It is possible to have an abnormal smear but a normal colposcopy result. This can happen when someone has a human papillomavirus (HPV) infection but no precancerous mutations in the cervix.

Cervical cancer is the fourth most common form of cancer among women. It can lead to various symptoms, including unusual bleeding and persistent discharge.

Smear tests and colposcopies are diagnostic procedures that can detect whether someone is likely to have or develop cervical cancer.

This article will discuss what it means to have an abnormal smear result but a normal colposcopy. It will also outline colposcopy results, second opinions, and cervical cancer screening guidelines.

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It is important to understand how these tests work to understand what can cause an abnormal smear but a normal colposcopy.

During a smear test or Pap smear, a healthcare professional scrapes cells from the cervix with a small brush. After collecting the sample, they send it for laboratory testing.

Smear tests look for signs of human papillomavirus (HPV) infection, which can cause mutations in cervical cells. HPV infection is a leading cause of cervical cancer. A smear test can determine whether or not someone has an HPV infection in their cervix. It can also determine whether or not someone with an HPV infection has atypical cell changes.

If a person has both an HPV infection and atypical cell changes, doctors will recommend a colposcopy. During this procedure, doctors use a speculum to open the vagina gently. They insert a microscope into the vagina to examine the cervix closely and take a biopsy.

Laboratory professionals will then test this sample for cancer or for genetic mutations that could cause cancer. If no cancer or genetic mutation is present, the result is a normal colposcopy.

A person can receive a normal colposcopy result even if they have HPV and an atypical smear.

Colposcopy results can be normal or abnormal.

What is normal?

A normal result means lab testing detected no abnormal cells. This means the person does not have cervical cancer or precancerous cervical cells.

What is abnormal?

An abnormal result means that lab testing detected atypical cells, such as cervical intra-epithelial neoplasia (CIN) and cervical glandular intra-epithelial neoplasia (CGIN).

Different abnormal test results mean different risks of cervical cancer.

Cell typeRiskNext steps
CIN1low riskfollow-up cervical smear test or colposcopy to check the cells
CIN2medium riskfollow-up colposcopy to check the cells or treatment
CIN3high risktreatment to remove the cells
CGINhigh risktreatment to remove the cells

Anyone who has received colposcopy test results can ask for a second opinion.

A 2022 study investigated the ability of colposcopies to detect CIN2 cells. The study found that colposcopies have a 66.67% likelihood of detecting CIN2 cells. They also have a 73.73% likelihood of detecting the absence of CIN2 cells.

Treatment is not always necessary, even after an abnormal test result.

However, doctors may recommend that people with a medium or high risk of cervical cancer receive treatment to remove precancerous cells.

Treatment may also be necessary if someone receives a cervical cancer diagnosis. Treatment may involve:

  • surgery
  • radiation therapy
  • chemotherapy
  • targeted therapy
  • immunotherapy

According to the National Cancer Institute (NCI), the current cervical screening guidelines include:

Age rangeScreening recommendation
21–29One smear test at 21, with another smear test every 3 years.
30–65There are three options: a smear test every 5 years, a test for HPV every 3 years, or a combined HPV-smear test every 5 years.
65+Further testing only if recent tests have yielded atypical results.

Cervical cancer can result from an HPV infection. If a smear test shows that someone has an HPV infection, doctors may recommend a colposcopy.

A colposcopy involves looking at the cervix and getting a sample of cervical cells. Some cervical cells, such as CIN and CGIN cells, have a higher risk of becoming cancerous. A person will receive an abnormal colposcopy result if lab testing detects these cells.

Not everyone with an HPV infection will develop CIN or CGIN cells. It is possible to have an abnormal smear test and a normal colposcopy.