Pap Smear Results: Atypical Cells

What is abnormal?
Until a few years ago, a Pap smear was called normal unless the cells were very, very unusual. Because every Pap test can miss abnormal cells that are actually there, many cancers were not detected until they were at advanced stages. To improve the accuracy of the Pap test and lower the number of false negative results and catch problems earlier, the method of reading was changed. Now, anything at all that seems less than perfect is noted as abnormal.

The lowest and most benign level of abnormality is ASCUS. These changes can be caused by common, minor irritations to the cervix. Minor vaginal infections, intercourse, douches, spermicides, tampons, dildos, or diaphragms--virtually anything that has been in the vagina can cause enough irritation to cause ASCUS. If irritation is the only reason for the abnormal result, then once the irritating factor is removed, the test reverts to normal.

At the end of your menstrual cycle, you may be shedding the sloughed off cells of the lining of the uterus at the level of the cervix before you actually notice the start of your period. These cells may be picked up on a Pap test taken at the end of your cycle and can easily be confused as an abnormal Pap. This is why a provider/doctor may ask a woman to repeat the test mid-menstrual cycle.

Do I have cancer?
ASCUS is not necessarily due to cancerous or pre-cancerous changes in the cervix. It does have the possibility of being the first sign of cervical cancer. If it is closely and carefully followed up on, any cancer will be recognized at a very early stage. At these stages there are relatively non-invasive office procedures to treat the problem. These procedures are not very uncomfortable, are not too expensive, and have little chance of impairing future fertility. The best part is that there is 100% cure rate. So, even though "cancer" is a scary word, don't let fear or anxiety over finding out keep you from going back. A cure will never be easier or more certain than it is at the earliest stages.

What to Do First
So, the first step in dealing with an ASCUS is to repeat the test. Providers will try to minimize any confusion with early menstrual sloughing by having you come in during mid-cycle. You can also improve your chances of a normal test by avoiding douching, intercourse, and putting anything in the vagina 48 hours before your next test.

If the next test is normal, your health provider will tell you how often to have Paps in the future. Some providers want a repeat in 6 months to be sure that the normal result was not a false negative. In any case, you should have annual exams for at least the next 3-5 years. If the test comes back ASCUS again, providers handle this differently. Some will actively look for and remove the above mentioned sources of irritation. This usually includes a course of antibiotics to kill any occult infection, even if it is not detectable by you or the doctor. Then they will do a third Pap. Other providers will do a coloposcopy. This is an instrument to magnify the cervix and look for problem areas. Often, biopsies are taken at this time. It's a relatively minor office procedure. Still, if you are not too keen on having this done, you can ask your provider to try antibiotics and a third test before trying the coloposcopy. Cervical cancer takes several years to grow from ASCUS to even pre-cancerous stages, so waiting a few months is unlikely to make a difference, even in the worse case scenario.

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