Abnormal Pap Smear Results

My Pap test showed some abnormal changes but nothing conclusive. What's up?

Your Pap test result most likely falls under the category of ASC-US, or atypical squamous cells of undetermined significance, and is probably the abnormal Pap test result we see most often. (Ask for a copy of your lab report, or verify this with your doctor.) It means that low-grade changes were found in your cells, for reasons that aren't obvious. So your doctor needs to rule out precancerous changes, which are very treatable.

However, there hasn't been much consensus among physicians about the best way to do this. You could wait 4 to 6 months and repeat the Pap test to see if the abnormal cells cleared up on their own, but a lot of women feel anxious until they find out what's going on. Or you could have a test called a colposcopy, which involves looking at the cervix with a special magnifying scope and taking a biopsy--little snips of tissue to examine--which can be uncomfortable and is perhaps unnecessary in the end.

The guidelines for physicians clearly outline the steps to follow when a Pap test has an ASC-US result. Here they are in a nutshell: While it's still perfectly acceptable to repeat the Pap test in 4 to 6 months or do a colposcopy, the preferred first step is to get an HPV DNA test. (With newer "liquid" Pap tests, this is done in the lab automatically when abnormal results are found. If you get an older type of Pap, you may need to see the doctor for another swab.)
Since certain high-risk types of human papillomavirus or HPV, a sexually transmitted disease, cause almost all cervical cancers and precancer abnormalities, a negative HPV test result can reassure you that it's highly unlikely your abnormal Pap test was due to anything serious, and no further testing is needed.

If the HPV DNA test is positive and the presence of a high-risk type of HPV is found, then a colposcopy may be recommended to check for possible precancerous changes. Even if your colposcopy shows abnormal cells, in many cases they will clear on their own. There are also outpatient procedures that can remove them.


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