Abnormal Pap? Stress Less With This Simple Guide

Updated January 20, 2021.

You completed your cervical cancer screening, great! But now you have been told that the results are abnormal which can be disconcerting and confusing, but it doesn’t have to be cause for alarm. The vast majority of cervical cancer abnormalities are either self-correcting or are detected so early that they can be treated easily, long before the most serious problems develop. After all, that’s why we do the test.

First, let’s look at what testing may be included in a cervical cancer screening:

Cytology: This looks at the cells of the cervix for any abnormalities.

HPV testing: This tests for the presence of human papillomavirus, some strains of which can cause cervical cancer. It is worth noting that usually HPV screening is not included until you are at least 30 years old. For more information on HPV you can also check out our blog all about HPV.

Now, let’s take a closer look at the various types of cervical cancer screening abnormalities and what sort of follow-up tests and treatments are recommended.

Translation:
The cervical cells of the pap test are “normal,” but you’re positive for high-risk HPV (human papillomavirus, the virus that can cause cervical cancer). How is it possible to have a “normal” result and be diagnosed with a virus at the same time?

Actually, it is possible to be infected with HPV for many years without the virus causing any damage to the cervix. The positive high-risk HPV result simply means that one of the concerning strains of HPV was found in the cells around the cervix. The “normal” part of your result means that the cervical cells look normal when examined under a microscope — so the virus hasn’t caused any detectable changes or damage.

What’s Next:

Your provider will determine if you need a closer examination of the cervix (known as a colposcopy) or whether monitoring with more frequent cervical cancer screenings is recommended. In all likelihood, the HPV infection will be eliminated by your immune system and will disappear without causing any trouble.

Translation:

ASCUS is the most commonly-reported cytologic abnormality, and as you might have guessed, its significance is undetermined. Squamous cells are flat, scaly cells normally found in the lining of the outer cervix. If these cells have a mildly unusual (atypical) appearance under the microscope — but aren’t so unusual as to appear precancerous — the lab will call it ASCUS.

What’s Next:

Depending on your prior cervical cancer screening history, your provider may recommend you have a repeat cervical cancer screening or a colposcopy, which is an up-close examination of the cervix. Your provider will take into account both current and previous HPV results as well as previous cytology results, if available, when making their recommendation regarding the best next step in your care.

Translation:

The cells lining the outer cervix are displaying some early precancerous features. These abnormalities (also called lesions) are low-grade, meaning that they are not severe, but should still be taken seriously. Most of the lesions will go away on their own, especially in younger people, but about 10 percent of the time the lesions will progress to cancer if left untreated.

What’s Next:

Depending on your prior cervical cancer screening history, your provider may recommend you have a repeat cervical cancer screening or a colposcopy, which is an up-close examination of the cervix. Your provider will take into account both current and previous HPV results as well as previous cytology results, if available, when making their recommendation regarding the best next step in your care.

For individuals 24 and under, LSIL almost never turns out to be precancerous and often goes away on its own, so experts usually recommend that young people have another cervical cancer screening a year later.

Translation:

This result reflects a higher grade change in cervical cells. Up to 20 percent of these lesions will progress to cancer if left untreated, and 2 percent of those with these lesions may already have cancer. Fortunately, even these serious abnormalities can be successfully treated in almost all cases.

What’s Next:

Your provider will recommend you have a colposcopy, which is an up-close examination of the cervix. You’ll need more frequent cervical cancer screenings for a few years to monitor and ensure cervical cells return to normal.

Translation:

This result reflects some potentially moderate or higher grade changes of the cervical cells. This specific abnormality is known as a "Atypical Squamous Cells - cannot rule out High Grade Lesion (ASC-H)." ASC-H means that changes in the cervical cells have been found that raise concern for the presence of HSIL.

What's Next:

Your provider will recommend you have a colposcopy, which is an up-close examination of the cervix. You’ll need more frequent cervical cancer screening testing for a few years, to make sure the cervix goes back to its normal state.

Translation:

There are two normal cell types on the cervix: glandular cells and squamous cells. You can get changes in both. It is more common to see changes in the squamous cells, but abnormalities can also occur with glandular cells.

An AGUS result means that your screening showed slightly atypical glandular cells.

What's Next:

Your provider will recommend you have a colposcopy, which is an up-close examination of the cervix. You may also be told an endometrial biopsy (EMB) is recommended as well - this is where a small sample is taken from the lining of the uterus.

Judging from the statistics, cervical cancer screenings are one of the great public health success stories: They’re the reason that the rate of cervical cancer in the United States has fallen by more than 50 percent over the past 30 years. Cervical cancer screening tests detect abnormalities like the ones described above, and enable you and your provider to arrange what might be life-saving follow-up.

Most deaths from cervical cancer are among those who have been screened too infrequently or not at all, so get screened regularly, according to the interval recommended by your provider!

Also, remember that cigarette smoking doubles your chances of developing cervical cancer. If you are a smoker, please come talk to us about ways that we can help you quit.

Finally, don’t forget to protect yourself from HPV. Using condoms and receiving the HPV vaccine can significantly reduce your likelihood of contracting high-risk HPV.