Receiving abnormal Pap smear results can be incredibly stressful for patients. They may feel overwhelmed by the implications and what they might mean for their health. Understanding the next steps can be difficult. Gynecologists can help ease confusion by educating themselves about the best approaches for notifying patients about abnormal Pap smear results.
A Spectrum of Pap Results
Gynecologists rely on Pap tests to help identify abnormal changes in cervical cells. Early diagnosis of precancerous changes to cervical cytology can lead to prompt treatment so that abnormal cells don't become cancerous. The primary cause of abnormal results is the human papillomavirus (HPV). In addition to raising the risk of cervical cancer, some forms of HPV can also increase the likelihood of developing cancer of the vulva and vagina, as well as of developing genital warts.
Laboratories use the Bethesda system to rank various Pap test results on a continuum from normal to indicative of cancer. There are five main categories of abnormal Pap smear results within the Bethesda system:
- Atypical squamous cells of undetermined significance (ASC-US). Changes in cervical cells that indicate HPV infection and possibly precancerous changes. This is the most typical abnormal Pap smear result.
- Squamous intraepithelial lesion (SIL). Abnormal changes that may signal precancer. These can be either low-grade (LSIL) or high-grade (HSIL), depending on the severity of dysplasia. LSIL usually clears up on its own, but HSIL is likely to progress to cancer if left untreated.
- Atypical squamous cells that may or may not be HSIL (ASC-H). Further testing is necessary.
- Atypical glandular cells (AGC). These indicate cell changes that suggest precancer of the upper part of the uterus or cervix.
- Cancer. Abnormal cells might have moved farther into the cervix or to other tissues.
How to Discuss Pap Results With Patients
Clinicians can help ease patients' fears by clearly explaining the next steps for potential cervical cancer evaluation or treatment. It's important to reassure them that most abnormal Pap smear results will not progress to cancer, and that abnormal cells can be treated when identified early. The vast majority of patients with abnormal Pap results will have ASC-US. Depending on their age, these women should be tested for HPV and/or return for another Pap smear within six or 12 months.
Those with LSIL, HSIL or ASC-H should undergo HPV testing and a colposcopy to better detect abnormal changes. If patients have AGC, they should also have a colposcopy, as well as endocervical and endometrial sampling to determine the spread of the precancer or cancer. By explaining what will happen next, physicians can help dispel patients' confusion and prepare them for further testing when necessary.
