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How to Decipher Your Abnormal Pap Smear Results

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A pap smear is something most women accept as a pretty straightforward (albeit slightly uncomfortable) necessary evil. It's what comes after—especially if you received an HPV test at the same time—that gets confusing. (Here are 5 Things You Should Know Before Your Next Pap Smear.)

Sure, we know a normal pap and negative HPV result is great—you're in the clear! But what about those other somewhat ambiguous results you might get back? And why don't you always get an HPV test with your pap? It's easy to end up unsure of whether you have a serious issue on your hands or if you're totally fine. And don't feel bad, this stuff is hard for even docs to explain. (Didn't get your HPV vaccine yet? Why Your HPV Vaccine Excuses Are Total BS.)

First thing's first, while both are screening tests for cervical cancer, a pap test and an HPV test look at two different things: While a pap checks your cervix for abnormal cells that can turn into cervical cancer, the HPV test uses those same cells to check your cervix for the human papillomavirus, which can cause normal cells on your cervix to turn abnormal. And over time, these abnormal cells can turn into cancer if not treated. (Good news! More Women Are Getting Tested for Cervical Cancer Because of the Affordable Care Act.)

It all started back in 2012, when the ASCCP—American Society for Colposcopy and Cervical Pathology—who oversees all things pap so to speak, introduced 'co-testing', a pap smear and a test for HPV at the same time. While HPV's link to cervical cancer wasn't new, prior to this, HPV testing wasn't universally available commercially, and studies had yet to be done to guide docs in how to actually apply the testing results.

With this also came a paradigm shift in how paps are handled on a broader level. The guidelines reduced (a) how often these tests should be done, and (b) how early you should get one since so many women under 21 were being over-treated for issues that usually resolved on their own.

Fast-forward four years and there's still a ton of confusion for both patients and doctors, says John Harkins, M.D., an OBGYN and assistant professor in the department of women's health at the University of Texas Dell School of Medicine.

"These guidelines are like the wiring diagram of a nuke," he says. In fact, "I don't know any doctor that follows these to a T—most everybody does some hybrid of them. They are just so confusing and sometimes they almost don't make sense," he says.

So, to save you the trouble (feel free to check out all 27 pages yourself if that's your thing!), we asked Harkins to provide some handy cliff-notes to reference next time you find yourself unsure of what the heck your pap smear and HPV results really mean, and what to do next.

Unsatisfactory

This unlikely result isn't cause for alarm but simply means your pap smear was unreadable—aka inflammation or blood obscured the cells, or there weren't enough cells for the pathologist to look at. Next step? Follow up with repeat testing within two to four months to find out if you fall into one of the groups below.

Normal (Negative)

Under 30: This is great! This means that no cell changes were found on your cervix. And for women under the age of 30 with a 'stone cold normal pap smear,' the pathologists stop there—meaning they don't test those cells for HPV. "HPV testing isn't recommended if you have a normal cellular pap since such a high percentage of women have been exposed to the virus, so you expect this to be positive," Harkins says. "But most young women will fight off HPV within a few years. If we do nothing, this stuff resolves on its own."

Over 30: If you're over 30-years-old and you have a normal pap, your doc will still do the HPV test. That's based on the recognition that women over the age of 30 are much less likely to clear that virus over time and are thus at risk of developing cervical abnormalities, which may lead to cancer, says Harkins.

ASC-US (Inconclusive/Unclear)

This common result stands for atypical squamous cells of undetermined significance and pretty much means your result is TBD. "This is a catch-all for pap smears where the pathologists found some sort of cell change. While this may not be anything to worry about (it might be inflammation from sex, or that docs didn't get a good look at the cells because of the way the cells are oriented), you just can't get a 'normal' result," says Harkins. In this case, an HPV test is needed to find out if these cell changes are actually cause for concern.

If your ASC-US pap smear result comes back with an HPV-negative result: You can consider that a normal pap, Harkins says. "An ASCUS result with negative HPV result means it's highly unlikely you have cervical dysplasia—any sort of pre-cancerous situation in the cervix. You have nothing to worry about in this scenario," says Harkins.

If your ASC-US pap smear result comes back with an HPV-positive result: This means you have HPV, but your doc will need to perform a colposcopy—an examination of the cervix with a magnifying device—to find out if your cells are abnormal. A mini-biopsy may also be done at this time to analyze a small piece of tissue from your cervix.

Abnormal (LSIL or HSIL)

LGSIL (Low-grade squamous intraepithelial lesion): This means your pap smear showed clear evidence of cell changes caused by HPV, but they are only mildly abnormal. The good news, LSIL is usually caused by an HPV infection that often goes away on its own.

HGSIL (high-grade squamous intraepithelial lesion): This means you have more advanced cell changes in the cervix than LSIL, and, therefore, is less likely to spontaneously resolve.

In both cases, a colposcopy and/or cervical biopsy are needed to confirm the findings of your pap and determine whether pre-cancer or cancer is actually present. Depending on results, a procedure to shave off the infected cells in question may be needed. LEEP— short for loop electrosurgical excision procedure —uses a wire loop with electric currents to quickly remove abnormal tissue procedure to allow normal tissue to regenerate.

Cancer

In rare cases, an abnormal pap can show that you have cervix cancer, but you'll need other tests to be sure.

See the CDC or American Congress of Obstetricians and Gynecologists websites for more info on how to decipher your pap and HPV test results.

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