A pap test is a test that screens for cervical cell changes. It is recommended for sexually active women and/or women over 18 years of age. Some women (women under 30 and those who are high risk) have annual pap smears, while others have pap smears every three years. Pap tests are done during a pelvic exam, in which a speculum is inserted into the vagina to open the vagina. The doctor then takes a scraping of cells from the cervix which he looks at under a microscope to detect abnormalities.
Pap Tests Results
The majority of labs in the United States use a uniform system called the Bethesda System to evaluate the results of pap tests. The results are placed in several different groups, each with a different protocol. The first group is "normal" which indicates that no cell changes are observed. Women with normal pap test results do not need any additional care or treatment. Other possible classifications include atypical squamous cells (ASC or ASC-US), low grade squamous intraepithelial lesions (LSIL), high grade squamous intraepithelial lesions (HSIL), atypicl glandular cells or cancer.
Atypical Squamous Cells (ASC)
A result of ASC means that some cells are slightly abnormal, but are not considered pre-cancerous. There may be many reasons for abnormal cells, including an infection or intercourse or simple irritation; however, this result may also indicate precancerous changes. There are several different options available to doctors when a pap test comes back with this result. Some doctors simply repeat the Pap test in four to six months. Other doctors will administer an HPV test, and if certain high risk forms of HPV are found, will recommend a procedure called a colposcopy. A colposcopy involves inserting a coloscope into the cervix so the doctor can see inside the cervix and look for abnormalities.
SIL (Squamous Intraepithelial Lesion)
SIL falls into two categories--low grade LSIL and high grade HSIL. LSIL means that early, mild precancerous changes were observed in the cells. HSIL means moderate or severe precancerous changes were observed. Low grade SILS may clear up on their own without treatment, while high grade SILS require treatment. A colposcopy should be done so the doctor can determine the extent of the cell changes. If LSIL is the result, the woman may be watched for a period and told to have regular pap smears to see if the LSIL clears up on its own. In cases of HSIL, cryosurgery or laser surgery may be used to destroy the abnormal cells. Fertility is usually unaffected by these treatments, which either freeze (cyrosurgery) or burn (laser surgery) the abnormal cells.
Atypical Glandular Cells
Atypical glandular cells usually suggest that an invasive squamous cell cancer is present; however further testing must be done to determine this. A colposcopy may be recommended, or a cervical biopsy may be performed to remove and evaluate the abnormal cells.
Cancer
The final classification is cancer. This result occurs when cancer has actually developed in the cervix. If this is the result of an abnormal pap smear, you will need to be referred to an oncologist to formulate a treatment plan for cervical cancer.
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