Receiving an abnormal Pap smear or HPV result is alarming, even when the finding turns out to be low-risk. Whether your result is a mild abnormality requiring surveillance or a high-grade finding requiring treatment, the steps below help you navigate the medical and financial pathway clearly.
First: An Abnormal Result Is Not a Cancer Diagnosis
The vast majority of abnormal screening results do not indicate cervical cancer. Most represent pre-cancerous changes that are entirely treatable. The screening system is designed to detect these changes early — which is exactly what is happening.
What your result means depends on the classification: - HPV positive, cytology normal (co-testing): Repeat in 12 months. No immediate treatment. - ASCUS (atypical squamous cells of undetermined significance): Usually managed with repeat test or HPV reflex testing. - LSIL (low-grade squamous intraepithelial lesion) / CIN 1: Usually surveillance (12-month repeat); most regress spontaneously. - HSIL (high-grade SIL) / CIN 2 / CIN 3: Colposcopy + treatment typically required. This is the category where action is most urgent. - Possible malignancy (rare from a screening test): Urgent referral to gynaecological oncologist.
Step 1: Understand Your Immediate Medical Coverage
Colposcopy (for HSIL/CIN 2/3): Colposcopy is a diagnostic procedure — your gynaecologist examines the cervix under magnification and takes targeted biopsies. It is typically performed in the gynaecologist's rooms.
From a medical aid perspective: - Colposcopy is funded from your day-to-day benefit/MSA. - Pre-authorisation may be required — ask your gynaecologist's rooms. - Cost: R2,000–R5,000. Shortfall above scheme tariff is possible — gap cover does not apply to in-rooms procedures.
LLETZ / Cone Biopsy (if CIN 2/3 is confirmed): This is a PMB-funded surgical procedure — treatment of pre-invasive cervical pathology. Pre-authorisation is required. It can be performed in-rooms under local anaesthesia or as a day procedure under GA.
Call your scheme and tell them: 1. You have an abnormal Pap / HPV result requiring colposcopy. 2. Your gynaecologist has recommended LLETZ pending biopsy confirmation. 3. You need pre-authorisation for both the colposcopy and the potential LLETZ procedure.
Step 2: Confirm Pathology Lab and Billing
When your Pap smear or HPV test was done, confirm with the pathology lab how it was billed: - Was it billed as a PMB preventive screening test? (If so: R0 to you.) - Was it billed from your MSA or day-to-day benefit? (If so: check whether you can retrospectively reclassify it as a PMB benefit.)
If you have been billed for a routine 3-yearly Pap smear (from age 30) that should have been a PMB benefit, ask your scheme for a reprocessing request.
Step 3: Understand Post-Treatment Surveillance Costs
After LLETZ, you will need more frequent cervical surveillance: - Typically a Pap smear or HPV test at 6 and 12 months post-LLETZ, then annually for 2 years before returning to the standard 3-year screening interval. - Each surveillance test: R600–R1,500 (funded from day-to-day benefit; NOT automatically PMB preventive since you are in a post-treatment surveillance protocol). - Budget R2,000–R5,000 per year for post-LLETZ surveillance costs.
Step 4: If Cervical Cancer Is Confirmed
If your biopsy or investigations reveal invasive cervical cancer, the medical aid situation changes entirely. Cervical cancer is a PMB condition — your scheme is legally required to fund treatment.
See the Cervical Cancer Diagnosed Guide for the next steps if this is your situation.
Step 5: HIV-Positive Women — Special Considerations
If you are HIV-positive: - Your PMB entitlement for cervical screening is annual (not 3-yearly). - Your risk of high-grade CIN and cancer is significantly elevated. - You should see a gynaecologist experienced in HIV-associated cervical disease. - Ensure both your HIV treatment (ARV programme) and your cervical surveillance are correctly registered with your scheme.
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Support Resources
CANSA: 0800 22 6622 (cervical cancer support and patient navigation) SASOG (gynaecology): ** sasog.co.za Council for Medical Schemes:** 0861 123 267 | www.medicalschemes.co.za