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Explaining Your Abnormal Pap Test

What is an abnormal Pap Test?

The Pap Test is a screening test used to detect cervical cancer or cellular changes which, if ignored, might develop into cervical cancer. The cells in the specimen collected during your pelvic exam are examined and classified as normal (negative) or abnormal.  The abnormal cells are further described according to how they appear under a microscope.

What causes an abnormal Pap?

Most abnormal Paps are caused by Human Papil­loma Virus, or HPV, a family of common virus­es. Most sexually active people have been ex­posed to HPV at some point.  Most of the time, HPV infections are subclinical, that is, they cause no signs or symptoms at all. A small percentage of infected people will develop signs of HPV in­fection, which can range from genital warts to cervical cancer. There are many different strains of HPV, and of these, a handful are designated “high risk” strains, because they are the ones that cause cervical cancer.

There is an HPV test that detects the high risk strains, and it can be used with the Pap test to guide follow-up decisions.  

Explanation of Pap abnormalities

ASCUS - atypical squamous cells of unde­termined significance.  These are cells which appear mildly abnormal but the cause is unclear. If you have this finding, an HPV test is automatically done for women age 25 and over. If high risk HPV strains are detected, further evaluation with colposcopy is recommended; if the HPV test is negative, you can resume routine Pap screening. Women under age 25 simply need a repeat pap test once a year for the next 2 years.

ASC-H - atypical squamous cells - cannot exclude high grade lesion.  These are cells which appear abnormal but the cause is unclear, and there is a possibility of pre-cancerous changes.  You will be advised to have a colposcopy.  

LSIL -Low grade squamous epithelial lesion signifies a mild cellular change which is not thought to be precancerous. It is usually caused by HPV infection. Women under 25 can simply get a repeat Pap once a year for 2 years. Women 25-29 are advised to have a colposcopy to confirm the findings. Women age 30 and over should have a colposcopy if their high risk HPV test is also positive.

HSIL - High grade squamous epithelial lesion describes cellular changes that are believed to be precancerous.  Women of all ages should have colposcopy to confirm the diagnosis.   

AGUSatypical glandular cells of undeter­mined significance. This abnormality of the glandular cells from the canal of the cervix will require further evaluation.  

What is a colposcopy?

Colposcopy is an examination of the cervix that enables a definitive diagnosis of your abnormal Pap.  A specially trained medical provider looks at your cervix with the aid of a microscope (a colposcope). Under magnification, abnormal areas can be identified and sampled by taking small biopsies.  

The biopsy specimens are evaluated by a pathologist. Your medical provider can then make a recommendation for follow-up based on a precise diagnosis.

Most of the time, cervical biopsies confirm a low-grade (minor) change that requires no treatment. If a precancerous change is found, your provider will review the treatment options. 

How can I prevent cervical cancer?

  1. Get immunized with Gardasil, which protects against the two most common high risk strains of HPV that cause cervical cancer as well as the two most common HPV strains that cause genital warts.  
  2. Use condoms. Although condoms are not completely effective at preventing HPV infections, they greatly reduce the risk of transmission if used consistently.
  3. Limiting the number of lifetime sexual partners decreases your risk of being exposed to HPV.  
  4. Avoid smoking. Smoking specifically interferes with cervical immune function.
  5. Keep up with recommended Pap tests.  Precancerous changes detected by Pap tests can be treated to prevent cervical cancer from developing.