Updated January 15, 2020.
What’s worse than getting a Pap test? Getting the news that your Pap is abnormal. That phone call from your health care provider can be disconcerting and confusing, but it shouldn’t be cause for alarm — as long as you get your Paps regularly. The vast majority of Pap 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.
This guide will help you understand the various types of Pap abnormalities and what sort of follow-up tests and treatments they require.
Result: Normal Pap With High-risk HPV
Your Pap is “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, you can be infected with HPV for many years without the virus causing any damage to your cervix. The positive high-risk HPV result simply means that one of the dangerous strains of HPV was found in the cells around your cervix. The “normal” part of your result means that your cervical cells look normal when examined under a microscope — so the virus hasn’t caused any detectable damage. At least, not yet.
Your provider will keep a closer eye on your cervix by suggesting that you have Paps more frequently for a few cycles. If any new abnormalities develop in your cervical cells, your provider will respond accordingly (see below). In all likelihood, the HPV infection will be eliminated by your immune system and will disappear without causing any trouble.
Result: Atypical Squamous Cells of Unknown Significance (ASCUS)
ASCUS is the most commonly-reported Pap 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.
If you are under age 30 and were not tested for HPV, we’ll recommend you have another Pap in one year to make sure these abnormal cells have disappeared. If you are a young woman, these abnormal cells almost always go away without any treatment.
If you are 30 or over and were tested for HPV, we’ll want to take a look at your HPV results. (Note: we typically begin HPV testing at age 30, more info can be found here.) If your results were HPV-negative, these findings are reassuring. It is very unlikely that these abnormal cells represent a pre-cancerous problem. We’ll recommend you have another Pap in three years.
If you are HPV-positive, then we have to take the ASCUS result more seriously. We’ll recommend you have a colposcopy — a close-up examination of your cervix — to get a better look at the changes that might be taking place.
Result: Low-Grade Squamous Intraepithelial Lesion (LGSIL)
The cells lining your 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 women, but about 10 percent of the time the lesions will progress to cancer if left untreated.
Your provider will recommend you have a colposcopy, which is an up-close examination of your cervix. You’ll need more frequent Pap testing for a few years to make sure your cervix goes back to its normal state.
For women 24 and under, LGSIL almost never turns out to be precancerous and often goes away on its own, so experts recommend that young women wait and have another Pap a year later.
Result: High-Grade Squamous Intraepithelial Lesion (HGSIL)
This result reflects a more worrisome (i.e., high-grade) change in your cervical cells. Up to 20 percent of these lesions will progress to cancer if left untreated, and 2 percent of women with these lesions may already have cancer. Fortunately, even these serious abnormalities can be successfully treated in almost all women.
Your provider will recommend you have a colposcopy, which is an up-close examination of your cervix. Usually the colposcopy will be followed by a quick procedure to destroy the precancerous cells. You’ll need more frequent Pap testing for a few years, under the supervision of a gynecologist, to make sure your cervix goes back to its normal state.
Get Your Test, Have Less Stress
Judging from the statistics, Pap tests 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. Pap 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 women 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.
The One Medical blog is published by One Medical, an innovative primary care practice with offices in Boston, Chicago, Los Angeles, New York, Phoenix, the San Francisco Bay Area, Seattle, and Washington, DC.
Any general advice posted on our blog, website, or app is for informational purposes only and is not intended to replace or substitute for any medical or other advice. The One Medical Group entities and 1Life Healthcare, Inc. make no representations or warranties and expressly disclaim any and all liability concerning any treatment, action by, or effect on any person following the general information offered or provided within or through the blog, website, or app. If you have specific concerns or a situation arises in which you require medical advice, you should consult with an appropriately trained and qualified medical services provider.