Abnormal Pap Tests

Most abnormal Pap tests do not mean anything serious. Some do, however, and so it is important to follow up as your doctor recommends.

ASCUS (atypical squamous cells of undetermined significance) with negative HPV (human papilloma virus) test – because almost all cervical cancers and significant pre-cancers are caused by HPV, it is unlikely that the woman who is negative for HPV has a serious problem. In fact, the woman who has an ASCUS/negative HPV Pap is no more likely to have dysplasia or cancer than the woman who has a normal Pap. We treat this as normal, except that we repeat the Pap test and the HPV test in one year, instead of the 3-5 years that is otherwise recommended.

Normal Pap test with a positive HPV test – being positive for HPV does not mean that you have cancer or pre-cancer, or ever will. It does mean that you are higher risk and should be followed more closely.  Because many HPV infections are transient, we often ask you to repeat the Pap and the HPV test in one year. If the HPV test is still positive, we may recommend a colposcopy even if the Pap remains normal. An alternative approach is to test for the specific types of HPV that are most likely to cause cancer — types 16 and 18. If the type specific testing is positive, a colposcopy may be recommended now, instead of waiting a year.

ASCUS/positive HPV – a woman who has an ASCUS/+HPV Pap has a 15% chance of having a significant pre-cancerous condition. Therefore, we usually recommend a colposcopic examination for a woman who has these results.

ASC-H (atypical squamous cells of undetermined significance, cannot rule out high grade dysplasia) – This Pap result always results in a recommendation for colposcopy. There is a 35-40% chance of a significant pre-cancerous condition.

LSIL (low grade squamous intraepithelial lesion) – typically we recommend a colposcopy for an LSIL Pap.  Though low-grade dysplasia is not serious and usually resolves spontaneously, it is important to rule out a high grade dysplasia with colposcopy. There is a 10-15% chance of a high grade dysplasia with an LSIL Pap. Even if the colposcopy is negative we will follow you more closely for a while.

HSIL (high grade squamous intraepithelial lesion) – a colposcopy is always recommended for an HSIL Pap. There is a 50% chance of a high grade dysplasia.  It is important to identify the high grade lesion, as this is a cancer precursor.  Keep in mind, however, that the usual cervical cancer develops very slowly over ten or more years. Though this Pap result is not an emergency, a colposcopy should be scheduled at your earliest convenience.

AGUS Pap – this Pap result is very likely (30%) to indicate some type of pre-cancer or cancer, so it is important to have the recommended follow-up tests in a timely fashion.

What is involved in a colposcopy procedure?

This is an office procedure that involves looking at your cervix with a low power microscope after the application of acetic acid (vinegar), which highlights the abnormal areas. Usually, a cervical biopsy or biopsies are taken. Monsel’s solution (a ferric subsulfate solution) is used to stop any oozing from the procedure.  The entire procedure takes 15-30 minutes, depending on the individual. It is uncomfortable, but usually tolerable. We recommend that you take 600-800 mg of ibuprofen (3-4 Advil®) 30 minutes prior to your scheduled appointment. Results from the biopsies are available in about a week.