What does an abnormal Pap Test mean?

Tampa Bay, FL

Nearly every day, I see patients who have received an abnormal Pap test result in my gynecology office. These abnormal results can trigger tremendous anxiety, so I spend significant time educating my patients about what the results may mean.

A Pap test, or Pap smear, looks for changes in the cells of the cervix that may indicate cervical cancer or other conditions that could develop into cancer. Cervical cancer is the third most common gynecologic cancer in the United States, after endometrial (first) and ovarian (second) cancers. If caught early, cervical cancer can be cured. A Pap test, part of a woman's routine physical exam, is a very effective screening tool for detecting precancerous conditions and small tumors that can lead to cervical cancer.

Women are advised to begin Pap tests about three years after becoming sexually active or by age 21. The tests are usually performed yearly, unless you are told otherwise by your physician. If no dysplasia (pre-cancer) or cancer of the cervix is detected, the result comes back negative. If your doctor says your result was "abnormal," it means the test found some cells on your cervix that do not look normal - it does not necessarily mean you have cancer. In fact, the likelihood that a woman with an abnormal Pap result has cancer is actually quite low. There are other causes for abnormal Pap results, including human papilloma virus, other types of infections and natural cervical cell changes related to menopause.

An AS-CUS Pap, otherwise known as atypical squamous cells of unknown significance, means that the laboratory detected some abnormalities, but cannot exactly classify the changes. Many physicians will ask the lab to further test this specimen for high-risk HPV - certain types of HPV associated with cervical cancer. If a woman with an AS-CUS Pap also tests positive for high-risk HPV, low-grade intraepithelial lesions (LSIL), high-grade intraepithelial lesions (HSIL), or atypical glandular cells of unknown significance (AGUS), she will be advised to undergo a colposcopy to further evaluate the problem.

A colposcopy allows the physician to look more closely at a woman's vagina and cervix with a lighted magnifying device. A vinegar solution is often applied to bring out changes on the cervix. If abnormalities are found, a cervical biopsy may be performed.

Depending on the woman's age and health and the severity of the abnormality, observation or treatment may be recommended. Most women with HPV or low-grade lesions will be watched closely, since these types of abnormal cell changes frequently go away on their own over time. They will repeat a Pap test every six months for several years and resume yearly screening only when the precancerous condition resolves.

Women with moderate to severe cell changes or persistent low-grade dysplasia are often advised to undergo a cervical conization. This procedure, performed in the office or an operating room, removes a cone-shaped piece of abnormal tissue from the cervix and cervical canal. It may be used to diagnose cervical cancer or to treat a cervical abnormality.

If you are notified that your Pap test is abnormal, follow your physician's instructions for follow-up and testing frequency. Make sure to find out the results of your Pap test, even if they are negative.

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