Watchful waiting after an abnormal Pap test

Watchful waiting usually involves repeat Pap tests as often as recommended by your health professional for the type of cervical cell change present. Watchful waiting can be a good option for women who can follow through with repeat tests. It may not be a good choice for women who think they will not be able to follow through with repeat tests as often as recommended.

A watchful-waiting period may be recommended for:

• A vaginal or cervical infection that has been identified and treated.
• Follow-up Pap tests after treatment for an infection that continue to show abnormal cell changes.
• An HPV infection that has been identified, even though it hasn't caused any symptoms or serious cell changes. Minor cell changes caused by HPV may not progress beyond mild changes. The natural course of most low-risk types of HPV is to resolve on their own within 6 to 18 months.
• Mild dysplasia (CIN1 or low-grade squamous intraepithelial lesions [LSIL]).

It is unlikely that women with minor cervical cell changes would develop more severe changes in a short period of watchful waiting. Cell changes classified as atypical squamous cells of undetermined significance (ASC-US) usually remain the same or return to normal after the first abnormal result.¹ Low-grade squamous intraepithelial lesions (LSIL) may be more likely to be identified as having more severe changes over time, but most LSIL cell changes return to normal or are not identified as more severe changes.

Citations

1. Sawaya GF, et al. (2000). Frequency of cervical smear abnormalities within 3 years of normal cytology. Obstetrics and Gynecology, 96(2): 219–223.