After an abnormal screening result: what usually happens next

A screening test only sorts people into "nothing found" and "needs a closer look". An abnormal result is the second group, not a diagnosis. Here is the usual next step for each common cancer screening, as the guideline bodies describe it. Your doctor decides what applies to you, based on the full result and your history.

We stop at the next test. This page explains what follow-up usually looks like so you know what to ask. It does not interpret your result. If you have a result in hand, call the office that ordered the test, and do not skip the follow-up.

At a glance

The usual next step after an abnormal result, by screening test
Screening	Abnormal result	Usual next step
Colorectal	Positive FIT, guaiac or stool DNA test; abnormal CT colonography or sigmoidoscopy	Colonoscopy (USPSTF, 2021)
Breast	Called back for more imaging (BI-RADS 0 means more imaging is needed)	More mammogram views or an ultrasound; then routine screening, a 6-month recheck or a biopsy (ACS, 2026)
Cervical	Positive HPV test or abnormal Pap test	Repeat test in 1 or 3 years, colposcopy with biopsy, or treatment, depending on risk (NCI, 2024)
Lung	Lung-RADS 3, 4A, 4B or 4X	Low-dose CT in 6 or 3 months, or a diagnostic CT, PET/CT, biopsy or referral (ACR Lung-RADS v2022)
Prostate	Raised PSA	Often a repeat PSA in 6 to 8 weeks; then watching, more tests, MRI or biopsy (NCI, 2025)

Positive stool test: a colonoscopy comes next

The USPSTF says positive results on stool-based tests, and abnormal findings on flexible sigmoidoscopy or CT colonography, need a follow-up colonoscopy for screening to deliver its benefit. (USPSTF, 2021) The American Cancer Society says the same for FIT, the guaiac test (gFOBT) and stool DNA tests, and adds that blood in the stool can come from polyps or cancer but also from ulcers, hemorrhoids or other conditions. (ACS, 2026)

Do not repeat the stool test instead. The American Cancer Society says any abnormal result from a test other than colonoscopy should be followed up with a timely colonoscopy. (ACS, 2026)
Cost: for private plans, federal rules say the follow-up colonoscopy counts as part of screening. How that works, and the Medicare rules, are on colorectal tests compared.

Mammogram callback: more pictures first

Being called back after a screening mammogram is fairly common, and the American Cancer Society says fewer than 1 in 10 women called back are found to have cancer. It is more common after a first mammogram, when there are no older images to compare, before menopause and with dense breasts. (ACS, 2026)

At the follow-up visit you usually get more mammogram views or an ultrasound, and often the result the same day: the area is fine, it needs another look in about 6 months, or it needs a biopsy. Most biopsy results are not cancer. (ACS, 2026)

Your report uses a BI-RADS category from 0 to 6. As the American Cancer Society summarizes it: (ACS, 2026)

BI-RADS mammogram categories and the usual next step
BI-RADS	Meaning	What the category says about follow-up
0	Incomplete	More imaging (spot compression, magnified or special views, ultrasound) or comparison with older mammograms
1	Negative	Normal: nothing new or abnormal found
2	Benign finding	No sign of cancer; a finding that is not cancer is noted so later readers do not mistake it
3	Probably benign (no more than 2% chance of cancer)	Repeat imaging in 6 to 12 months, then regularly until stable, usually for at least 2 years
4	Suspicious (4A low, 4B moderate, 4C high suspicion)	Biopsy should be considered
5	Highly suggestive of cancer (at least 95%)	Biopsy very strongly recommended
6	Cancer already shown by biopsy	Used during treatment, not screening

Source for the table: American Cancer Society, Understanding Your Mammogram Report (2026).

Abnormal Pap or positive HPV test: follow-up depends on your risk

A positive HPV test means a high-risk HPV infection was found. ACOG says it does not mean you have cancer now. The most common abnormal Pap result is ASC-US. LSIL means mildly abnormal changes that often go away; HSIL, ASC-H and AGC raise more concern for precancer. (ACOG)

Follow-up no longer depends on the latest result alone. Under the ASCCP risk-based guidelines, your clinician also weighs past results, past treatment and your age. You may then be advised to: (NCI, 2024)(ASCCP, 2020)

have a repeat HPV test or HPV and Pap cotest in 1 or 3 years;
have a colposcopy, a magnified look at the cervix, usually with a small biopsy;
or, at very high risk, have treatment without more testing, after talking through the risks and benefits. (ACOG)

The National Cancer Institute notes that most people with abnormal cervical screening results do not have cancer, and many early cell changes go away on their own. (NCI, 2024)

Lung scan: the Lung-RADS category sets the next scan

Low-dose CT reports use Lung-RADS. In version 2022, a negative screen is category 1 or 2 and a positive screen is category 3 or 4. (ACR Lung-RADS v2022)

Lung-RADS v2022 categories and their management
Lung-RADS	Meaning	Next step in Lung-RADS v2022	Share of scans (ACR estimate)
0	Incomplete	Comparison with an older CT, more imaging, or a scan in 1 to 3 months	About 1%
1	Negative	Next yearly screening scan	39%
2	Benign	Next yearly screening scan	45%
3	Probably benign	Low-dose CT in 6 months	9%
4A	Suspicious	Low-dose CT in 3 months; PET/CT may be considered	4%
4B / 4X	Very suspicious	Diagnostic CT, PET/CT, tissue sampling and/or specialist referral	2% / under 1%

Source for the table: American College of Radiology, Lung-RADS v2022.

The USPSTF counts false-positive results among the harms of lung screening and says its benefit depends on most of them being resolved with follow-up scans rather than invasive procedures. (USPSTF, 2021)

Raised PSA: often a repeat test first

PSA is measured in ng/mL. Many doctors use 4 ng/mL as the point for further testing, and some use a lower level such as 2.5 or 3, or age-based cutoffs. Between 4 and 10, the American Cancer Society puts the chance of prostate cancer at about 1 in 4. An enlarged prostate, prostatitis, recent ejaculation and some procedures can also raise PSA. (ACS, 2023)

The National Cancer Institute says a doctor may repeat the PSA in 6 to 8 weeks to confirm it. If it stays high, options include watching it with repeat PSA tests and rectal exams, other blood or urine tests, an MRI, or a biopsy. (NCI, 2025) Tests such as percent-free PSA can help decide whether a biopsy is needed, though doctors do not all agree on the cutoffs. (ACS, 2023)

Questions to ask about an abnormal result

What exactly did the result show, and what category or number is on the report?
What is the next test, and when should I have it?
Who schedules it, and who will tell me the result?
Is the follow-up covered as part of screening under my plan?
If this turns out to be nothing, when is my next routine screening?

More on questions to ask your doctor about screening.

Questions people ask

What happens after a positive FIT or Cologuard test?

A colonoscopy. The USPSTF says positive stool test results need a follow-up colonoscopy for screening to work, and the American Cancer Society says the same for FIT, guaiac and stool DNA tests. Blood in the stool can also come from ulcers, hemorrhoids or other conditions. (USPSTF, 2021) (ACS, 2026)

Does a mammogram callback mean cancer?

Usually not. The American Cancer Society says fewer than 1 in 10 women called back after a screening mammogram are found to have cancer. Often more pictures or an ultrasound are all that is needed. (ACS, 2026)

What happens after an abnormal Pap or positive HPV test?

Depending on your age, this result and past results, you may have a repeat test in 1 or 3 years, a colposcopy with biopsy, or, if the risk is high, treatment. This risk-based approach comes from the ASCCP guidelines. (NCI, 2024) (ACOG) (ASCCP, 2020)

What does Lung-RADS 3 or 4 mean?

In Lung-RADS v2022, category 3 (probably benign) leads to another low-dose CT in 6 months. Category 4A leads to one in 3 months, and 4B or 4X to a diagnostic CT, PET/CT, a biopsy or a specialist referral. (ACR Lung-RADS v2022)

What happens if my PSA is high?

Often a repeat PSA test in 6 to 8 weeks to confirm it, the National Cancer Institute says. If it stays high, options include watching it with repeat tests, other blood or urine tests, an MRI, or a biopsy. (NCI, 2025) (ACS, 2023)