follow-up matters. Cancer at this stage is rare.

The results you may see, and what usually happens next

In the UK, the sample is tested for HPV first, and cells are checked if HPV is found. The NHS sets out these outcomes:

The NHS also says that cell changes will not get worse while you wait for your appointment, which is worth holding on to if the wait feels long.

Outside the UK your report may look different. A Pap test report uses terms such as ASCUS, LSIL and HSIL, which we explain in our HPV and screening guide. If you had visual inspection with acetic acid (VIA), the result is usually given as positive or negative. Ask for a copy of your result and ask someone to explain the exact words on it.

A positive HPV result is not a judgement on you

HPV is extremely common, and most sexually active people will get it at some point. A positive result is a health finding. It is not a judgement on you or your partner, and you do not owe anyone an explanation for it.

What happens at a colposcopy?

A colposcopy is a closer look at your cervix using a magnifying instrument with a light. According to the NHS, it usually takes 15 to 20 minutes and is done by a specially trained nurse or doctor. A speculum is used as in a smear, and a liquid is put on the cervix to highlight any abnormal cells, which may tingle. You can ask to stop at any time.

If an area looks unusual, the clinician may take a biopsy, a piece of tissue about the size of a pinhead. It can feel like a mild pinch, and results usually take 4 to 8 weeks.

What the biopsy grades mean

Abnormal cells found on biopsy are graded. The NHS uses these terms, and the higher the grade, the more likely the cells are to grow and spread if left alone:

• CIN1 (low grade): usually no immediate treatment, with a follow-up test or colposcopy.
• CIN2 (medium grade): a follow-up colposcopy or treatment.
• CIN3 or CGIN (high grade): treatment to remove the cells.

CIN stands for cervical intra-epithelial neoplasia, and CGIN is the glandular version. Neither of them is cancer.

How cell changes are treated

The most common treatment in the UK is LLETZ, where a heated wire loop removes the affected tissue under local anaesthetic. It takes about 15 minutes, often on the same day as the colposcopy, and you go home afterwards. A cone biopsy, which removes a cone-shaped piece of tissue under general anaesthetic, is used less often.

In screening programmes across Africa you may be offered thermal ablation, cryotherapy or a loop procedure. The WHO lists these among the options and describes treating pre-cancer as simple and effective.

Afterwards you may have period-like pain for a few days, and bleeding or discharge that can last up to 4 weeks after LLETZ. Use pads rather than tampons or cups, and you may be advised to avoid sex for 4 weeks. Contact a doctor for heavy bleeding, smelly discharge or tummy pain that does not settle.

The follow-up test after treatment

In the NHS programme you are invited back 6 months after treatment for CIN for another sample. If HPV is negative, your next test is in 3 years. If HPV is positive, you go back to colposcopy. Wherever you live, ask when your check is due and put it in your calendar, because this is the appointment that confirms the treatment worked.

Can I have a colposcopy while pregnant?

Yes. The NHS says a colposcopy is safe in pregnancy, but tell the clinic before you attend. One NHS hospital explains that biopsies are rarely taken and treatment is not carried out during pregnancy, so you may be asked to return in your second trimester or about three months after birth.

Will treatment affect a future pregnancy?

For most women the added risk is small. A Cochrane review found that preterm birth was more common in women who had been treated (10.7 percent) than in those who had not (5.4 percent), though much of that evidence is low quality. The risk was higher with deeper treatments, and with repeat treatment. The same NHS hospital says the risk is very small and outweighed by removing cells that could become cancer. If you become pregnant after treatment, tell your midwife or doctor so it is in your notes.

Follow-up care in Nigeria, Kenya, Ghana and South Africa

Services vary a lot, so here is what we could verify.

Nigeria. In a study of 177 government health facilities in Lagos, Kaduna and Rivers, 81 percent of women were screened with VIA and 19 percent with HPV testing. Of women found to have pre-cancer, 96 percent were treated, often the same day after VIA. But only 21 percent of women with a positive HPV result completed the next examination they were referred for. If you are told to go back, please go back.

Kenya. National guidelines recommend screening women aged 30 to 49, with HPV testing as the preferred test, though that paper noted HPV tests were not yet widely available and only a quarter of eligible facilities offered screening and treatment in 2018. In January 2026 Kenya launched a national elimination plan for 2026 to 2030 that aims to reach women in all 47 counties.

Ghana. National policy recommends VIA and Pap tests, but researchers report that no funded national HPV-based programme exists and coverage remains under 5 percent. You may need to ask your hospital directly where colposcopy is available, and ask for a written referral if it is not.

South Africa. The national policy provides women over 30 with three free screening tests in the public sector, ten years apart. Women living with HIV are advised to be screened every three years from diagnosis.

The WHO notes that women living with HIV are six times more likely to develop cervical cancer and advises screening every 3 to 5 years from age 25, so if this applies to you, ask for your own schedule.

Questions to ask at your appointment

Screening is for people without symptoms. If you have unusual bleeding, including after sex, contact a doctor rather than waiting for your next test. Our post on the UK cervical screening gap has tips for making appointments feel more manageable, including asking for a female clinician.

Waiting for results is hard, and it can help to write your questions down as they come. You can keep notes on symptoms and appointments in Asele, and the Health Brief can help you bring them to your next visit in a clear format.

This post is education, not medical advice. Please speak to a qualified clinician about your own result.

References

1. NHS. Cervical screening: your results. nhs.uk
2. NHS. Colposcopy. nhs.uk
3. World Health Organization. Cervical cancer fact sheet. who.int
4. NHS Cervical Screening Programme. Topic 6: understanding test results. gov.uk
5. Cambridge University Hospitals NHS Foundation Trust. Coming for colposcopy following an abnormal or inadequate cervical sample. cuh.nhs.uk
6. Kyrgiou M, et al. Obstetric outcomes after conservative treatment for cervical intraepithelial lesions and early invasive disease. Cochrane Database Syst Rev. 2017. pubmed.ncbi.nlm.nih.gov
7. Lawson O, et al. Cervical cancer screening outcomes in public health facilities in three states in Nigeria. BMC Public Health. 2023. pubmed.ncbi.nlm.nih.gov
8. Mwenda V, et al. Findings and lessons from a Kenyan pilot study of point-of-care HPV testing. PLoS One. 2023. pmc.ncbi.nlm.nih.gov
9. WHO Regional Office for Africa. Kenya launches national cervical cancer elimination action plan 2026 to 2030. afro.who.int
10. Effah K, et al. A collaborative cervical precancer screening strategy across Ghana. PLoS One. 2026. pmc.ncbi.nlm.nih.gov
11. National Department of Health, South Africa. Cervical Cancer Prevention and Control Policy. knowledgehub.health.gov.za
12. Cervical cancer screening in women living with HIV attending primary care clinics in a health district, South Africa. pmc.ncbi.nlm.nih.gov
13. Cancer Research UK. What does HPV self-testing mean for cervical screening in England? news.cancerresearchuk.org