Abnormal Pap Smears

YOUR PAP SMEAR IS ABNORMAL ! You can't remember much else the doctor said. Do you have cancer? What will they do now? Can it be treated?

RELAX. TAKE A DEEP BREATH. GOOD. Now find out exactly what having an abnormal Pap Smear means.

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ABNORMAL PAP TESTS

	WHAT IS A NORMAL PAP TEST?		WHAT DOES AN ABNORMAL PAP MEAN?
	WHAT ARE THE POSSIBLE RESULTS?		WHAT DO THE RESULTS MEAN IN ENGLISH?
	HOW RELIABLE ARE THE RESULTS?		WHAT DO I DO NOW? WHAT IS THE NEXT STEP?
	A SPECIAL CASE: DES DAUGHTERS		ADDITIONAL RESOURCES TO HELP

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What is Normal?

A normal or negative Pap Smear result means that no abnormal cells were found when the slides were looked at under a microscope. This can include inflammation or irritation. This is a sample of a Normal or Negative Pap Smear Test Report.

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What does an abnormal pap result mean?

AN ABNORMAL PAP DOES NOT MEAN YOU HAVE CANCER. IT IS A SCREENING TEST FOR CELL ABNORMALITIES. An abnormal result means that cells which are showing abnormal growth patterns have been found on the slide. The abnormality found is explained in the report from the laboratory.

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What Are the Possible Results?

REPORTING SYSTEMS

This is the older method of reporting Pap Smear results. It is still in use by some laboratories, but most now use the Bethesda System (following chart) which is more descriptive and gives the care giver more information about the Pap Smear.

RESULTS	MEANING
Class I	Normal
Class II	Atypical, inflammation or uterine cells seen
Class III	Dysplastic, mild, moderate or severe
Class IV	Carcinoma-in-situ
Class V	Suspicious for an invasive cancer

The Bethesda System gives the care giver much more information than the older, Class System does. It tells whether or not the smear is adequate, contains cells from the cervical canal, and explains what the person saw who read the slide.

RESULTS REPORTED WITH BETHESDA SYSTEM

Adequacy
    Satisfactory
    Limited
    Unsatisfactory

Descriptive
    Normal
    Benign
    Epithelial cell abnormality
        Inflammation
        Atypical squamous cells of unknown significance (ASCUS)
        Low grade squamous intraepithelial lesion (LSIL)
        High grade squamous intraepithelial lesion
    Glandular cell abnormality
        Atypical glandular cells (AGUS)
        Adenocarcinoma

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What do the Results Mean in English?

ADEQUACY
Satisfactory: means that enough cells were seen as well as cell of the cervical canal (endocervix)
Limited: only a few cells were seen. This may be all right but most doctors will repeat the test
Unsatisfactory: means not enough cells or no cells from the inside of the cervical canal (endocervical canal) were seen. The Pap needs to be repeated.

ASCUS (atypical squamous cells of undetermined significance): These changes in the squamous cells of your cervix mean that the cells on your Pap smear were slightly abnormal. This may be caused by a vaginal infection or an infection with a virus called HPV (human papillomavirus, or wart virus). Your care giver may repeat you Pap Smear in 3-4 months or elect to do a colposcopy, a test that looks for abnormalities of the cervix with this result. (Colposcopy is explained in detail on the Cervical Dysplasia Page and below.)

LSIL (Low grade squamous intraepithelial lesion) This may be found when you have HPV, the beginning of dysplasia, or the cells were healing from an infection. Your care giver may elect to repeat your pap smear in 3-4 months or proceed directly to colposcopy.

High grade squamous intraepithelial lesion means that there were abnormal cells found from the outside of the cervix and you need more evaluation by a colposcopy to see how severe the abnormality (dysplasia) is.

AGUS (Atypical glandular cells) means that endocervical cells were found to be abnormal, slightly or otherwise. This can be caused by infections and other things. Most likely your doctor will do a colposcopy if this is found just to make sure that there is nothing else there.

Adenocarcinoma: means that cancer cells from the endocervix were seen and you need a colposcopy

Inflammation means that there were a significant number of white blood cells found on your pap smear. Depending on the amount of inflammation found, your doctor may do cultures, treat you, and repeat the pap test in three to four months. This can also be caused by recent use of tampons, a recent infection, douching, or recent intercourse. Please see How Prepare for Your Pap Smear on the Pap Smear Page.

Hyperkeratosis, thick dried skin cells, is often found in women using a cervical cap or who have had a recent infection. Usually your doctor will repeat your pap smear in six months. If it is still present you may need to have a colposcopy.

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How Reliable are the Results?

There is a 10-25% False-negetive rate for current method Pap Smears (Pap smear that are read as negative but actually have abnormal cells on them are called False-Negative). These occur as a result of errors in sampling, preparation, screening, interpretation and limitations of the technique used. By Federal Law, Labs must re-read at least 10% of there Pap tests and inspections in which the readings are performed are done to carry this out. Every lab has to pass this inspection.

If symptoms such as bleeding after sexual intercourse, bleeding between periods or a foul watery discharge are present, your doctor needs to make sure that you do not have cervical cancer. A Pap Smear cannot rule out cancer only correct diagnostic tests and biopsies can do this. If no visible lesion is seen then an endocervical biopsy (taking a small piece of tissue) needs to be done from inside the cervical canal.

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What is the Next Step?

An abnormal Pap test never leads to treatment nor can it give a diagnosis. Treatment cannot be performed until a diagnosis is obtained.

The Pap Smear is just a SCREENING test. If you have any of the results which would make your doctor suspicious that there are abnormal cells called DYSPLASIA, she will then do a definitive diagnostic test called a COLPOSCOPY. Colposcopy is the examination of the cervix under magnification. A colposcope is similar to a pair of binoculars with a light attached. Please see the Colposcopy Page (on the Main Gynecology Menu) for How this procedure is done and what it tells us.

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DES Daughters and Abnormal Results?

There is a group of women who have an increased risk of having abnormal Pap Smears: DES daughters. DES (diethylstilbestrol) is a synthetic form of the female hormone estrogen which was given to over prescribed from the early 1940s until 1971 to help women maintain a pregnancy. It's use declined in the early 60's after studies showed it may not really work, after approximately 5 to 10 million babies were exposed to DES. This was well before the real effects of DES were known: given during the first 5 months of a pregnancy, it can interfere with fetal reproductive tract development. It wasn't until 10 years later that it was linked to a very rare vaginal cancer and abnormalities of cells of the vagina and cervix, including dysplasia. These cell changes can occur at any age. There were also other abnormalities seen, such s odd shaped uterus and others genital tract abnormalities.

It is sometimes difficult to find out if you have been exposed to DES. There may not be obvious physical signs. However, if you were born between 1938 and 1971, ask your mother if she took any medications during her pregnancy with you.

Women who have been exposed are at a very high risk of cancer and need to be seen yearly and tersted differently than everyone else. A DES daughter's pelvic exam is much more complicated and some problems are found only because your doctor looks for them - this can save your life. All DES daughters (women whose mothers took DES while pregnant with them) have a risk of about 1 in 1,000 for a rare cancer of the vagina or cervix called clear cell adenocarcinoma. That is also why this more extensive testing is required.

Your examination should always include the following:

A careful visual inspection and gentle palpation (feeling) of the entire vagina
Separate pap smears from the cervix and one from each of the four surfaces of the upper vagina around the cervix. This is called a "four-quadrant" Pap test
A bimanual exam (the care giver feels the uterus, tubes, and ovaries with the fingers of one hand inside the vagina and the other hand on the abdomen)

If you doctor is being cautious you may also:

Use Iodine to stain the vagina and cervix (normal tissue stains brown)

Do a colposcopy (if something doesn't stain on the iodine test) and biopsies (small samples of tissue) taken of any tissue that looks abnormal. Some doctors routinely do Colposcopies on DES daughters on a schedule of every 2 - 4 years.

DES also causes other problems such as Infertility, Pregnancy problems, and abnormal reproductive organs. It is important to see a doctor who knows how to care for DES-exposed individuals. You have a right to question your doctor and seek a second opinion.

If you are or believe you may be a DES Daughter, please check THE DES ACTION GROUP and the Links below for Information you NEED to know.

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ADDITIONAL RESOURCES THAT MAY HELP:

	MUST READ Glossary Of Terms Related To Colposcopy And Abnormal Pap Smears		Everything You Need to Know About Your Pap Test
	Abnormal Pap Smears		What to Do with an Abnormal Pap
	Pap FAQ's		What does it all mean?
	The Mining Company Links and Explanations		Explanations and Information About Pap Smears
	DES Daughters, Abnormal Pap Smears, and How to Stay Healthy		FAQ's About DES Daughters and Cancer

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