Pap Smears: When Yours is Abnormal
What does an abnormal Pap smear mean?
A Pap smear allows your healthcare provider to look at the cells from your cervix (the lower part of your uterus, sometimes called the womb) and see if there are any problems. An abnormal Pap smear means that the cells of your cervix have shown some abnormal changes. Some abnormal cells are more likely than others to be warning signs of cancer. Ask your healthcare provider which of the following changes you have.
ASC stands for atypical squamous cells. Squamous cells form the surface of your cervix. ASC is divided into two categories:
- ASC-US means that although some of your cells are not normal, your healthcare provider may not know why the cells changed or what impact it will have on you. ("uncertain significance") These changes are usually not serious and may be caused by a vaginal infection, cervical irritation, or infection with a virus called HPV (human papillomavirus). Your healthcare provider might perform an HPV test in light of an ASC-US result. If you are between the ages of 21 and 24, your provider may simply request a repeat pap in 1 year to determine whether or not the cells are still abnormal. The pap smear will then be repeated the following year. If the pap is normal two years in a row, you will be able to have your next pap smear in three years. If you are older than 24 and the HPV test is positive we will likely recommend that you have a colposcopy (see below for more information). If the HPV test is negative despite a pap smear that results in ASC-US, and you are not between the ages of 21 and 24, then you will be asked to return for a repeat pap smear and HPV test in three years.
- ASC-H means that some of your cells are not normal and there is a possibility that they may be PREcancerous. Your healthcare provider will probably want to perform a colposcopy, which will allow your doctor to more closely examine your cervix. (See below for more information on colposcopy.)
LSIL stands for low-grade squamous intraepithelial lesion. Low-grade means there are early changes in the size and shape of the cells. LSILs are almost always associated with the presence of HPV. If you are between the ages of 21 and 24, it is recommended that you have a repeat Pap smear in one year if yu have had a LSIL pap. If you are older than 24 and ahve an LSIL pap, we may perform a test for high-risk HPV, and if that test is positive, we ill recommend coploscopy. If that test is negative, we will recommend a repeat pap with HPV in oneyear. If you are age 30 or older, and your HPV test is negative, your helathcare provider will likely recommend repeat HPV testing and Pap smear in one year. If your HPV test is positive, we will recommend colpsocopy.
HSIL stands for high-grade squamous intraepithelial lesion. High-grade means the cells are very different from normal cells. These cells are usually precancerous and are more likely to lead to cervical cancer, although usually requiring many years for this change to occur. Your healthcare provider will probably perform a colposcopy to localize and confirm the abnormality.
If inflammation is present in the cells on the Pap smear, it means that some white blood cells, cells of the immune system, were seen on your Pap smear. Inflammation of the cervix is very common and usually does not mean there is a problem. If the Pap smear showed the inflammation is severe, your healthcare provider may want to find the cause, such as an infection. Your healthcare provider may also recommend a repeat Pap smear to see if the inflammation has gone.
What is a colposcopy?
A colposcopy is a procedure that allows your healthcare provider to closely examine abnormal cells on your cervix. At Clark University, colposcopies are performed by Dr. Golding and his colleagues. If you'd prefer, you can see your own family doctor or gynecologist of gynecolgic nurse practitioner. Your healthcare provider may coat your cervix with a vinegar solution that causes abnormal areas to turn white. Then, your healthcare provider will examine these areas using a colposcope, an instrument like a microscope. A small piece of tissue may be removed for study in a laboratory. This is called a biopsy.