AGC stands for atypical glandular cells, a finding that sometimes appears on a Pap smear. It means the lab detected glandular cells from your cervix or uterus that look unusual under the microscope but can’t be definitively classified as normal or cancerous. AGC is relatively uncommon, and while more than half of cases turn out to be caused by benign conditions, the finding carries enough risk of serious underlying problems that it always requires follow-up testing.
Where Atypical Glandular Cells Come From
Your cervix and uterus are lined with two main types of cells. Squamous cells cover the outer surface of the cervix, and glandular cells line the inner cervical canal (the endocervix) and the uterus (the endometrium). When a Pap smear flags AGC, the abnormal cells are glandular, meaning they originated from one of those inner linings rather than the outer surface.
When possible, the pathologist reading your Pap will try to specify whether the cells look endocervical or endometrial in origin. This distinction matters because the two sources point toward different potential causes and affect what testing comes next. In practice, though, telling these cell types apart under a microscope is difficult. The features overlap significantly, and even experienced pathologists sometimes disagree on the classification.
How AGC Results Are Categorized
Not all AGC findings carry the same level of concern. The Bethesda System, which standardizes how Pap results are reported, divides AGC into two main groups:
- AGC-NOS (not otherwise specified): The cells look abnormal but don’t have strong features suggesting cancer or a precancerous condition. This is the more common and less worrisome category.
- AGC-FN (favor neoplasia): The cells have features that lean toward a precancerous or cancerous process. This category carries a higher risk of significant findings on follow-up.
Each of these can be further broken down by whether the cells appear endocervical or endometrial in origin. Your Pap report may use any combination of these labels, and your doctor will tailor the next steps accordingly.
What AGC Often Turns Out to Be
Getting an AGC result can feel alarming, but the majority of cases are not cancer. More than 50% of AGC findings are linked to benign or normal physiological conditions. Common culprits include cervical or endometrial polyps, inflammation of the cervical canal, changes from an IUD or oral contraceptives, pregnancy-related changes, and a harmless process called microglandular hyperplasia where glandular tissue simply becomes more active.
That said, AGC is considered a high-risk cytology category for good reason. Studies show that about 21% of women with AGC have a high-grade cervical or endometrial lesion found on follow-up biopsy. These include precancerous changes to the cervix, a condition called adenocarcinoma in situ (where abnormal glandular cells haven’t yet invaded deeper tissue), and in some cases invasive cancer of the cervix or endometrium. One large retrospective study found malignancy in roughly half of cases that were classified as “significant” AGC results.
Why Age Matters
Your age plays a meaningful role in what an AGC result is likely to indicate. In women under 50, AGC more often points toward precancerous or early cancerous changes in the cervix itself. In women 50 and older, the finding is more strongly associated with endometrial (uterine) problems, including endometrial cancer. Nearly all women diagnosed with endometrial cancer following an AGC result in one study had postmenopausal bleeding symptoms alongside the abnormal Pap. This is why doctors are especially attentive to AGC findings in older women and those with unusual bleeding patterns.
What Happens After an AGC Result
AGC always warrants further evaluation, regardless of the subcategory. The typical next step is a colposcopy, a procedure where a doctor examines your cervix under magnification and takes small tissue samples from any areas that look abnormal. During this same visit, tissue from the inner cervical canal is usually sampled as well.
For women who are 35 or older, or for younger women with abnormal bleeding, a separate sampling of the uterine lining is also performed. This is because AGC can sometimes signal endometrial conditions that a cervical biopsy alone would miss. The combination of these procedures gives doctors a much clearer picture of what’s actually going on.
If the follow-up biopsies come back normal, your doctor will typically recommend closer monitoring with repeat Pap smears or HPV testing at shorter intervals than the usual screening schedule. If a precancerous or cancerous lesion is found, treatment options depend on the specific diagnosis, its location, and how advanced it is. Precancerous cervical changes, for example, are highly treatable when caught at this stage.
How Common AGC Results Are
AGC is one of the less frequent abnormal Pap findings. Data from a five-year institutional review found that the overall AGC rate was roughly 0.2% of all Pap smears. For comparison, abnormal squamous cell findings (like ASC-US or LSIL) are far more common. The rarity of AGC is part of why it gets taken seriously: it’s not a result that appears casually, and when it does, it has a meaningful chance of reflecting a real underlying problem that benefits from early detection.